Breast Cancer from the Inside Out

By Vance Dell, MD, FACR; Cooper Clinic

One in eight women will be diagnosed with breast cancer at some point during her lifetime. Roughly 40,000 women in the United States will die of the disease this year. This common cancer is treatable and beatable, especially when detected early. Vance Dell, MD, FACR, is a radiologist at Cooper Clinic who specializes in mammography. He is trained to spot even the slightest abnormality within breast tissue depicted in a mammogram, and his unique perspective on breast cancer offers facts and advice that often fly under the radar when it comes to the disease.

The American Cancer Society (ACS) recently released new recommendations for mammograms, in which women should begin having annual exams at age 45 until age 55, and then have the option to get an annual or biannual exam after age 55. ACS notes that incidence of breast cancer begins to noticeably increase around age 40, and that women should still have the opportunity to begin screening at age 40 if they so choose or at the recommendation of a physician.

Cooper Clinic begins baseline screening for breast cancer at age 40, although some women may choose to be screened earlier due to family history of the disease. The American College of Radiology and Society of Breast Imaging also recommend screening beginning at age 40.

Other public health organizations recommend that women have mammograms every two years beginning at age 50 and women under 50 consult with their physician, but Dr. Dell refutes this recommendation. “Forty percent of new breast cancers occur in women younger than 50,” he says. “Breast cancers can progress rapidly, so taking the risk of letting a cancer grow over the course of two years between mammograms can lead to a more advanced tumor stage when the cancer is finally diagnosed.”

Finding breast cancer early is key to diagnosis, treatment and survival. Radiologists are becoming better and better at identifying cancers in their smallest stages of development, even in dense breasts. “If we catch a cancer that is one centimeter or less in diameter, there is almost a 98 percent five-year survival rate, no matter how aggressive that cancer is,” says Dr. Dell. “We want to find the cancer before it can be felt during a self-exam, because by the time a tumor can be felt there is an approximately 20 percent chance that it has spread. This is why annual mammograms are so important, as they can identify cancers that would otherwise be unsuspected.”

There are a few things that Dr. Dell says women should know when preparing for a mammogram. First, the procedure can be uncomfortable, but this is only because of the need to get a clear picture of the breast. The clearer the picture, the better opportunity to identify any potential problems. Secondly, women should not be afraid to ask questions of the radiologist or technologist performing the exam. Being comfortable with their expertise and trusting their knowledge can help make the procedure a bit more relaxing. Since mammogram screening quality was mandated by law in 1992, breast cancers have been found much earlier and mortality has dropped by 35 percent. Dr. Dell explains that for every 1,000 women screened, we can expect to find three to six cancers.

A factor that women should be aware of when it comes to their own breast health is breast density. About 50 percent of women above the age of 40 have dense breasts, which means their ratio of fibroglandular tissue (which includes milk ducts) to normal breast fat is increased. Because 97 percent of breast cancer originates in the milk ducts, women with more fibroglandular tissue (denser breasts) have a slightly increased chance of developing breast cancer. Though cancers can be harder to find in dense breasts, Dr. Dell notes that ultrasound and MRI technology can be used in addition to mammography to provide the most thorough screening possible. The increased use of ultrasound in breast screening is now a national trend.

Family history of breast cancer can also increase a woman’s risk of getting the disease. However, a negative family history does not mean a minimal risk of breast cancer. “Actually, three out of four new cancers found are in women with no family history of breast cancer,” says Dr. Dell. No matter the risk, an annual mammogram greatly reduces the chance of dying from the disease.

Despite its commonality in today’s society, breast cancer and its harmful effects can be treated more effectively when detected in its earliest stages through mammography and ultrasound technology. Don’t wait––if you are 40 years or older, get screened––it could save your life.

For more information about services, including mammograms, provided by Cooper Clinic, please call 972-560-2667 or visit