Cancer is the second leading cause of death in the United States, exceeded only by heart disease. One of every five deaths in the United States is due to cancer.
Breast cancer is the second most common cancer among women in the United States. Black women die from breast cancer at a higher rate than White women.
For many years, the American Cancer Society (ACS) recommended that women receive mammograms annually at age 40. However, in October 2015, they changed their guidelines, and the new recommendations now state that women at average risk of breast cancer start getting annual mammography exams from age 45 to 54 and continue to undergo mammography every other year after that. The ACS guidelines state that regular mammograms should be continued as long as a woman is in good health.
There are two main types of mammography: 2D digital mammograms and 3D mammograms — also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis.
What Is A Breast Cancer Screening?
A breast cancer screening checks the breasts for cancer. Breast cancer screenings can’t prevent cancer; they can help find it early when it is easier to treat. Without symptoms, your doctor will recommend the best time and frequency to start regular breast screenings. Mammograms have changed over the years, giving doctors a more transparent look at abnormal developments in a breast and a better understanding of when additional tests are warranted.
When To Be Screened For Breast Cancer
The U.S. Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 50 and older. Women aged 40-49 should contact their PCP to determine if they should be screened. Talk to your doctor about which breast screening tests are proper for you and when you should have them. Healthcare providers usually recommend starting mammogram screenings for breast cancer from the ages of 40 to 50. Recommendations can vary significantly for people at a higher risk for breast cancer.
However, the exact age depends on the professional organization’s guidelines your healthcare provider chooses to follow. For example, the American Cancer Society (ACS) recommends breast cancer screening beginning at age 45 with the option to start at age 40,1 whereas the Preventative Services Task Force (USPSTF) recommends mammography beginning at age 50.2
Mammograms for breast cancer screening have some limits. The main concern is the chance of a false-positive result. This means that something is found on a mammogram, but after more testing, it is not cancer. False positives are more likely to occur in your 40s and 50s.
Talk With Your Healthcare Team About:
You might need more testing if a mammogram finds a concern area. Healthcare professionals often recommend more mammogram images. Sometimes, ultrasound imaging is used.
In certain situations, you may need a procedure (a biopsy) to remove a sample of breast tissue for testing. These tests have some minor risks. Some people feel frustrated that they have to undergo these other tests. Others feel reassured when they find out that there’s no cancer.
Your Risk Of Breast Cancer
A healthcare professional can review your and your family’s health history to understand your risk. Your healthcare team might suggest other breast cancer screening tests if you have risk factors. Sometimes, people with a higher risk of breast cancer have screening tests more often.
Examining your breasts can make you familiar with how they look and feel. It can help you see if there are changes so you can seek medical care immediately.
DIAGNOSTIC MAMMOGRAMS
Screen-Film Mammography
Screen-film mammography replaced basic X-ray technology to produce foggy images that were difficult to analyze and took time to process. In contrast, screen-film mammography uses less radiation, processes images faster, and produces more explicit images. Screen-film mammography benefited patients, physicians, technologists, and lab analysts.
Once they have scanned the tissue sufficiently, they process the images through a cassette that contains a screen and film. A phosphor coating in the cassette glows and exposes the film to the X-rays, causing the film to develop similar to a photograph. Screen-film mammograms take approximately 20 minutes to complete. Comparatively, screen-film mammograms take several minutes to process and require a darkroom. Due to increased efficiency, most clinics now use digital mammography instead of film.
Traditional mammograms are read and stored on film, which may result in false positives or an inaccurate diagnosis. A mammogram can be used to screen healthy women with no signs of breast cancer. It is also used to help in the diagnosis of women who have symptoms. A mammogram can pinpoint minimal abnormalities before they can be physically felt.
3-D Mammographies
If your doctor prescribes a diagnostic mammogram, realize it will take longer than a routine screening mammogram because more X-rays are taken, providing views of the breast from multiple vantage points. The radiologist performing the test may also zoom in on a specific breast area with suspicion of an abnormality. This will give your doctor a better image of the tissue to arrive at an accurate diagnosis.
In addition to finding tumors too small to feel, mammograms may also spot ductal carcinoma in situ (DCIS). These abnormal cells in the lining of a breast duct may become invasive cancer in some women.
Digital mammograms are only used in diagnostic imaging centers certified by the FDA to perform digital mammography. Digital mammogram images are stored on a computer and can be easily shared electronically, allowing multiple providers to transmit necessary data to improve your care. Digital mammography uses less radiation, has better picture clarity, and can alter the photos afterward. This can make detecting abnormal changes more accurate due to the detail provided. This creates fewer false positive test results because of the nature of the testing itself.
This means that the screening will pick up only the vital information and differences or abnormalities in the breast tissue and eliminate what is irrelevant. This is known as specificity. Even though it catches many little things that are not important, digital mammography also detects small changes that could be early signs of breast cancer. As with any cancer, the earlier it is caught, the better. Saving lives is worth the occasional false positive. Digital mammography is quickly proving to be the best option.
Both types of mammogram technology use X-ray radiation to produce an image of the breast. The main difference is that older mammography systems rely on film, and today, digital images are viewed and stored on a computer. Digital mammograms are also easier to view and manipulate. The radiologist can access the images on a computer, which can be enhanced, magnified, or run for further evaluation. In many instances, they can highlight areas, zoom in and out, and use specific filters to gain a more accurate view of the breast.
As a rule of thumb, digital mammograms are often recommended for patients with denser breast tissue. It may also be best for women who have not yet entered menopause or those who are under the age of 50. In other words, Studies have shown that digital mammograms detect up to 28 percent more cancers than film mammography in women 50 years of age and younger, premenopausal women, and women with dense breast tissue. A 28 percent increase in accuracy means earlier detection and, most importantly, a better chance for optimal treatment.
ULTRASOUNDS
Breast ultrasound is an imaging test that uses sound waves to look at the inside of your breasts. It can help your healthcare provider find breast problems. It also lets your healthcare provider see how well blood is flowing to areas in your breasts. This test is often used when a change has been seen on a mammogram or when a change is felt but does not show up.
A breast ultrasound is most often done to determine if a problem found by a mammogram or physical exam of the breast may be a cyst filled with fluid or a solid tumor.
Ultrasound is safe to have during pregnancy because it does not use radiation. It is also safe for people allergic to contrast dye because it does not use dye.
What is breast ultrasound?
An ultrasound imaging test uses high-frequency sound waves to take pictures of internal organs and tissues.
A breast ultrasound provides pictures of the insides of your breasts. This test can give more information about small areas of interest within the breast that may be difficult to see in detail on a mammogram.
When is a breast ultrasound needed?
Typically, healthcare providers don’t use breast ultrasound to screen for breast cancer. They often recommend an ultrasound to follow up on suspicious areas seen on a mammogram. Because hand-held ultrasound uses a small probe to check the tissue, it is most useful when examining a specific targeted area of interest within the breast. Mammography is still the best tool for screening the entire breast, even in dense breasts.
A healthcare provider may recommend a breast ultrasound for many different reasons. Some of the most common are:
- Checking if a breast lump is a fluid-filled breast cyst (usually not cancerous) or a solid mass (which may require further testing).
- Investigating a focal area in the breast that appeared abnormal on a mammogram.
- Examining a pregnant woman’s breasts in conjunction with a physical exam. Occasionally, a mammogram is also used in pregnant women because radiation doses are very low and the abdomen can be shielded if concern for breast cancer detection is high.
- Guiding a needle into a mass to sample tissue for a biopsy. Pathologists (specialized doctors) can then evaluate the tissue under a microscope to determine if the mass is breast cancer.
Breast ultrasound is not usually done to screen for breast cancer. This is because it may miss some early signs of cancer. An example of early signs that may not appear on ultrasound is tiny calcium deposits called microcalcifications.
Ultrasound may be used if you:
- Have particularly dense breast tissue. A mammogram may not be able to see through the tissue.
- Are pregnant. Mammography uses radiation, but ultrasound does not. This makes it safer for the fetus.
- Are younger than age 25
- Your healthcare provider may also use ultrasound to look at nearby lymph nodes, help guide a needle during a biopsy, or remove fluid from a cyst.
Your healthcare provider may have other reasons to recommend a breast ultrasound.
Breast Magnetic Resonance Imaging (MRI)
A breast MRI uses magnets and radio waves to take pictures of the breast. Breast MRI and mammograms are used to screen women at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.
A Breast MRI Is Used to:
• Examine the breasts when other imaging tests are inadequate or inconclusive
• Screen for breast cancer in women with a high risk of developing the condition
• Monitor the progression of breast cancer and the efficacy of its treatment
Your doctor may also order a breast MRI if you have:
- Symptoms of breast cancer
- A family history of breast cancer
- Precancerous breast changes
- A leaking or ruptured breast implant
- A lump in the breast
- Dense breast tissue
Breast MRIs are meant to be used with mammograms. While breast MRIs can detect many abnormalities, the mammogram remains the standard screening tool for breast cancer.
Risks of a breast MRI
There’s no evidence to suggest that the magnetic fields and radio waves in a breast MRI are in any way harmful. But if you’re pregnant and your case isn’t urgent, avoiding a breast MRI is best.
Here are a few more things you should keep in consideration:
- “False-positive” results. An MRI doesn’t always distinguish between cancerous and noncancerous growths. Therefore, it can detect masses that may appear cancerous when they’re not. You may need a biopsy to confirm the results of your test. This is the surgical removal of a small sample of tissue from the suspected lump.
- Allergic reaction to contrast dye. During an MRI, a dye is injected into your bloodstream to make the images easier to see. The dye has been known to cause allergic reactions and severe complications for people with kidney problems.
A radiologist will review your breast MRI scan, dictate their interpretation of the findings, and give the findings to your doctor. Your doctor will review the radiologist’s findings and be in touch to discuss your results or to schedule a follow-up appointment.
MRI images are black and white. Tumors and other abnormalities may appear as bright white spots. These white spots are where the contrast dye has collected due to the enhanced cell activity.
If your MRI indicates a mass could be cancerous, your doctor will order a biopsy as a follow-up test. A biopsy will help your doctor determine if the lump is cancerous.
How Reliable Are Mammograms For Detecting Cancerous Tumors?
The ability of a mammogram to detect breast cancer may depend on the size of the tumor, the density of the breast tissue, and the radiologist’s skill in performing and reading the mammogram. Mammography is less likely to reveal breast tumors in women younger than 50 years than in older women. This may be because younger women have denser breast tissue that appears white on a mammogram. Likewise, a tumor appears white on a mammogram, making it hard to detect.
Beginning in late 2024, radiologists will be required to report the degree of density found within your breast tissue. Highly dense breast tissue is considered a risk factor for developing breast cancer. Dense breast tissue can also make mammogram images harder to read and interpret. If you have dense breast tissue, you should discuss additional imaging studies with your healthcare provider, such as ultrasound or breast MRI.
SUMMARY
Mammograms can be painful for some people. Most women and men find them uncomfortable. Still, the discomfort doesn’t last long. Each breast is compressed for a few seconds at a time. From start to finish, the entire procedure takes about 20 minutes.
It’s important to know that not all health insurance plans cover 3D mammograms, so it makes sense to call and ask if your health plan does. Both Medicare and Medicaid now cover 3D mammograms.
RESOURCES
American Cancer Society (ACS)
BreastCancer.org
CDCs (Centers for Disease and Prevention)
Health Images
Hopkinsmedicine.org
Independent Imaging
National Breast Cancer Foundation
VeryWell Health
