DEAR DR. GOTT: I had a mammogram and they said they saw a nodule and called me back in to do more views. They said without doing an ultrasound, it was a lymph node and that I don’t have to go back for a year. Does this sound normal?
DEAR READER: Unfortunately, you failed to tell me your age because the guidelines for mammography have changed, depending on the source you rely upon. Other important issues include your family history, breast density, use of birth control pills, and more. I will generalize and hopefully will answer your question.
In 2009 the U. S. Preventive Services Task Force issued revised guidelines regarding preventive health care. Without a family history of known complications, they indicated routine screening mammograms should be performed every two years beginning at age 50. They have determined the benefits of screening mammography for women ages 40 to 49 do not outweigh the potential harms that include false positive results, leading to unnecessary biopsy, anxiety and stress. Note that these guidelines differ from those of the American Cancer Society (ACS) where mammography is recommended beginning at age 40 for women at average risk of breast cancer. The ACS also recommends self-examination (which the U. S. Preventive Services doesn’t), since a woman will likely be the first to identify changes that may occur to her body.
Lymph nodes resemble a filtration system that screens out and trap cancer cells, viruses, bacteria and other substances. As blood surges through the breasts and is pumped back to the heart, lymph must also be refreshed and recycled. This is accomplished through drainage from the breasts through the lymphatic system and is likely what your radiologist saw on your mammogram.
There are about seven other possible abnormalities (some indicative of cancer and some completely benign) other than lymph glands or cysts that can be revealed through a conventional mammogram; however, because your radiologist chose to wait and review your next mammogram rather than order an ultrasound, it is my guess he or she felt very comfortable making that decision. Your radiologist doesn’t want to make any mistakes and, if anything, should err on the conservative side by scheduling whatever tests might be deemed appropriate if any question remains. If you feel differently and are not completely comfortable with waiting, I recommend you request a copy of your films that can be taken to a second radiologist or other specialist for yet another opinion. This is a very common step for a woman to take, considering the mental anguish she might be going through.
Screening mammography isn’t perfect, but it is the best choice we have right now for early detection of questionable lesions that may require further investigation.
Readers who would like related information can order my Health Report “Medical Specialists” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website, www.AskDrGottMD.com.
