High tech tests that could save your life
Published: September 28, 2019
By: Sandra Gordon
A yearly mammogram is the gold standard for breast-cancer screening and detection. Mammography is the only test that has been scientifically proven to save lives. Still, it’s not infallible.
“In women with very dense breasts, mammography will miss cancer 58 percent of the time,” says breast-cancer radiologist Thomas Kolb.
Dense breasts contain more glands, ducts and connective tissue than fat. Breasts tend to be denser during a woman’s reproductive years; density makes it harder to detect suspicious lumps on a mammogram. That’s because glandular tissue appears white on a mammogram, just like a mass can.
Fortunately, these tools are available that can give you a clearer picture of your breast health — and could possibly save your life — especially if you have dense breasts or you’re at higher risk for breast cancer because of your personal or family health history.
The latest in breast-cancer detection technology, tomosynthesis, also known as 3D mammogram, is a digital mammogram that takes images of the breast from multiple angles. Tomosynthesis takes an arc of pictures through each breast, in 5 millimeter slices, which are then reconstructed into a three-dimensional image. It allows radiologists to see through the breast tissue. With tomosynthesis, they can more easily distinguish a true mass from overlapping structures that can hide or mimic cancer, such as ligaments or glandular tissue. Tomosynthesis can be used for screening and diagnostic mammograms.
PROS/CONS: Compared to a digital (2D) mammogram, tomosynthesis is more precise. Studies show that three more women per thousand will receive a cancer diagnosis with tomosynthesis, compared to a digital mammogram. Also, women with dense breasts who undergo tomosynthesis are 40 percent less likely to be called back for additional imaging.
Should you ask for it? Screening tomosynthesis is indicated if you have dense breasts or you’re at average or intermediate risk for breast cancer. To determine your lifetime breast cancer risk, visit BrightPink.org and take the risk-assessment quiz. Depending on your answers, you’ll end up in one of three categories: high risk, intermediate risk or average risk. High risk is defined as a lifetime risk of breast cancer of 20 percent or more; intermediate risk is a lifetime risk of breast cancer of 15 to 20 percent; and average risk is anything under 15 percent.
AUTOMATED BREAST ULTRASOUND
During this test, an automated ultrasound machine, which uses a computer program, takes ultrasound images of breast tissue. The images are recorded and given to a radiologist who can interpret them. Doctors currently use handheld ultrasound devices to hunt for breast tumors in some patients, and the labor-intensive process can skip some tumors. Automated breast ultrasound eliminates the need for an ultrasound technologist so there’s less risk of missing a lesion.
PROS/CONS: Automated breast ultrasound can help detect breast cancer. Breast cancer detection doubled from 23 to 46 in 6,425 screening studies using automated breast ultrasound with mammography, resulting in a significant cancer detection improvement. Some insurance providers don’t cover the test yet, so check your policy.
Should You Ask for It? Ask for automated breast ultrasound in addition to a screening mammogram if you have extremely dense breast tissue (in the 75-percent-or-greater range).
MAGNETIC RESONANCE IMAGING (MRI)
This tool employs magnetic and radio waves instead of X-rays to create high-definition, cross-sectional images of breast tissue. The patient is injected with safe, nonradioactive, contrasting salt solution in the arm, then lies face down on a table with both breasts positioned into cushioned coils that contain signal receivers. The entire bed is then sent through a tube-like magnet. In areas where there might be cancer, the contrasting agent pools and is illuminated on computer-generated images.
PROS/CONS: MRI has been shown to find 2 to 6 percent more cancers than mammogram alone. In 1,000 women, studies show MRI will find twice as many cancers compared to 3D mammogram alone.
Should You Ask for It? If you’re at high risk for breast cancer (in the 20-percent category or more), you automatically qualify for supplemental screening with MRI. Insurance carriers will cover the cost of this sensitive but expensive test. If you’re not at high risk but you have extremely dense breast, consider paying out-of-pocket for this test. Screening breast MRI costs $600 to $700.
“Even if you have as little as a 2-percent risk of breast cancer over the next five years, talk to your doctor about adding MRI,” says Wendie Berg, a breast imaging consultant. MRI breast-imaging centers are springing up across the country, but it’s important to seek out a facility that has MRI-guided biopsy capability, so a tissue sample can be retrieved for diagnosis at the time of your scan if a questionable mass is spotted.
Do You Have Dense Breasts?
Breast density depends in part on hormonal status, which is why premenopausal women are more likely to have dense breasts. Genetics also plays a part. If your mom had dense breasts, you’re more likely to have them. But only a mammogram can make that determination.
In Florida, and 34 other states, radiologists are required by law to tell you, in the letter you receive about your mammogram results, whether you have dense breasts. If your state doesn’t require that information, simply ask your doctor if your mammogram results indicate whether you have dense breasts. The letter won’t tell you the percent of breast density, which can be helpful for knowing which supplemental tests to push for, such as MRI. To find out the percentage of breast density, ask your doctor for a copy of the radiology report. You have a right to it.
When to Get a Mammogram
The American Cancer Society recommends that women at average risk between ages 40 and 44 have the option to start with a screening mammogram every year. Women 45 to 54 should get a mammogram yearly. Women 55 and older can switch to a mammogram every other year or choose to continue yearly mammography. If you’re at high or intermediate risk, your doctor may advise starting mammography before age 40.