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Beyond Mammography

The pros & cons of 4 breast screening tools that, used with mammography, should better diagnose breast cancer



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A yearly mammogram is the gold standard for breast-cancer screening and detection. It’s what both the National Cancer Institute and the American Cancer Society recommend for all women age 40 and older. Women with a family history of breast cancer are often advised by their doctors to start mammography even earlier. Mammography is the only test that has been scientifically proved to save lives. Still, it’s not infallible.

Do You Have Dense Breasts?

 Breast density depends in part on hormonal status, which is why premenopausal women are more likely to have dense breasts. Genetics also plays a part. If your mom had dense breasts, you’re more likely to have them. But only a mammogram can make that determination.

 In some states, including New Jersey and Pennsylvania, radiologists are required by law to tell you, in the letter you receive about your mammogram results, whether you have dense breasts. If your state, like Delaware, doesn’t yet require that information, simply ask your doctor if your mammogram results indicate that you have dense breasts.

“In women with very dense breasts, mammography will miss cancer 58 percent of the time,” says leading ultrasound researcher and breast-cancer radiologist Thomas Kolb, MD. The attributes of dense breasts — more glands, ducts and connective tissue than fat — appear white on a mammogram, just like a cancerous mass can, and can make it harder to detect suspicious lumps. Breasts tend to be denser during a woman’s reproductive years.

Fortunately, a quartet of modern tools — tomosynthesis, computer-aided detection, MRI and automated breast ultrasound — can give women with dense breasts or an elevated cancer risk a clearer picture of their breast health — one that could possibly save lives. 

Click here to find out which local radiology centers offer these four important screenings.

1. Tomosynthesis

The latest in breast cancer-detection technology, tomosynthesis takes an arc of pictures from multiple angles through each breast, in 5-millimeter slices, in conjunction with a digital mammogram. These slices are then reconstructed into a 3-D image. This allows radiologists to more easily distinguish a true mass from overlapping ligaments or glandular tissue.

Pros/cons: Women with dense breasts who undergo tomosynthesis are 40 percent less likely to be called back for additional imaging. Tomosynthesis exposes women to the same amount of radiation as a traditional, analog (film) mammogram, but the risk of radiation-induced breast cancer affects only 0.1 percent of women screened. In comparison, the screening itself can reduce the risk of dying from breast cancer by about half.

Should you ask for it? Screening tomosynthesis is in order if you have dense breasts but no symptoms. Because the FDA-approved technology is relatively new, screening tomosynthesis isn’t routinely covered by health insurance.

2. Computer-Aided Detection (CAD)

With this technique, a computer scans a digital mammogram and flags areas of concern. “It’s like having an automatic second opinion,” says Mitchell D. Schnall, MD, PhD, professor of radiology at the University of Pennsylvania in Philadelphia.

Pros/cons: Two studies reported that CAD found 20 percent more cancer than mammography alone. But CAD also tends to mark non-cancerous lesions, so the false-positive rate is high: Less than 1 percent of findings marked by CAD turn out to be cancer. Widely available at mammography centers and breast clinics, CAD is generally covered by insurance.

Should you ask for it? To reduce your risk of unnecessary additional testing, find a facility with mammography-certified technologists and trained radiologists who have been using CAD for at least a year.

Next page: Learn about MRI and automated breast ultrasound.

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