Breast Cancer Risk: A Screening 3 Times Better Than Mammograms

Breast cancer screening should be individualized depending on breast density.

All women should know their breast density so they can choose the right breast cancer screening tool for their breasts and their level of risk. High breast density is a stronger risk factor for breast cancer than having a mother or a sister with breast cancer. Women with dense breasts get more breast cancers that are hard to find on a mammogram. Mammography alone is not sufficient screening for early detection in these women.

How can you find out your breast density? If you have ever had a mammogram, the radiology report documents your breast density. Ask you doctor for a copy of your mammogram report and you will know your breast density. If you have dense breasts, tell you doctor that a mammogram is not sufficient as a screening or diagnostic tool. If you are at high risk for breast cancer due to high breast density, you need to do more than have a mammogram to accomplish early breast cancer detection.

Women with fatty or low density breasts can still use mammograms with confidence knowing mammography will find their early tumors more than 80 percent of the time. You may have to educate your doctor in order to get the right breast cancer screening test for you.

If you have dense breasts, and more than 50 percent of all women do, then your risk of breast cancer is increased and mammograms will miss early breast cancer 75-80 percent of the time -- making mammograms almost worthless in detecting cancer to women with dense breasts. Most postmenopausal women using Hormone Replacement Therapy have dense breasts, making mammograms a poor technology in a group of women with high rates of breast cancer.

What does early detection mean? When breast cancer is detected early, lives are saved. We want to be able to find a tumor the size of 1 centimeter or less. Ninety percent of women who receive the right breast cancer screening and accomplish early detection will live.

This month in the Journal of Radiology Breast Cancer Prevention expert , Dr. Deborah Rhodes, M.D. and her colleagues will publish research on this new technology, Molecular Breast Imaging (MBI), that finds three times more breast tumors than mammograms. Dr. Rhodes is an expert at managing breast cancer risk. She works at Mayo Clinic testing a gamma camera that can see tumors that get missed by mammography.

In fact the gamma camera finds 83 percent of all tumors in women with dense breasts. It can find a tumor as tiny as 3 millimeters. In one study, when MBI was combined with mammograms 92 percent of all tumors were found. This is in contrast to to one study in which 75 percent of all tumors were missed using mammography in women with dense breasts.

In one patient with dense breasts a 5cm tumor the size of a golf ball was missed by a mammogram but found by the gamma camera. This is astonishing. Now, why don't we have access to this screening tool? Dr. Rhodes states that, "the breast has become a very political organ" and that forces of the status quo are against and hamper the progress of new technologies, such as this, due to political and financial interests. Welcome to Medicine in America: Medicine for Profit.

This new technique, which would complement (not replace) mammography, is sensitive enough to pick up a mass two-fifths of an inch in diameter. Molecular breast imaging requires patients to be injected with a radioactive drug, but it is much more comfortable than the vise-grip mammogram and is expected to cost only slightly more. Today Breast MRI technology is exquisitely sensitive at finding tumors, but due to its very high cost (10 times the cost of a digital mammogram), most insurers will not approve a Breast MRI for women who have never had breast cancer. So, we cannot use Breast MRI for prevention or early detection in today's insurer controlled health care system. And there are few radiologists today experienced at reading Breast MRI films with a high level of skill and accuracy. While Ultrasound and Thermography are also used, both technologies are not as highly specific and may result in increased numbers of biopsies, which are either not necessary and can increase the risk of spreading an existing cancer.

Dr. Rhodes states:

This new technology MBI (Molecular Breast Imaging) detects three times as many breast tumors as mammography in high-risk women. Although it would not replace mammograms, it might become an additional tool for screening, especially in higher risk women with a dense tissue that makes tumors hard to spot.

Because this new FDA Approved MBI technology continues to be studied and is not widely available and because Breast MRI technology is infrequently approved by insurers Dr. Rhodes recommends the following guidelines:

• Know your breast density (so you can choose the correct screening exam)

• If premenopausal, have your mammogram during the first half of your menstrual cycle when your breasts are less dense

• Demand additional imaging studies if you notice persistent changes in your breast tissue

• Have an annual mammogram if you are over 40

She also states that while mammograms are not perfect, they save lives and are accessible and affordable. Use them.

As with many changes in health care, these changes in the use of new, better, cost effective technologies are often consumer driven. That means, that if we, as patients demand that this FDA approved technology, as accurate as a Breast MRI at a fraction of the cost, be made widely available, it is far more likely that we will have access sooner than later. If money talks, then consumer/patient demand will continue to be a force in the health care marketplace.

Dr. Rhodes gave a talk at TEDWomen in December 2010
References.

For an Anti Cancer Diet Food List And Shopping List click here
For information and resources on Integrative and Alternative Cancer Care, tools and strategies of Breast Cancer Prevention and Breast Cancer Survivors see www.doctornalini.com

 

 

 

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Comments

[Maisey Moore]

11:03 AM on 03/04/2011

Thanks for such and interesting and insightful article! I had no idea that women can have different breast densities and that the density can affect early detection. I have learned a lot about both teleradiology and about breast cancer in such a short time and it is scary to hear things like this!

[Jacquessafety]

11:10 AM on 01/18/2011

It is good to see that there are more breast cancer detection methods that involve MRI. Detection is very important. My good friend's mother was diagnosed 2 years ago, and because of the MRI, the doctors were able to administer the treatments before it became worse. Her biggest fear of the MRI was the claustrophobia and safety in the MRI scanner room because of the powerful magnet.

[Saxton]

07:58 PM on 01/14/2011

Perhaps this isn't the right forum to ask this question, but having read some of the comments regarding MRI and the dye that is used, I have a question.
I have been diagnosed with atypical ductal hyperplasia, stage 0. I have been told, that although it is not breast cancer now, I stand a higher chance of it developing into breast cancer. I have already had the mammogram as well as the biopsy. Now I am scheduled to have the MRI followed by removal of the cell area. I have been told that I will be screened every 6 months, mammogram and then 6 months later MRI.
I am concerned about the dye, which I assume is gadolinium. I can't think this is safe to be undergoing this procedure for an extended period time.
I would appreciate any feedback if possible. Thank you.

[fredricksonmd]

11:45 AM on 01/12/2011

As a breast surgeon, I would like to correct some misconceptions in this stream of comments. First, mammography does not have 1000 times the radiation exposure of a chest X-ray; they are about equal. Second, please don't rely on thermography. It is not proven effective, and I have personally seen 3 patients with breast cancer who have had a normal thermogram. Third, there is clear evidence published earlier this year, the risk of a woman dying from breast cancer or colon cancer after getting one "gamma" imaging scan at age 40, is higher that that from a lifetime of annual mammograms. The increased risk is not worth doing the test for the vast majority of women. Fourth, gadolinium, the contrast agent used for breast MRI, can be nephrotoxic. It's a small risk. MRI screening is expensive as well. Because the test is very sensitive, there are many false positive results which can result in additional testing and/or biopsy. However, the benefit of breast MRI as a screening test may outweigh these negatives for the patient with a substantially elevated risk of developing breast cancer. At the end of the day, mammography is still the best screening tool for most women.

[Sharon Hanson]

02:48 PM on 01/12/2011

First let me provide links that show the new warnings the FDA has issued on gadolinium based contrasting agents:

http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm142882.htm

Second let me provide the case of Robbie Booker vs. GEHC ET. EL. regarding a motion for leave to add punitive damages to her complaint.

GE (Omniscan)

http://www.spanglaw.com/dangerous-drugs/mri-contrast-agents/documents/BookerNSFDecision.pdf

And third let me provide a link where it is admitted that Bayer knew this stuff was toxic a long time ago and did nothing about it.

Bayer (Magnevist)


http://www.diagnosticimaging.com/display/article/113619/1184977

I'll leave it up to you if you want to order anymore of these MRIs with contrast but if I were a doctor I'd want to know about these important facts before ordering. And doctor for your information you do not need to have kidney disease to get NSF and you do not need to have the skin condition to have NSF.

A few more links to look at:

Gadolinium in brain tumors of the non-renally impaired.

http://www.ncbi.nlm.nih.gov/pubmed/20868305

NSF in patient without the skin involvement

http://www.ncbi.nlm.nih.gov/pubmed/20462761

[fredricksonmd]

05:56 PM on 01/12/2011

For your information, Ms. Hanson, I do know the important facts before I order any test. I already said there is a small risk, and patients are informed about it before the test is ordered. As with anything in life, there is a risk/benefit analysis performed before just about anything we do, and not just in medicine. The benefit of going to the grocery store is that you will have food in your house to eat, whereas, the risk is that you will be killed in a car accident on the way. We make decisions such as these all day every day. Making a medical decision is no different. Each individual has to decide if the benefits outweigh the risk. Life is multiple shades of grey, Ms. Hanson, rather than just black and white.

[querencia]

10:11 PM on 01/11/2011

Detection and prevention are NOT the same thing - you can't detect what you don't have and you can't prevent what you do have. It is part of the scam to speak about them as if they are. Also part of the scam to scare the hell out of women about their breasts so that they will go in and get mammograms constantly, except that- for dense breasts- and cystic breasts that is the wrong solution which is documented here but most MD's will deny. I actually was able to advocate for a different type of scan at Kaiser but it was only because the surgeon who has aspirated numerous cysts for me intervened on my behalf. Despite the nonsense and profit motive, there are MD's out there who are tracking with what is going on and a few brave enough to advocate for patients here and there.

[Sharon Hanson]

08:24 AM on 01/12/2011

Here, here. I totally agree. I was poisoned with gadolinium based contrasting agents (GBCAs) they use for MRIs. And they did exactly what you said. They scared the hell out of me, found out I had the BRCA mutation and told me I needed to get MRIs. Why are the insurance companies not paying for MRIs? Because I believe they know the contrasting agents are toxic and cause chronic illness but can't say anything because they are still approved by the FDA.

I will be using thermography in the future and I will not trust the medical industrial complex anymore. I went from being terrified of getting cancer but healthy to not caring if I lived or died I was so sick. Of course I want to live but each dose of this toxic-heavy metal stays in the body at 1% and I believe it has impacted my brain in some way. It has definately impacted my endocrine sytem.

[Danchi]

08:34 PM on 01/11/2011

A friend has breast thermography on a yearly basis because of breast cancer in her family. Twice, the scan has detected cancer cells at stage zero. The Drs. removed the cells and some surrounding tissue and in both biopsies the cells were classified as a fast growing cancer. She swears by these scans and now use scans for all her health tests. She recently had a colon scan instead of the traditional colonoscopy. Her insurance doesn't cover it but she says her piece of mind is priceless.

[Sharon Hanson]

08:29 AM on 01/12/2011

My oncologist doesn't think they are accurate. He's still ordering and recommending the toxic and sometimes lethal MRIs with gadolinium based contrasting agents that cause a new man-made disease called nephrogenic systemic fibrosis. It you want to see what heavy metals do to the body just look up this disease.

I took him documents including court documents that show how toxic this stuff is and I mentioned that after the lawyers get done suing the manufacturers they are going to go after the doctors. I don't think he will comfortably order another MRI with contrast again.

[Danchi]

09:26 PM on 01/12/2011

Sorry about the double sentencing. I have a new laptop and if you hit the wrong button or my nail hit a button, strange things happen.

[devaflowers]

07:54 PM on 01/11/2011

FYI, I just had this procedure done at Mayo's. I was invited to join because of my class 4 density breasts.(I'd had previous mamo's there.) The procedure took longer than a mamo and involved a small injection,however the "squeeze" was about 1/3 of what you experience in a regular mamo. I do hope this will be available to women soon who have dense breasts. I was always told my test was "hard to read " because of breast density-not exactly reassuring. Women who might want to participate in the study should contact Mayo to see if they meet criteria.

[Sharon Hanson]

11:41 AM on 01/12/2011

Can you elaborate on the type/brand of contrast/dye they used?

[cespeckert]

07:45 PM on 01/11/2011

Dear Dr. Nalini Chilkov,

I just wanted to say that I really appreciate your blog. Your content is well written, engaging and heart felt and seems to speak to your readers (or atleast to me). So thank you for providing such well researched and informative information!

I just wanted to also comment on the dire need of funding for breast cancer research. I try to contribute as often as I can and one way for me to more affordably do this is to shop at Process Pink participating stores.

Process Pink is an organization with the mission of raising funds for breast cancer research. When consumers make credit card purchase at a Process Pink participating merchant, a portion of Process Pink 's profits from the credit card processing fees is donated to the National Breast Cancer Foundation.

It's just a way for us to continue to move forward in finding a full-proof cure for breast cancer.

Keep up the great work and I look forward to reading your next article!

[Nalini Chilkov]

10:29 PM on 01/11/2011

Yes, more research is needed, particularly in "Integrative" Cancer Care so that health and not just disease is part of the model. Remember there are breast cancers..plural. and each woman should have totally individualized care. Each cancer is a unique cancer in a unique individual. If we understand that, then we won't treat breast cancer, we will treat her2neu, EGFR cancer in a woman with high inflammation, low Vitamin D, high coagulation, poor digestion, a history of fibroids, etc etc,
That kind of care gives the best outcomes. Not only in treatment , but in low recurrence rate and high quality of life.

I think that research dollars directed at more chemotherapy agents and more radiotherapy machines is not going to change the terrain of cancer care. It will be more of the same because the model is flawed.

[Elaine Baly]

05:19 PM on 01/11/2011

“While a mammogram may be considered "affordabl­e" it is also extremely painful to have one's breasts squeezed between metal plates causing many women to shy away from this process. If there is a more comfortabl­e method that is more efficient at detecting breast cancer then I say it's time for women to "get out the pitchforks and torches" and demand access to it. I'm fed up with the HMOs treating us like 2nd class citizens. I say women are worth every penny of the cost of the breast MRI technology­. If the government can pay millions of dollars for men to get Viagra it certainly ought to pay for the MRI which unlike Viagra saves women's lives.”

[cespeckert]

07:55 PM on 01/11/2011

I also agree with you, but unfortunately the government's priorities aren't always clear or justified for that matter. As women, we have to do as those with breast cancer have done before us and take matters into our own hands in ways of raising money for research and then seeing that any findings and new treatments are reachable and affordable for all women.

If you're interested in donating, there's a great resource that I use that actually doesn't cost anything. The organization is called process pink and it donates to the national breast cancer foundation. When you use your credit card at process pink participating stores, Process Pink donates a portion of the profits from the credit card processing fees to the National Breast Cancer Foundation­.

If you're interested in learning more about this service, I'll provide a couple links below explaining how to take part in it.

- Cheers!

http://processpink.com/About/Blog/tabid/1001/EntryId/13/Online-Credit-Card-Payment-Processors-Will-Enable-Your-Business.aspx

http://processpink.com/About/Blog/tabid/1001/EntryId/9/Virtual-Terminal-Credit-Card-Processing.aspx

http://processpink.com/About/Blog/tabid/1001/EntryId/12/The-Merchant-Cash-Advance.aspx

[Teresa Langston]

10:36 PM on 01/11/2011

Agreed but would also like to suggest a special mammogram for testing for testicular cancer - especially insurance executives who are pretty much all male.

[Ljilja]

03:35 PM on 01/11/2011

As a former breast cancer patient, I couldn't agree more.

Thank you for pointing out a sensible (and very obvious) way to both save lives and save money in the long run.

http://graciouslivingdaybyday.com/

[Nalini Chilkov]

10:24 PM on 01/11/2011

Thank you. Spread the word. Share with your sisters and friends, mothers and grandmothers. And remember that men can get breast cancer too!

[Carolyn McNicoll Jones]

02:15 PM on 01/11/2011

why not go one step better to Breast Thermography instead?

[robin360]

02:41 PM on 01/11/2011

"While Ultrasound and Thermography are also used, both technologies are not as highly specific and may result in increased numbers of biopsies, which are either not necessary and can increase the risk of spreading an existing cancer".

[Sharon Hanson]

11:43 AM on 01/12/2011

As opposed to getting poisoned with contrasting dyes as in the contrasting dyes they use for MRIs?

[CarolLee]

03:18 PM on 01/11/2011

Yes, agreed 100%. Women should note also that mammograms have up to 1000x the radiation of a chest x-ray; this radiation (considering that women expose themselves to this annually) can actually cause the cancer that it is supposed to diagnose.

http://articles.mercola.com/sites/articles/archive/2009/12/03/Avoid-Routine-Mammograms-if-You-are-Under-50.aspx

[onionboy]

01:20 PM on 01/11/2011

What is the increased radiation exposure with this method? If it's to get through denser tissue and provide a more detailed image then it must be using more radiation. For women at particularly higher risk, that balance may be appropriate, but this article implies that over 50% of women should ask for this over standard mammography. If this has 20x more radiation then women should be told, especially since they would be getting it regularly for the rest of their lives. Any radiologists out there with info?

[highfivekhan]

05:29 PM on 01/11/2011

I work in Nuclear Medicine. We use radioactive isotopes for imaging. The radiation is very little probably less than a chest x-ray and definitely less than a CT. Unless, we are doing therapy treatments for cancer patients but for diagnostic it's very small. The reason it's so sensitive is because the radioactive isotope is uptaking by the cell on a molecular level based on physiology. The imaging time is longer so the gamma camera can "count" the gamma rays being emitted from the organ of interest forming an image. Hope this sheds some more light on the subject.

[onionboy]

05:51 PM on 01/11/2011

I absolutely hear you. I'm really only familiar with similar peri-operative uses (lymphoscintigraphy, etc.). But it's a different ballgame when you're recommending something for someone already diagnosed with a tumor compared to using it as a screening tool. When I did a Google search, the numbers were all over the place (2x - 30x). Since the article noted over half of women...wow. That's a lot. I know we've had trouble with Tc-99 shortages a couple of times over the last few years. I'm imagining how worse that could be if these became almost as common as mammograms. It might be a non-issue. I was just curious.

[Nalini Chilkov]

10:17 PM on 01/11/2011

According to Dr. Rhodes as the technology exists today, it is equivalant to the radiation exposure of a mammogram. Their goal is to improve the technology and lower the exposure. However, because of the radioisotope, the tumor cells are literally "lit up" and very easy to see. Not only are the cells targeted and labeled..but because the images are clearer, the films are easier to read, there is less ambiguity, less missed lesions. No technology is perfect. Each patient must weigh the risks and benefits of each choice to decide what makes the most sense to her.

[onionboy]

10:42 PM on 01/11/2011

I was just curious. I'm familiar with technology, but mainly for deeper diagnoses or even prognosis, not basic screening. The recommendation would be a pretty significant change on the first line diagnostic side. Thanks.

[Sharon Hanson]

11:12 AM on 01/11/2011

Ha! Another scare tactic to get women to be in fear of cancer so they can run and get expensive screening big PhRMA can make billions on.

I WAS POISONED BY GADOLINIUM BASED CONTRASTING AGENTS AND I AM TOTALLY DISABLED. These contrasting agents are toxic and you don't even mention them in your article. And not only are they toxic they are known carcinogens. I will never trust the medical industrial complex again. And I will now use themography a much better choice. I don't fear cancer anymore, I fear the rest of my life I will be in pain, with everything turning hard in my body - fibrotic - that's what I fear.

Can this exam help me with that?

[highfivekhan]

05:41 PM on 01/11/2011

I'm sorry to hear about what happened to you but the modality used here is nuclear medicine. We use radioactive isotopes and not contrast agents like MRI or CT.

[Sharon Hanson]

12:00 PM on 01/12/2011

And what makes you think these are safe? Gadolinium based contrasting agents have been on the market since the late 80s and we are now just finding out how toxic they are. Don't believe me look at the twice updated black box warnings the FDA has issued.

Also what is wrong with pursuing proteomics? These tests are non-invasive and would cut down on the need for these expensive screening tests and yet we never hear about them. I wonder why.

[MichaelArlen]

09:35 AM on 01/11/2011

An excellent, "must read" explanation that updates women on new procedures which might beter detect breast cancer; and the potential need to query (maybe even inform) your doctor.

[Nalini Chilkov]

10:23 PM on 01/11/2011

Thanks for your support Michael!