Who has a high risk of developing breast cancer?
The American Cancer Society recommends that women with a lifetime risk of breast cancer of 20% or greater be screened annually with breast MRI in addition to mammography regardless of breast density. For more information on calculating a woman’s lifetime risk of breast cancer, visit https://www.cancer.gov/bcrisktool/. In addition, genetic counseling can help determine the lifetime risk of breast cancer and thus help a woman decide if additional breast cancer screening is appropriate for her.
Factors that greatly increase the risk of breast cancer include:
- The BRCA gene mutation
- A family history of a first-degree relative who has a BRCA gene mutation (for those individuals who have not been tested)
- Li-Fraumeni, Cowden/PTEN, or Bannayan-Riley-Ruvalcaba syndrome
- History of chest radiation between the ages of 10 and 30
- A history of more than one first-degree relative with breast cancer
- A personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
- A personal history of lobular carcinoma in situ (LCIS)or atypical hyperplasia
If I am at average risk for breast cancer, do I need additional breast imaging?
The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors (Committee Opinion Number 625, reaffirmed 2017).
What other types of breast imaging are available?
Studies have shown that breast ultrasound and breast magnetic resonance imaging (MRI) can help find some breast cancers that cannot be seen on mammograms. Women with dense breast tissue are advised to discuss whether additional breast imaging is appropriate for them.
Unfortunately, there are not any clear guidelines for helping patients with dense breasts decide whether to undergo additional testing. Additional tests carry risks as well as benefits; the patient is undergoing a costly procedure both in terms of expense and in terms of fear and anxiety in response to the additional screening. Additional imaging such as breast ultrasound can lead to additional procedures such as breast biopsy, and only a very small percentage of those biopsies will actually find cancer. Finally, breast ultrasound and MRI may not be covered by insurance.
What is dense breast tissue?
In recent years, numerous states have passed legislation that requires mammography providers to inform women when they have dense breast tissue. It is thought that dense breast tissue may impact a woman’s risk of breast cancer in one of two ways. First, the density of the breasts may decrease the ability to detect cancer on a screening mammogram. Second, there have been studies showing that dense breast tissue may be an independent, slight risk factor for breast cancer, although others argue that the relationship between breast density and cancer risk is not entirely clear.
For more information on dense breast tissue, visit:
What is 3D Mammography?
Patients have the option to choose digital breast tomosynthesis as an initial screening modality. Digital breast tomosynthesis, commonly known as 3D mammography, has been shown to increase breast cancer detection while decreasing recalls and biopsies. 3D mammography eliminates the view of some overlapping tissue and may better clarify the reading of the mammogram for the radiologist.
For more information about 3D mammography, visit http://www.breastcancer.org/research-news/benefits-of-3d-mammograms-last-over-time.
When should I have a screening mammogram?
Currently, screening mammography remains the most useful tool for breast cancer detection and consistently has demonstrated a reduction in breast cancer mortality. The American College of Obstetricians and Gynecologists (ACOG) recommends offering screening mammography to average-risk women beginning at age 40 and annual or biennial screening mammography based on the patient’s preference between the potential benefits of early detection versus the harms of testing.
For more information on breast imaging, visit:
What is breast self-awareness?
Breast self-awareness focuses on having a sense of what is normal for your breasts so that you can tell if there are changes and report them to your doctor. Changes that should be reported include breast lumps, skin changes, noncyclic breast pain, and bloody or clear nipple discharge.