6 Essential Questions About Breast Cancer Screening

How many of you are confused by the seemingly endless rounds of recommendations about breast cancer screenings? I know that I am, and so this post is designed to help answer the six essential questions that will help you decide what to do about breast cancer screening.

1. When Should Mammograms Be Started?

In general, for women without a family history of breast cancer, according to the American Cancer Society, mammograms should begin at age 40. If there's a strong family history of breast cancer, your health care provider may recommend earlier screening.

2. Are Mammograms Enough?

For many women with dense breasts, it's now thought that the addition of an ultrasound will help to detect breast cancers that can be missed by traditional mammography. Women who benefit from the addition of ultrasound are those with more breast density.

Breast density is reported as a BI-RADS classification. For women with a BI-RADS classification of 3 or higher, an ultrasound should also be offered. At the very least, women need to be informed about their breast density.

Some states have legislation in place that ensure that women are informed of their density. Right now in California, where I live, we're hoping Governor Brown signs this legislation. Here's a quick one-minute video and more information on breast density.

Some women with a family history of breast cancer or who have the BRCA-1 or 2 genetic mutations may also need to have MRI. It's best to talk to your own health care provider about your own unique situation.

3. How Often Should Mammograms Be Done?

Though many groups advocate for mammograms every two years, I agree with the American Cancer Society, which recommends that women have a mammogram every year starting at age 40.

4. When Should Women Stop Having Mammograms?

There are wide differences in opinion for this question also. Some groups only advocate screening until age 70, others until age 75. Since women are living longer now than ever before, I find myself agreeing with the American Cancer Society, which advocates annual screening as long as a woman is in good health. I have many patients in their 80s who are strong and vigorous and who plan to be around for another 20 years, and want their annual mammograms, which I'm happy to order for them.

5. Who Needs Genetic Testing for Breast Cancer?

Any woman who has a one or more family members with breast or ovarian cancer should consider genetic testing for the BRCA-1 and 2 mutations. These are associated with an increased risk of breast and ovarian cancer. Though only about 15 percent of breast cancers are hereditary, it's helpful to know if a person is at higher risk.

If possible, the person with breast or ovarian cancer should be tested to see if they carry the mutation. If that person is positive, then other family members can be tested. If the family members who had breast or ovarian cancer can't be tested, then other family members may decide to be tested.

6. Who Needs MRIs for Breast Cancer Screening?

Women with a family history of breast cancer, those with a personal history of breast cancer and those who are at higher risk from having had previous breast biopsies may benefit from the additional screening possible with MRI. Though there can be many false positives leading to biopsies and procedures, MRI can help detect early breast cancers.

For more, here's a video of an interview with Dr. Wendie Berg about breast cancer screening.

Disclosure: I have no financial or business relationships with the American Cancer Society, anyone working on breast density legislation, nor any companies working on breast imaging or genetic testing.

For more by Barbara Dehn, click here.

For more on breast cancer, click here.

 

Follow Barbara Dehn on Twitter: www.twitter.com/NurseBarbDehn

Comments

[lilcombatboots]

08:04 AM on 09/07/2012

http://vitals.nbcnews.com/_news/2012/09/06/13711551-radiation-may-up-breast-cancer-risk-in-some-women?lite So based on this, why havn't we switched to MRI's? I have a BioChem degree, but and not in a medical field, however added any kind of radiation does to an area of the body so susceptible to cancer that we "check" every month and do annual testing for, seems like a no brianer.

[bmitche]

02:20 PM on 09/06/2012

The guidelines on the age for mammograms can get a bit complicated, Some studies have shown that breast cancer in younger patients appears to be more aggressive, making it necessary to detect it even earlier.

[kaysings]

11:30 AM on 09/06/2012

I had a mammogram two consecutive years, and both times the tests showed multiple "masses". So both years, I was also shuffled into ultrasound, and that showed what I knew was the actual truth: All those masses are simply harmless cysts, a condition I inherited from my mother.

After the second ultrasound, I asked the technician why I should bother with a mammogram in the first place when the ultrasound was (and still is) clearly far more accurate. Her answer sounded like something out of a brochure: "We believe that the mammogram is still the best preventive test for detecting breast cancer." To which I replied: "Bull".

I have not had a mammogram since, only ultrasounds.

[Adrian Palmer]

08:06 AM on 09/06/2012

The ACR (Amer College of Radiology), the ACS (Amer Cancer Society), the NIH (Nat'l Inst of Health) and NCI (Nat'l Cancer Institute) all still maintain that every woman should have a baseline mammogram at age 35 with regular screening beginning by age 40! If there are risk factors and breast, as well as other particular types of cancer in first and second degree relatives, then baseline and screenings should be discussed and commence sooner. High quality Ultrasound and MRI are additional options depending on the circumstances. The radiation from mammography is very low (you are actually get more radiation from a dental x-ray, you get no radiation from Ultrasound), but mammography is still the most efficacious means of detecting breast cancer and the older you get the greater the likelihood of a positive diagnosis. I've worked in mammography for over 22 yrs, and I am more than familiar with the ACR guidelines and I have seen firsthand that when those guidelines are followed, early diagnosis and good prognoses are the results and that includes patients as young as age 24 up to 90.

[rikadarling]

10:24 AM on 09/06/2012

This link shows the amount of ionizing radiation a person receives from one mammogram. Since there is no safe limit on the amount of radiation one can be exposed to it would be prudent to err on the side of caution. Many doctors say it isn't wise to get mammograms until age 50 or older because younger breast tissue is more susceptable to the genetic damage that x-rays cause.

http://www.slate.com/articles/news_and_politics/explainer/2009/11/how_much_radiation_do_you_get_from_a_mammogram.html

[Adrian Palmer]

11:45 AM on 09/06/2012

I recommend you go to the FDA website (www.fda.gov) to the CDRH link (Centers for Devices of Radiologic Health) if you want accurate information on mammography and ionizing radiation or to the American College of Radiology (www.acr.org). This is not like 25-30 yrs ago when the x-ray tubes for mammography were the same as a standard x-ray tube. Mammography x-ray tubes issue very, very low doses of radiation. You get radiation every day just walking around, not to mention how much 'CT' type radiation you get from airport scanners. You are welcome to your opinion, but medically speaking you are not accurate. I, fortunately, don't know doctors who tell patients to wait until age 50 to get mammograms. A radiologist and facility with whom I work diagnosed a 24 year old a few weeks ago via mammography, after her primary care physician listened to her concerns and did not dismiss it out of hand because she was ONLY 24. She has had breast conservation surgery and will have follow-up only for now. She had no positive lymph nodes and the surgeon knew to leave a clean 1cm margin around the tumor bed. Those choosing to forego mammography end up being part of the reason we now see 1 in 8 women with breast cancer. If they wait, they have advanced disease, and end up being in the other statistics--those who die from breast cancer.

[LFS1]

02:10 PM on 09/09/2012

Since you work in mammography maybe you can answer a question. I have breast cysts and every time I've gone in for a mammogram they call me back in for a second and they are excruciating! Why wouldn't they send me for an ultrasound that would seeker and not be painful?

[Adrian Palmer]

02:57 PM on 09/09/2012

An ultrasound is precisely the standard of care for someone with cysts. If you go to the same imaging facility every time, they should be well aware of your history. Even if you have gone or go to a different facility, your previous images and reports should be in the hands of the techs and the radiologist(s). Unfortunately, I can't answer why your imaging facility is not doing US (ultrasound) but I do know that unless there is some sort of difference in your images or location, your previous history indicates you have cysts and US is the logical and usual follow-up recommendation. Also, cysts (unless they are really deep in the breast) can be 'drained' via US and if air is then injected into the area of the cyst after the fluid is drained the cyst wall will collapse and should not recur. I think you should discuss the entire cyst situation and US with your referring physician as well as the radiologist(s) at your imaging site.

[rikadarling]

12:49 PM on 09/05/2012

The is ample evidence showing that the radiation emitted from mammograms can and do cause some cancers to form that othewise wouldn't. In addition to the radiation the physical force of crushing the breast can rupture some tumors causing cancer cells to spread. A far safer approach would be using ultrasound and thermography, neither of which have been shown to cause cancer.

[No death panels]

08:25 AM on 09/06/2012

Nonsense. Thermography is useless. Mammograms neither cause nor rupture breast cancers. Provide links proving me wrong (you won't). Ultrasound can be a useful adjunct to mammography though.

[Kali03]

08:57 AM on 09/06/2012

"Nonsense"? Why don't you provide a link?

I'll be going with thermography, thank you very much.

[rikadarling]

10:14 AM on 09/06/2012

Thermography useless? Don't think so.

http://www.breastthermography.com/what_doctors_say.htm

Cheers.