What kind of breast screening is right for me?

February 13, 2019 | by Edward-Elmhurst Health

It can be confusing to stay up-to-date on the latest breast screenings available for women. As researchers continue to study new ways to detect breast cancer, women have more options from which to choose.

“Although there are many breast screening tools available to women, mammography still remains the gold standard for breast screening in women’s healthcare. Regular mammograms have proven to be very effective in detecting cancer early in most patients,” says Regina Liebman, M.D., radiologist on the medical staff of Elmhurst Hospital.

Some women, such as those with dense breasts, may need additional screening beyond a mammogram. Each woman should discuss her options for breast cancer screening with her doctor, says Dr. Liebman.

The following are some breast cancer screening tools currently available:

2D and 3D mammograms

 A mammogram is a low-dose X-ray of the breast that allows doctors to look for changes in breast tissue. There are two different types of digital mammograms: digital mammography (2D) and three-dimensional mammography (3D), also known as tomosynthesis. Though there’s no difference in how either mammogram is performed, there is a difference in how the image is created:

  • In 2D mammography, X-rays produce a two-dimensional image of the breast. The digital image produced can be lightened, darkened and enlarged for closer inspection. This makes it easier for a radiologist to look for abnormal changes.
  • In 3D mammography, the screening device takes several low-dose images in one-millimeter slices from different angles around the breast to create a 3D picture. Several studies have found that 3D mammograms find more cancers than traditional 2D mammograms and reduce the number of false positives. This type of technology is especially useful for finding tumors in women with dense breasts.

Edward-Elmhurst Health offers 3D mammography at 11 of its 14 mammography locations. A referral is not always needed for a mammogram. We offer self-referral and self-requesting mammograms that you can schedule online. We also offer same-day screening mammography results when performed before 2 p.m. on weekdays.

Breast magnetic resonance imaging (MRI)

A breast MRI uses magnetic fields to create an image of the breast. Often used for screening women at higher risk, a mammogram plus breast MRI can increase the likelihood of detecting breast cancer. It is not recommend for women of average risk. It also has some drawbacks

  • Breast MRI is more invasive than mammography because a contrast agent is given through an IV before the procedure. In rare cases, women can have a reaction to the agent. 
  • Breast MRI has more false positive results than mammography. 
  • Patients who are claustrophobic (fear of confined spaces) or have certain implanted metal devices are unable to undergo a MRI. 
  • Some MRI centers don’t have the technology or specifically-trained radiologists to read breast MRIs.
  • Breast MRI is expensive and is not always covered by insurance. Your doctor can help assess your risk of developing breast cancer and determine if a breast MRI is right for you.

Molecular breast imaging (MBI)

MBI is a newer technology performed in nuclear medicine that supplements mammography by helping detect breast cancer in women with dense breast tissue, and those at higher risk of breast cancer.

Unlike other breast imaging technologies, MBI looks at cellular activity within the tissue. A patient undergoing MBI is injected with a small amount of a molecular tracer that brightens highly active breast cancer cells. This allows the camera to differentiate them from normal cells and gives the radiologist the ability to compare anatomical and functional images from similar perspectives.

MBI may benefit patients who have: 

  • A normal mammogram and ultrasound but clinical symptoms or a palpable abnormality
  • Increased risk of breast cancer but are unable to undergo MRI (due to claustrophobia or implanted devices that preclude an MRI)

MBI exams themselves are similar to mammograms but the compression is about 30 percent less, so patients experience less discomfort during the exam. In addition, patients are able to sit comfortably during the procedure. There is radiation exposure as in mammography. If an abnormality is detected, ultrasound may be necessary to further evaluate the finding. A physician referral is required for an MBI.

Whole breast ultrasound

Whole breast ultrasound is a complete ultrasound of both breasts. It is a supplementary screening study used in conjunction with mammography to evaluate dense breasts. It is not a substitute for a mammogram.

For women with dense breasts, whole breast ultrasound can help detect small cancers that a mammogram can miss. Patients with dense breast tissue should discuss the use of this modality as a supplementary screening tool with their physician.

When should I start getting screened for breast cancer?

Different organizations recommend different ages to start screening. Experts at the American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend that women receive annual mammograms starting at age 40. Women at high risk for breast cancer may need to begin screening earlier.

Talk to your doctor about your breast cancer risk, what screening tool is best for you, and when you should begin screenings. Early detection is the goal of screening mammography.

Learn more about breast health services at Edward-Elmhurst Health.

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