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What Doctors Don't Tell You © (Volume 6, Issue 11)
I have lumpy breasts, but I am loathe to have a mammogram because of doubts about its safety and accuracy. My doctor has recommended that I go for a breast ultrasound scan. What's your view? I'm 47. M D, Boston, Massachusetts.

These days, any gynecologist who feels a bump is likely to recommend a scan of some sort. According to our Alternatives columnist, Dr Harald Gaier, in the early stages, it's highly difficult to tell with absolute certainty whether a lump is cancerous or benign, unless the lump is biopsied. (In this procedure, a needle is inserted into the lump and some cellular tissue extracted, in order to be analyzed in a lab.) Nevertheless, he says, it's possible to get some idea of the sort of lump it is by feel. Pain, changes in size during your menstrual cycle, easy mobility, absence of hardness and the presence of multiple nodules probably means there is no cancer, he says, while malignant lumps are usually hard, irregular, non-tender and fixed. A lump that remains the same throughout your cycle or increases dimpling of the overlying skin or tethering to the skin above or muscle below the lump is slightly more likely to indicate cancer.

Discharges, says Dr Gaier, may indicate a number of things. A blood stained discharge from the nipple may not definitely indicate cancer but also be present in benign cystic mastitis. A greenish or yellowish discharge is invariably caused by mastitis; a watery one, early pregnancy; and a milky discharge (that is, if you're not breastfeeding), an adverse drug reaction. Pain in the breast per se isn't necessarily cause for alarm, he says (although it may sometimes prefigure the future development of breast cancer). Pain is often one of the the collection of symptoms of PMS, is present with breast abscesses or a candida albicans yeast overgrowth.

As we've written about in many issues of WDDTY, mammograms are increasingly falling into disrepute. Not only are they considered inaccurate and difficult to interpret, but downright harmful for certain women whose breasts may be sensitive to the carcinogenic potential of the strong x-rays (See WDDTY vol 3 no 10).

With doubts growing about mammograms and other forms of x-rays, researchers are turning to mammary ultrasound as well as ultrasound for many other diagnoses. As you know, ultrasound employs soundwaves to produce an image on what appears to be a television set.

As the instruments, including the transducer (the gadget producing the sound and "listening" for returning echoes) have grown far more sophisticated, ultrasound use has dramatically increased. These days, it is used to diagnose heart problems, a variety of tumours, circulatory problems, and to examine organs and body parts, including liver, spleen, uterus, placenta, brain and now breasts.

However, the success of ultrasound largely depends on the skill of the operator, as images can be hard to read and are open to misinterpretation. In particular, operators worry about visualizing "artifacts" that is, a ghosted image of something that isn't there or mistaking something quite normal for something sinister. For instance, fetal hair has been mistaken for serious neural tube defects; bladders have been mixed up with pelvic tumours. This often happens when operators make errors in setting up scanning technique instruments or positioning the transducer (JAMA, March 6, 1991).

There's also the problem of false echoes creating images on the screen that suggest things that aren't there at all. This is a particular problem with curved, highly reflective surfaces such as the diaphragm or near large masses, such as the gallbladder or bladder. And problems in the accurate reflection of the sound beam can distort the size, shape, position and brightness of structures, miss real echoes and so miss important pathologic features.

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What Doctors Don't Tell You What Doctors Don’t Tell You is one of the few publications in the world that can justifiably claim to solve people's health problems - and even save lives. Our monthly newsletter gives you the facts you won't......more
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