A yearly mammogram is the gold standard for breast-cancer screening and detection. The National Cancer Institute and the American Cancer Society recommend a mammogram yearly for all women age 40 and older. If you have a family history of breast cancer, your doctor may advise starting mammography before age 40. Mammography is the only test that has been scientifically proven to save lives.
Still, it’s not infallible.
“In women with very dense breasts, mammography will miss cancer 58 percent of the time,” says Dr. Thomas Kolb, a breast-cancer radiologist and leading ultrasound researcher in New York City. Dense breasts contain more glands, ducts and connective tissue than fat. Breasts tend to be denser during a woman’s reproductive years; density makes it harder to detect suspicious lumps on a mammogram. That’s because glandular tissue appears white on a mammogram, just like a mass can.
Fortunately, new tools can give a more precise diagnosis, especially if you have dense breasts or you’re at higher risk for breast cancer because of your personal or family health history. Here are four that may give you a clearer picture of your breast health — and could possibly save your life:
The latest in breast cancer-detection technology, tomosynthesis is done in addition to a digital mammogram. During tomosynthesis, the breast is compressed, though slightly less so than with a conventional, digital mammogram, and a series of images are obtained from multiple angles. Tomosynthesis takes an arc of pictures through each breast, in 5 millimeter slices, which are then reconstructed into a three-dimensional image.
It allows radiologists to see through the breast tissue. They can more easily distinguish a true mass from overlapping structures, such as ligaments or glandular tissue. Tomosynthesis can be used for screening and diagnostic mammograms.
Pros and cons: Compared to a digital mammogram, women with dense breasts who undergo tomosynthesis are 40 percent less likely to be called back for additional imaging. Women who undergo tomosynthesis will be exposed to the same amount of radiation as a traditional, analog (film) mammogram, which is slightly more than today’s digital mammogram. The risk of radiation-induced breast cancer is extremely low, affecting only 0.1 percent of women screened. In comparison, the screening test itself can reduce the risk of dying from breast cancer by about 50 percent.
Should you ask for it? Screening tomosynthesis is in order if you have dense breasts, but no symptoms. It takes a global 3D picture of each breast. If you have a complaint or something is found during a screening mammogram, you’ll go to the diagnostic level, which is a mammogram with tomosynthesis that magnifies and focuses on one particular area of the breast. Because the FDA-approved technology is relatively new, screening tomosynthesis isn’t routinely covered by health insurance. Diagnostic tomosynthesis is typically covered by health insurance with no copayment necessary.
With this technique, a computer scans a digital mammogram and flags areas of concern, enabling a radiologist to take another look and decide whether the computer markings warrant further action.
“It’s like having an automatic second opinion,” says Dr. Mitchell D. Schnall, professor of radiology at the University of Pennsylvania in Philadelphia.
Pros and cons: Two studies reported that Computer-Aided Detection (CAD) found 20 percent more cancer than mammography alone. But it also tends to also mark non-cancerous lesions, such as bunched-up tissue, benign lymph nodes and benign calcifications, so the rate of false positives is high. Less than one percent of findings marked by Computer-Aided Detection turn out to be cancer. It is widely available at mammography centers and university- and hospital-affiliated breast clinics across the country and is generally covered by insurance.
Should you ask for it? Although it isn’t a perfect tool, “it should be the standard of care for every woman who gets a mammogram,” says Dr. Stamatia Destounis, staff radiologist at the Elizabeth Wende Breast Clinic, in Rochester, New York. “But there’s definitely a learning curve.”
To reduce your risk of unnecessary additional testing, such as biopsy, find a facility with mammography-certified technologists and trained radiologists who have been using CAD for at least a year.
Automated breast ultrasound
During this test, an automated ultrasound machine, which uses a computer program, takes ultrasound images of breast tissue. The images are recorded and given to a radiologist who can interpret them. Doctors currently use handheld ultrasound devices to hunt for breast tumors in some patients. The labor-intensive process can skip some tumors. Automated breast ultrasound eliminates the need for an ultrasound technologist, so there’s less risk of missing a lesion.
Pros and cons: Automated breast ultrasound can help detect breast cancer. Breast cancer detection doubled from 23 to 46 in 6,425 studies using automated breast ultrasound with mammography, resulting in a significant cancer detection improvement. Some insurance providers don’t cover the test yet, so check your policy.
Should you ask for it? Ask for it in addition to a screening mammogram if you have dense breast tissue. If you’re at high risk but you don’t have dense breasts, a mammogram should suffice.
Magnetic resonance imaging
This tool employs magnetic and radio waves instead of X-rays to create high-definition cross-sectional images of breast tissue. For the test itself, the patient is injected with safe, nonradioactive contrasting salt solution in the arm, then lies face down on a table with both breasts positioned into cushioned coils that contain signal receivers. The entire bed is then sent through a tube-like magnet. In areas where there might be cancer, the contrasting agent pools and is illuminated on computer-generated images.
Pros and cons: Magnetic Resonance Imaging (MRI) has been shown to find two- to six-percent more cancers than mammograms and clinical breast exams in high-risk women. MRI can’t detect calcifications (a frequent sign of Ductal Carcinoma In-Situ), which is why it’s used as a complement to mammography, not a replacement. It has also a significant risk of false positives. Screening breasts costs $1,000 to $2,000, though many insurance carriers now cover it.
Should you ask for it? “Even if you have as little as a two percent risk of breast cancer over the next five years, talk to your doctor about adding MRI,” says Dr. Wendie Berg, a breast imaging consultant in Baltimore. MRI breast-imaging centers are springing up across the country, but it’s important to seek out a facility that has MRI-guided biopsy capability, so a tissue sample can be retrieved for diagnosis at the time of your scan if a questionable mass is spotted.
Do you have dense breasts?
Breast density depends in part on hormonal status, which is why premenopausal women are more like 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, 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 doesn’t require that information, simply ask your doctor if your mammogram results indicate that you have dense breasts.
Sandra Gordon is an award-winning freelance writer who delivers expert advice and the latest developments in health, nutrition, parenting and consumer issues.