Dedicated to the acceptance, medical treatment, & legal protection of individuals in the process of correcting the misalignment of their anatomical sex, & supporting their transition into society.
Mammography. This technique uses low-dose X-rays to examine the human breast (approx. 0.7 mSv).
The primary goal has been the early detection of breast cancer, typically through the detection of characteristic masses and/or microcalcifications.
Mammography alone has been shown to reduce mortality from breast cancer. However, risk reduction is enhanced by regular breast self-examination (BSE) and physician exams. All elements are considered essential to regular breast care.
Refer to the breast self-exam guide at the end of ths text (PDF Download).
A dedicated mammography machine compresses the breast to even out the tissue and increase image quality (holding the breast still prevents blurring from motion). The doctor or technician takes images from both the front and side.
Deodorant, talcum powder or lotion may show up on the X-ray as calcium spots, and women are discouraged from applying these on the day of their examination.
Currently, mammography is undergoing a transition to digital detectors, known as Full Field Digital Mammography (FFDM).
Digital mammography has demonstrated superior cancer detection when compared to traditional film-screen techniques. The digital media permit more detailed analyses and a more reliable basis for comparison over time.
Existing studies of women born with Harry Benjamin Syndrome (HBS) suggest a low incidence of breast cancer. However, the study populations tend to be skewed toward an older population with relatively recent breast development.
The changing demographics of the HBS-born suggests caution. In any case, regular breast self-exams and physician care are waranted, particularly if high-risk conditions are present, such as an unfavorable family history and questionable environmental exposures.
Video courtesy of the Da Vinci Medical Center. Time 00:02:06
Monthly Breast Self-exam. Pamphlet. Canadian Breast Cancer Foundation. 2008. [ Download PDF ]
Boise, ID, USA. Reducing breast discomfort before a mammography exam is a simple matter of applying pain-relieving gel. The results from a clinical trial to be published in the print journal Radiology. Even better, the anesthetic is a readily available as an over-the-counter (OTC) preparation that is easy for women to apply and remove at home.
Breast cancer affects more women than any other non-skin cancer and, according to the American Cancer Society, accounts for more than 40,000 deaths annually in the U.S. Most experts agree that the best way to decrease breast cancer mortality is through early detection using mammography and a clinical breast exam.
Clinical Trial. Clinical Remedication to Reduce Discomfort during Screening Mammography. Colleen Lambertz, James R. Maxwell, Christopher J. Johnson, and Paul G. Montgomery. Print publication scheduled for Radiology in September 2008.
For a mammography exam, a radiologic technologist positions the patient's breast on a platform in a mammography unit. The breast is then gradually compressed with a paddle. The patient may feel pressure and occasionally some discomfort or pain. Fear of this discomfort leads many women to avoid mammograms altogether. Studies have shown that as many as two-thirds of women don't follow established guidelines for mammography.
"We now have something that we know reduces discomfort with screening mammography in women who expect higher discomfort — lidocaine gel," said the trial's principal investigator, Colleen Lambertz, F.N.P., a nurse practitioner at St. Luke's Mountain States Tumor Institute in Boise, Idaho. "With a more positive experience, we hope women will undergo more regular mammography screening."
"Mammography is the only screening tool proven to reduce mortality from breast cancer in women over 40," said study co-author James R. Maxwell, M.D., medical director of St. Luke's Breast Care Services. "Annual screening is the most important option available to a woman to best ensure early detection and decrease the chance of being diagnosed with an advanced stage breast cancer."
"Breast tenderness, anxiety and expectation of pain are all directly correlated with the amount of discomfort women experience with mammography," Lambertz said.
For the clinical trial, the researchers recruited 418 women, ages 32 to 89, who expected significant discomfort with screening mammography. Fifty-four of the women reported that they had probably or definitely delayed their mammograms due to concern over possible discomfort.
The women were randomized to receive placebos or pre-medication with acetaminophen, ibuprofen and/or a local anesthetic gel followed by mammography screening. The gel was applied to the skin of the breasts and chest wall and then removed 30 to 65 minutes before mammography. The gel had no effect on subsequent image quality.
The results showed that oral medication produced no significant differences in breast discomfort, nor did other factors such as breast density. However, women who received a topical application of 4 percent lidocaine gel reported significantly less breast discomfort during mammography.
"We designed this study around safe and available over-the-counter products in order to put women more in control, so they may have a more comfortable and satisfactory experience," Lambertz said.
Eighty-eight percent of study participants indicated they would definitely get a mammogram the following year, and 10 percent said they would probably get a mammogram the following year.
Lidocaine gel is a readily available, over-the-counter anesthetic that is easy to apply and remove. For the study, the gel was applied by the attending nurse; however, women could apply the gel at home one hour prior to appointment time and remove it right before undergoing the exam.
"Women can now take charge of the situation," Lambertz said. "They can schedule a mammography appointment for a time in their cycle when their breasts are least tender, apply the gel at home and drive to the appointment knowing they have taken steps toward a positive experience with this potentially life-saving procedure."
This study was supported by the St. Luke's Mountain States Tumor Institute and the Mountain States Tumor Medical Research Institute. A brand-name (Topicaine) lidocaine gel was provided at no charge to the researchers for use in the study. The authors had full control of the data and information submitted for publication.
Clinical Trial. Clinical Remedication to Reduce Discomfort during Screening Mammography. Colleen Lambertz, James R. Maxwell, Christopher J. Johnson, and Paul G. Montgomery. Print publication scheduled for Radiology in September 2008.
Study Purpose
This study will explore the effect of pre-medication with acetaminophen, ibuprofen, and topical lidocaine gel (Topicaine) on the perception of discomfort and overall satisfaction with the mammography experience. The research questions are: What is the relationship between the use of acetaminophen, ibuprofen, and Topicaine prior to screening mammography and the perception of discomfort during the procedure? What is the relationship between perception of discomfort and overall satisfaction with the mammography experience? What is the relationship between the perception of discomfort and plans for future mammograms? What other factors are associated with the perception of discomfort and satisfaction?
Clinical Trial Description
Breast cancer is prevalent, deadly, costly, and has low cure rates unless detected in its early stages. Mammography is the key component to early detection, yet it remains underutilized due to cost, access, and factors such as fear of pain.
Multiple studies have shown that most women find mammography uncomfortable, even painful. Yet, little research has been done to find methods to reduce mammography-related discomfort. In an unpublished Master’s thesis, this investigator found that women who expected discomfort > 40 on a visual analog scale (VAS) who were pre-medicated with 1000 mg of acetaminophen reported lower discomfort scores than those pre-medicated with placebo, but the sample size was too small to reach statistical significance. Further study on the effects of pre-medication is needed.
Pain should not be associated with a potentially lifesaving procedure. A more comfortable and positive experience with mammography may increase the number of women who participate in regular mammography screening, and, thereby, increase early detection and reduce the mortality rate, costs, and emotional trauma associated with breast cancer.
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The General Theory of Employment, Interest and Money (13 December 1935)
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