Most women know the importance of breast health and staying current with annual breast exams, but may not know that both screening guidelines and technology is evolving. Dr. Brian E. Juell of the Renown Institute for Cancer explains new screening options and guidelines.
By Brian E. Juell, MD, surgical oncologist, medical director for breast cancer, Renown Institute for Cancer
If you’ve never struggled with breast cancer, chances are you know someone who has. An estimated one in eight woman will develop breast cancer in her lifetime. And according to the American Cancer Society, 252,710 new cases of invasive breast cancer will be diagnosed this year alone.
The death rate from this disease, however, has steadily decreased since 1989, with the medical community attributing the decline to increased breast cancer awareness, improved treatments and earlier detection. Women today have more and better options when it comes to breast cancer screenings. And for women at greater risk for developing breast cancer, that’s good news.
Know Your Risk Factors
What increases a woman’s risk? First and foremost are aging and simply being female. Other factors include:
- Family history: Risk doubles if a woman has a mother, daughter or sister who has been diagnosed with breast cancer
- History of other cancers such as ovarian
- Radiation treatment to the chest as a child or young adult for Hodgkin’s lymphoma
- Gene mutations (BRCA)
- Dense breast tissue
Talk to your healthcare provider about your chances of developing breast cancer. Women with no significant risk factors should start undergoing annual mammograms at age 40. Women at high risk, however, may benefit from getting screened at an earlier age.
Which Breast Screening is Right for You?
For most women, those with average to moderate lifetime risk for developing breast cancer, mammography screening is sufficient. For women at high risk — greater than 20 percent lifetime risk — MRI screening may be justified.
Today, women can opt for 3D mammography — an adaptation of 2D mammography. In both cases, X-ray technology is used to capture images of the breast. The difference lies in the number of images taken. With 3D mammography, multiple images of the breast are captured from various angles and used to create a more complete picture of the breast. This advancement detects subtle cancers that may be missed with a conventional 2D screening.
Whole-breast ultrasound was designed to improve rate of detection, most notably among women with dense breast tissue. It uses sound waves, not radiation, to capture a full image of the breast. Changes or abnormalities that would be obscured on mammography or undetected in a physical examination are potentially picked up with ultrasound.
Ultrasound is not a substitute for mammography. Rather, it’s an additional tool to help find those subtle cancers that may be nested in dense breasts. Studies have shown it detects an additional two to three cancers per 1,000 women that wouldn’t have been detected with routine mammography.
New Guidelines for Dense Breast Tissue
Breast density, however, is measured through mammography. Commensurate with Nevada breast density notification law, women with breasts deemed heterogeneously dense or extremely dense are automatically issued a letter after their mammogram notifying them about their breast density. It is up to each individual to consult her care provider to determine if she would benefit from whole breast ultrasound based on her breast composition, along with family history and other risk factors.
Remember that abnormalities don’t necessarily mean cancer. If something questionable is found through a screening, patients need to be scheduled for a diagnostic exam which may include additional mammogram views or an ultrasound to look at that specific location or mass. A biopsy also may be necessary.
If cancer is found, the screening method utilized doesn’t alter the prognosis. Most studies show that ultrasound is detecting cancers sized similarly to those detected by mammography. But the earlier cancer is detected, the better. That’s why it’s so important to know your family history, know your risk and start getting screened at the right age.
The American Cancer Society reports that there are more than 3.1 million breast cancer survivors in the U.S. today. And when it comes to surviving breast cancer, regular screenings and early detection are key.