With a woman’s risk of breast cancer at 1:8 in our lifetime in the US, all of us know or are related to someone who has breast cancer. While prevention is a great long term goal, early detection is currently our main focus as early stage breast cancers are generally completely curable. In general we recommend screening beginning at 40 for normal risk women, continuing every 1-2 years until age 50 then annually thereafter. By following these guidelines it is extremely unlikely that an early breast cancer will be missed.
For women at high risk or with an abnormality on physical exam, earlier or more frequent screening may be recommended. Risk factors include increasing age, family history, certain genetic disorders, obesity, not having children or having the first baby after age 30, prior history of breast cancer and certain benign breast disorders, dense breast tissue, current oral contraceptive use or combined hormone replacement, smoking and heavy alcohol use. Studies have shown mammography to be the best screening technique for women over 35. Mammography uses X-rays to take images of the breast from several angles which will make most cancers visible to the radiologist.
Almost all mammograms are now digital, so that the pictures are processed and stored on a computer rather than a film, and the pictures may be enhanced digitally to help with visualization. Many patients worry about the radiation exposure from years of mammograms and ask about non-radiation options such as thermography.
Thermography has been shown to be less effective than mammography at detecting breast cancer, so any potential reduction in risk from radiation exposure would be surpassed by the increased chance of missing a cancer. Ultrasound also does not expose the patient to radiation but is not a good screening technique for the whole breast, but often is used to focus in on abnormal areas detected by mammogram. Mammograms do no pick up every cancer and are more likely to miss an early cancer if the breasts are very dense.
For this reason we often recommend an ultrasound in conjunction with a mammogram for dense breasts. Additional mammogram views can also be used to create a 3D image which may be helpful with dense breasts. So called “3-D mammography” is offered at some Houston facilities and may not be covered by insurance since it is a relatively new technique. MRI can also be useful in evaluating dense breasts. The downsides of MRI are that is it expensive and time consuming, and has a higher false positive rate resulting in possibly unnecessary biopsies. If you have questions about our breast cancer screening recommendations please let us know!
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