Breast cancer screening saves lives

Anytime is the perfect time to review breast cancer screenings and learn about advanced breast care technologies available at Beebe Healthcare.

Mammography is still the gold standard for breast cancer screening and detection. Between 1989 and 2012, there was a 36 percent decrease in breast cancer deaths as a result of screening mammography. There is some debate as to when women should start having mammograms and how often. However, the American College of Radiology, the National Comprehensive Cancer Network, the Society of Breast Imaging, and the American College of Surgeons all agree that screening mammography should begin by age 40 and continue annually while a woman is in good health. Even women who are pregnant or lactating should have their yearly mammogram. There is no age when mammography stops being beneficial, so women should continue screening as long as possible, and be willing to have additional tests including a biopsy if an abnormality is found.

The average woman’s risk of developing breast cancer is less than 15 percent over her lifetime, and yearly mammography beginning at age 40 is recommended.

Women with a 20 percent or greater lifetime risk of developing breast cancer are considered at high risk. This includes women with the breast cancer gene (BRCA 1 and 2) and their untested first-degree relatives, women with other less-common genetic conditions, women with a strong family breast cancer history, and women who have received radiation to the chest before age 30. In this subset of women, yearly mammography is recommended beginning at age 30 and in some cases as early as age 25.

Women between 15 percent and 20 percent are considered intermediate risk. This includes women with a history of breast cancer and certain precancerous breast conditions. These women should also receive yearly mammography beginning at the age of diagnosis but not less than age 30. MRI or ultrasound is also recommended in addition to mammography for screening in certain patients based on other risk factors.

All women, by age 30, should know their risk of developing breast cancer. There are several models that calculate risk based on a series of questions. These include the modified Gail model and the Tyrer-Cuzick or IBIS model, among others, which can be found on the internet.

A screening mammogram is appropriate for women without a breast problem. The options are traditional 2D digital mammography, and digital breast tomosynthesis, aka 3D mammography. Studies have shown that cancer detection rates are higher for 3D mammography, and the recall rate following a 3D screening mammogram is lower. Unfortunately, not all insurance carriers cover 3D mammography.

The benefits of 3D mammography are greatest for women with dense breasts, since this can make breast cancer harder to see on a mammogram. Having dense breasts increases a woman’s risk of breast cancer. Following a screening mammogram, about 7 percent of women may be recalled for additional images, a diagnostic mammogram or an ultrasound for further evaluation of an abnormality. Most of the time, the additional imaging results in a normal or benign finding.

A diagnostic mammogram is appropriate for women with a breast problem such as a lump, pain, nipple discharge or history of breast cancer, or following an abnormal screening mammogram. A diagnostic mammogram is reviewed right away by the radiologist and may require extra mammogram images or breast ultrasound.

Breast ultrasound is often the next step if a mammogram abnormality needs to be evaluated further, or if there is a physical finding such as a lump not seen on the mammogram. Ultrasound can also be used in women with dense breasts as a supplement to screening mammography.

Studies have shown that ultrasound can help find breast cancers not seen on a mammogram. However, ultrasound also shows some findings that are not cancer, which can result in added testing and negative biopsies. Also, the cost of screening breast ultrasound may not be covered by insurance.

Ultrasound does not replace screening mammography, and the decision to supplement mammography with ultrasound should take into account breast density, breast cancer risk, added cost, and the possibility of additional testing, including false-positive biopsies.

MRI is another method used for imaging the breast in certain circumstances. Breast MRI requires specialized equipment that allows the breasts to be adequately imaged without compression.

In women with a high risk of breast cancer (greater than 20 percent lifetime), yearly MRI is recommended beginning at age 25-30, depending on circumstances. Yearly MRI is also recommended in women with a history of breast cancer or certain precancerous conditions. In women who cannot tolerate MRI, yearly ultrasound is recommended instead. Screening MRI or ultrasound does not replace annual screening mammography. Sometimes the exams are performed together and sometimes six months apart.

Breast MRI may also be used to determine the extent of cancer after a new breast cancer diagnosis and to evaluate for cancer in the opposite breast, to evaluate for breast cancer recurrence, for further evaluation of abnormalities that are hard to assess with mammography and ultrasound alone, and to evaluate breast implants for rupture.

Some breast imaging findings may require a biopsy to determine if there is cancer. If the abnormality is visible with ultrasound, the biopsy can be performed using ultrasound guidance. If an abnormality is seen on a mammogram but not on an ultrasound, a stereotactic biopsy can be performed.

Both ultrasound-guided biopsy and stereotactic biopsy are minimally invasive. They are performed under local anesthesia through a small nick in the skin which minimizes scarring. This is important because more than half of all breast biopsies are benign, so minimal scarring is desirable.

In a small number of cases, a breast abnormality recommended for biopsy is only visible by MRI. Sometimes, a second-look ultrasound can find the lesion, but if not, MRI-guided biopsy is a third minimally invasive biopsy option.

Beebe Healthcare offers comprehensive breast imaging services. Traditional mammography or 2D digital mammography is offered at all Beebe locations, and 3D mammography is offered in Rehoboth Beach, Millville, and Georgetown. Breast ultrasound is offered at all locations except Milton and Millsboro. Breast MRI is offered at Beebe’s Margaret H. Rollins Lewes Campus. Beebe Healthcare offers state-of-the-art minimally invasive breast biopsy, including ultrasound-guided breast biopsy and stereotactic breast biopsy using 3D mammography guidance.