October is Breast Cancer Awareness Month, so there’s no time like the present to talk about screening. Early detection of breast cancer before symptoms develop can be life-saving, but many women are unsure about when and how often to be screened – and which screening method is best for them. Here’s what you should know.
Know Your Risk Level
Screening recommendations vary depending on your risk of developing breast cancer:
Women are at average risk if they have no history of invasive breast cancer, no family history of breast cancer in a first-degree relative (like a parent, child, or sibling), no symptoms, and haven’t been exposed to mantle radiation, which is used to treat Hodgkin’s disease.
Women are at increased risk if they have a family history of breast cancer, atypia (a non-cancerous breast disease), abnormal cells in the milk duct known as lobular carcinoma in situ, or mantle radiation treatment before age 32.
Understand Screening Guidelines
Being able to visualize what’s going on inside a woman’s breasts makes a crucial difference when it comes to early detection. The greater the detail, the more likely it is that doctors can spot unwanted changes early, before potentially cancerous cells have a chance to grow or spread.
“Mammography is the only breast cancer screening test that has been shown to save lives,” says Elizabeth Morris, MD, Chief of the Breast Imaging Service at Memorial Sloan Kettering Cancer Center (MSK). “In fact, large clinical trials have found that yearly mammography screening of women 40 and older with no symptoms of breast cancer reduces the number of women who die from the disease by about 30 percent.”
Experts at MSK recommend that women at average risk should get an annual mammogram starting at age 40.
“For high-risk women, including those with a family history, having mammograms earlier might be a good choice,” notes Dr. Morris, who also serves as President of the Society of Breast Imaging. Screening more often and/or adding MRI screening to regular mammography may also be recommended. “Women and their doctors should decide together on the best screening strategy for them,” she adds.
Consider Breast Density
Breast density may also affect breast cancer risk and screening. It’s quite common: About half of all women have dense breasts. So, what exactly does that mean?
Simply put, breasts are made up of fatty, glandular, and fibrous tissue. Breasts that are mostly fibrous and/or glandular appear white on a mammogram and are considered dense. “Because cancer cells also appear as white on a mammogram, it may be harder to identify the disease on a mammogram in women with dense breasts,” explains Dr. Morris.
Although dense breasts are totally normal, very dense breasts pose a risk for cancer. When you compare the 10% of women with extremely dense breasts to the 10% of women on the opposite end of the density spectrum, their risk is four to six times greater.
The only way to know for sure if you have dense breasts is via a mammogram. In 2013, a New York State law went into effect requiring radiologists to tell patients if they find dense breast tissue on a mammogram. Your doctor can help you assess whether additional imaging is necessary, and if so, what type would be best.
Screening Methods on the Horizon
Different screening methods have pros and cons. For example, an ultrasound or an MRI can detect cancer that might be missed by a mammogram alone, but they may also have false-positive results, which can be incredibly distressing to patients and lead to unnecessary biopsies.
The good news is that there are a number of promising screening innovations on the horizon for women at all levels of breast cancer risk. Thanks to advances in technology and ongoing research at MSK and elsewhere, the medical community is well on its way to implementing next generation imaging methods aimed at improving early detection.
Digital mammography is already being used at imaging centers across the country. This method can capture X-ray images as well as computer images of the breasts that can be moved and viewed from different angles.
Contrast-enhanced digital mammography (CEDM) uses a harmless dye during a digital mammogram that allows doctors to see results in more detail. Initial findings show that CEDM is just as accurate as MRI screening, produces fewer false positives, and is less expensive. This method may be more successful than mammograms when it comes to finding cancer in women with dense breasts.
Digital breast tomosynthesis (a.k.a. 3-D mammography) takes images of the breast from different angles to create a three-dimensional picture. Studies show it’s around 30% more effective than digital mammography in detecting early breast changes and also reduces the number of false positives. MSK is currently researching a combination of CEDM and tomosynthesis, known as contrast tomosynthesis, which has the potential to have a major impact on screening.
“This is a time of rapid and exciting change in breast cancer screening,” says Dr. Morris. “New technologies are generating images that are clearer and more detailed than ever before. This means we’re better able to make decisions that are right for our patients.”
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