Early breast cancer detection saves lives.
By Maggie Landermeyer, M.D.
Women have a 1 in 8 risk of developing breast cancer in their lifetime. Due to improved breast cancer screening and early detection of small breast cancers, the five-year survival rate for breast cancer in the US is over 90%. This is a great improvement from 50-years-ago when the five-year breast cancer survival rate was 75%. And it’s still important to explore the different available screening modalities for breast cancer in the United States.
Risk Assessment
All women should have a risk assessment done by age 25 to determine the best individual path of breast cancer screening. This can be accomplished by assessing the patient’s family history of different types of cancer. If the family history is not known, genetic testing for currently known cancer genes may be considered. This testing has recently become more affordable and can be very helpful with individualizing a screening or treatment plan.
Mammogram
A 3D mammogram is the gold standard for breast cancer screening. A technician compresses breast tissue between two flat plates and the breast issue is imaged. The amount of radiation that the patient is exposed to is very small – about the equivalent of the exposure you receive flying from New York to Los Angeles.
The American College of OB/Gyn and the American College of Radiology both recommend starting annual mammograms (MMG) at age 40 for average risk women. The U.S. Preventative Health Task Force only recommends receiving an MMG every other year, but most providers agree that yearly is a better schedule for early detection. Plus, most insurance companies cover MMGs yearly.
Women who have a higher risk of developing breast cancer, usually due to genetic predisposition, may need to start annual mammograms at a younger age; possibly as young as age 25.
When reading an MMG, the radiologist will comment on the breast composition. If a patient has dense breast tissue, a supplemental form of breast cancer screening should be considered. In Texas, Henda’s Law requires the radiology group to notify patients who have dense breast tissue so that they can discuss supplemental screening with their provider. Dense breast tissue on an MMG can give a false negative reading – in other words, it’s easier for an early cancer to be missed.
Women with dense breast tissue tend to be younger and have a lower body mass index, but it is a radiographic finding so anyone can have dense breasts.
Breast Ultrasound
Ultrasound is the most common supplemental screening modality in the case of dense breast tissue. A wand is passed over the breast in an organized fashion to image the underlying breast tissue. This modality is helpful in cases of dense breast tissue, but breast ultrasound is not a comprehensive enough study to replace yearly mammograms. It should only be used as an adjunct to an MMG.
Breast MRI
Magnetic resonance imaging of the breast can be a helpful screening tool for high-risk women. This requires the patient to lay very still in an MRI tunnel for some time while the machine images the breast. The good news about an MRI is that it sees everything in the breast, so it is unlikely to miss an early cancer. The bad news about an MRI is that it sees everything in the breast which can lead to unnecessary breast biopsies and worry.
Contrast Enhanced Mammography
This is a new breast imaging modality that may help in early diagnosis of breast cancers in a select population. It is similar to a regular mammogram except that the intravenous contrast is used to assist with visualization of the breast tissue. This procedure carries added risk of increased radiation exposure and the risk of a reaction to the contrast dye. Therefore it is reserved for selected patients where other imaging may not be as accurate in early detection.
Thermogram
The FDA does not recommend thermograms in place of MMGs for breast cancer screening. Many patients ask about this modality in lieu of an MMG, so it should be discussed with your healthcare provider in order to be complete. This is a modality that can detect changes in the breast tissue temperature to detect breast cancer. Many patients opt for this method for breast cancer screening because they find mammograms uncomfortable or they wish to avoid radiation. Unfortunately, thermography doesn’t do a great job of early detection to be recommended as a beneficial screening method. By the time the cancer is large enough to change the temperature of the breast tissue, it has already advanced past the goal of early detection. If a thermogram is abnormal, the next step is an MMGfor evaluation. Most offices that provide hormone replacement therapy will not accept thermography for breast cancer screening and require yearly MMGs.
This list can be used as a tool to start a conversation with your healthcare provider about your personal path for breast cancer screening. And, if in doubt about the way you currently screen for breast cancer, please contact your healthcare provider.
Maggie Landwermeyer is an OB/GYN at Hill Country OB/GYN, which is celebrating its 25th anniversary this year of serving the healthcare needs for women in South West Austin. There are two locations in South West Austin and Dripping Springs. Hill Country OB/GYN has recently added a screening MMG machine at their location on Brodie Lane. For more information or to make an appointment, please call (512) 462-1936