Tickled Pink?! Our Annual Updated Breast Cancer Screening Review

Are you confused by conflicting recommendations about breast cancer screening? Let’s sort them out.

Have an ANNUAL mammogram. Mammography is still the gold standard because it has been proven time and again to save lives. Only mammography reveals micro calcifications, which can be malignant, and other structural abnormalities. The U.S. Preventive Services Task Force recommends biennial mammograms for women ages 50 - 74. But that additional year could give a developing tumor more time to grow without treatment.

Ask what kind of mammography exam you are getting. When you go for your mammogram, ask your provider what kind of technology is being used for your exam. Many facilities use a combination of standard mammography equipment and Digital Breast Tomosynthesis (DBT), also known as 3D Mammography, and do not tell patients which one they are getting. DBT is now the preferred technology for breast cancer screening. It is an enhanced mammographic technology that acquires images at multiple angles. The images are then reconstructed, reducing or eliminating tissue overlap in areas of concern, particularly on dense tissue. Digital Breast Tomosynthesis has been found to decrease patient call backs by 30 percent.

Women’s Digital Imaging uses Low-Dose Digital Breast Tomosynthesis for all patients. This technology incorporates C-View imaging software that cuts both the radiation level of the exam and time in compression in half. We introduced Low-Dose DBT to Bergen County and it is still not widely available.

Consider supplemental screening if you have dense breasts. Advocates for educating physicians and patients about breast density have made great strides in getting the word about why women should be told if they have dense breast tissue. There are now 35 states with breast density notification laws that require mammogram providers to send letters to patients, either informing them of their results or telling them to contact their provider for results. I tell all my patients about their breast density category and make recommendations for supplemental imaging if needed.

Mammograms are 98% accurate in finding tumors on fatty tissue, which appears black on a mammogram. But 50% of cancers are missed on mammograms when there is a large amount of dense, white glandular and fibrous tissue. Cancers, which also appear white, are obscured. A mammogram on dense tissue is like a car with a blind spot - the cancer might be there, you just can’t see it. Studies have shown that having dense breast tissue is in itself a risk factor for developing breast cancer - up to 4-6 times the risk when compared to women with fatty tissue.

Supplemental screening is helpful in dense tissue because the images show tissue and tumors differently. Ultrasound, Magnetic Resource Imaging (MRI) and Molecular Breast Imaging (MBI) are excellent at finding cancers in dense tissue.

Since the introduction of Breast Density Notification Laws, many states, including New Jersey, now require health insurance providers to cover screening ultrasounds for women with dense breast tissue.

Know your family history. If you have a family history of cancer (including but not limited to breast, ovarian, pancreatic or colon) you may be a candidate for genetic testing. A simple saliva test will let you know if you have one of many genes implicated in cancer. We use MyRisk from Myriad Genetics, a 28 gene panel that evaluates genes associated with 8 cancer sites including breast, ovarian, pancreatic, prostate, endometrial, colon, gastric and melanoma. If you were tested for BRACA1 and BRACA2 and the results were negative, you may be eligible for the rest of the MyRisk panel.

Pink is great for ribbons, bracelets and tee-shirts, but knowledge is best for your health. Have an annual mammogram, know your breast density and family history, and get supplemental screening if recommended by your doctor.

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