According to the CDC, female breast cancer is the highest incidence of new cancer cases. And by a large margin. In 2018, there were 126.8 new breast cancer cases per 100,000 women. The next incidence of cancer was lung which had 48.6 cases for every 100,000 people. Thankfully breast cancer can be cured as show by the rate of death (20 deaths per 100,000). The best way to increase odds of surviving breast cancer is to identify changes in breast tissue before it develops into cancer. That is where breast disease screening comes in, and we’re here to help you understand the various options available to you.

Breast physiology changes over time, and typically years before you see structural changes, like tumors. No screening by itself can conclusively confirm breast disease – that would require a biopsy – so when considering breast screening options, think of these as an aid, but not the final word.

Mammograms are the most prevalent screening tools for breast cancer, but they miss about 1 in 5 breast cancers, with dense breasts more likely to get false negatives. False positives are also a thing, where the results appear abnormal but there is no cancer. False positives require extra testing by a second form of screening, perhaps an ultrasound, MRI, or a breast biopsy. About 50% of women with annual mammograms over a 10 year period will have a false-positive at some point. In fact, you have higher odds of a false positive on your first mammogram but once you have prior mammograms you have a comparison to your current screening, which reduces the odds of a false positive by half.

There are 3 types of mammogram: conventional, digital (full-field digital mammography), and 3D (Tomosynthesis mammography). All three procedures use the same squished breast technique to get an image.

Conventional:

  • Most frequent form of mammogram
  • Low dose x-ray in black and white
  • Detects and monitors micro calcification
  • Detects lumps or mass once 1 cm or larger
  • Radiation exposure
  • Not effective for dense breasts

Digital (Full-field digital mammography):

  • Uses digital chip in place of an x-ray
  • Can view on computer or print on special film
  • Faster image, fewer exposures and less discomfort
  • Better than conventional for detecting breast cancers in
    • Under 50 years of age
    • Dense breasts
    • Premenopausal
  • Detect and monitor micro calcifications
  • Detect lumps or mass after 1 cm or larger
  • Radiation exposure
  • Not effective for dense breasts

3D (Tomosynthesis mammography):

  • Better at identifying masses and cancerous tissue
  • Creates layers to show views
  • Low dose x-rays
  • Better able to interpret results
  • Reduces false positives
  • More accurate in detecting cancer early
  • Detect and monitor micro calcification
  • Detect lump or mass 1 cm or larger
  • More radiation exposure than conventional mammograms
  • Not effective for dense breasts

One of the risks with screening mammograms is that they find invasive breast cancer and ductal carcinoma in situ (DCIS) that does NOT need to be treated. According to the American Cancer Society approximately 1 to 10% of breast cancer diagnoses are “overdiagnosis”. Doctors can’t identify which cancers are life threatening and which are cancers that might never cause any problems. Once cancer is diagnosed, doctors tend to attack the problem directly with surgeries, chemo therapy and radiation, when in fact, some cancers might never need treatment.

Another screening approach to breast health is to use thermal imaging. A large advantage to other approaches, thermal imaging enables young people to keep a breastprint timeline to more effectively see the changes in their breasts before they become structural changes.

Breast thermography (Thermal imaging):

  • Digital infrared camera
  • Detects surface heat
  • Temperature readings turned into image
  • Started young, get a timeline of changes in your breast. Can see physiological changes before structural
  • Good for breast implants, dense breasts, pregnant, breastfeeding women
  • Requires Physician interpretation
  • Best aspect is the risk assessment provided
  • Worst aspect is that it doesn’t detect calcifications or lumps

MRI (Magnetic Resonance Imaging):

  • Magnets and radio waves used to create pictures
  • Detailed, cross sectional images
  • Not as effect as mammograms and more likely to produce false positives
    • Good for high risk patients since may appear abnormal when they aren’t
  • Need contrast liquid to find lumps and masses
  • More expensive than mammograms and ultrasounds
  • Effective for dense breasts
  • After cancer found, MRI is used to identify additional tumors and size them

Ultrasonography (ultrasound):

  • Uses sound waves to produce pictures
  • Helpful for diagnosing lumps or abnormalities found in other screenings
  • Helps determine if abnormality is solid, fluid-filled or cystic and solid
  • Safe, noninvasive – no radiation
  • Ultrasound and mammogram provide similar detection for breast cancer.
    • Ultrasound screens find cancers that are more likely to be the invasive kind and lymph node negative
  • Ultrasound, as an adjunct to mammograms, hasn’t been found to meaningfully increase breast cancer detection rates
  • More false positive than mammograms

Molecular Breast imaging:

  • Newer, and not widely available
  • Radioactive tracer injected into vein and nuclear medical scanner
  • Tracer injected into vein, tracer lights up cancer cells
  • Adjunctive to mammogram for dense tissue or further check on abnormalities
  • Low dose radiation
  • Rare chance of allergic reaction to tracer
  • Because of false positive rate, best used for 2nd screening to mammogram

Deciding which if these to use really depends on your age, your risk category, the trade-off between radiation and effectiveness and where you place value – on the benefit or on the harm.

Guidelines:

Screening really depends on your history and your health factors. If you have average risk of breast disease, mammograms should start at age 40 to 45, and they should be done annually. If your doctor finds an irregularity on your physical exam you should follow up with a mammogram. Screening is the best way to track the progress of lumps and irregularities.

Dense Breasts:

Dense breasts have tissue that is so dense the mammogram doesn’t show the details sufficiently to determine if they are tumors, lumps or regular healthy tissue. The American Cancer Society says there is no evidence.

The risk of being diagnosed with breast cancer during the next 10 years, starting at the following ages:

  • Age 30 – 0.49% (1 in 204)
  • Age 40 – 1.55% (1 in 65)
  • Age 50 – 2.40% (1 in 42)
  • Age 60 – 3.54% (1 in 28)
  • Age 70 – 4.09% (1 in 24)

No matter the screening method chosen, breast health must include routine breast cancer screening, as self-screening isn’t sufficient to find early markers of cancer. Given the number of options available, health insurance will usually cover some method of screening. While screening at a young age isn’t necessary, the risk of being diagnosed with cancer increases as you age, so best to start a routine of screening in your 40’s at the latest.

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