Medically Reviewed by John W. Sonfield, MD

McLeod Surgeon Dr. John W. Sonfield answers some important questions about mammograms and breast cancer treatment options.

Question: When should a woman start getting a regular mammogram?

Answer: This is an interesting topic. Over the last couple of years, it’s sort of been a moving target, as far as different organization’s guidelines. But I would say the standard is starting at age 40 a woman should get a mammogram yearly for life. What life means is if they have a 10-year life expectancy after the age of 74, they should still continue with mammograms. The American Cancer Society feels that for average risk women, that is women who have less than a 15% chance of developing breast cancer a year, they should maybe get mammograms every two years and then discuss with their doctor if they need yearly mammograms or not. So, the position has been, if a woman is comfortable with every two years after the age of 40 that is fine, but if a woman wants it yearly, we accept that too.

Q: Once a woman decides to undergo a mammogram and receives a negative outcome, what surgical options are available in the treatment of breast cancer?

A: Surgically, there are two options for breast cancer, and they are equal. I think that is what women need to know — if you are a candidate for both options, there is equal survival. A woman will not lose their life for what decision they make about their breast, and I think this is very important to make clear. Breast conservation is where we are able to save the breast and just remove the tumor, and that is associated a lot of times with radiation therapy. The other choice is mastectomy, which is removal of the breast. And that can be performed with or without breast reconstruction by a plastic surgeon. It’s really a woman’s choice and what they are comfortable with.

Q: Are there times when it’s best to undergo chemotherapy before surgery?

A: We use chemotherapy for two reasons before surgery. One, if you have a very large tumor, we sometimes try to shrink that down if a woman wants to save her breast. Chemotherapy before surgery also allows us to have a better cosmetic outcome and oncologic outcome. In addition, if you use chemotherapy before surgery, you can see if the chemotherapy is working. If the mass is shrinking it gives you a good idea that what we are giving to the patient is working, but for the overall survival benefit, universally, there is not a difference. There are some situations where it does make a difference, and that is why as a tumor board we all get together to help decide collectively what would be best for the woman involved.

Q: Why should someone feel confident coming to McLeod for breast cancer treatment?

A: McLeod has a terrific breast cancer team from the radiologists to the oncologists and pathologists to the nursing staff, the radiation oncologists and the surgeons. It’s a group effort. Breast cancer is a disease that is tailored to the individual. McLeod has a dedicated breast tumor board made up of all these specialties, and we meet every Tuesday. We discuss every new breast cancer case that comes through the system as well as every breast cancer patient who comes back through this board, because a recurrence can really change the management of a patient’s treatment. Some data indicates that up to 52% of patients, because of tumor boards, will see their cancer treatment plan change. The key is the expertise of all these physicians in one room determining a woman’s treatment plan by looking at her case individually. McLeod has all these parts perfected to make treatment successful for the woman involved.