As you may have heard, the American Cancer Society recently changed their recommendations for breast cancer screening
. However, many other medical organizations, such as the American College of Radiology, the Society of Breast Imaging, and the American College of Obstetrics and Gynecologists continue to recommend annual screening mammography starting at age 40. Because the risks and benefits of cancer screening depend on a number of individual factors such as your age, medical history, race and/or ethnicity, family history, and breast density, doctors at Smilow continue to recommend annual screening mammograms beginning at age 40 for most average risk women. However, you should discuss the screening schedule that is best for you with your health care provider.
Women who are at an increased risk for breast cancer due to strong family history or certain other risk factors should discuss the option of screening MRI with their physician. These women should also continue with annual mammograms. For more information, see below: Who should have an MRI?
It is generally recommended that all women be familiar with the normal look and feel of their breasts and report any changes to their doctor or health care provider right away.
What tests are available through the Smilow Screening and Prevention Program?
Mammograms and other breast imaging tests are available at Smilow Cancer Hospital. However, you can also get these tests at the Long Wharf facility at Sargent Drive in New Haven, at Devine Street in North Haven, and at the Shoreline Medical Center in Guilford as well as through our mobile mammography
A mammogram is an x-ray examination of your breasts to check for breast cancer. Sometimes a woman has a diagnostic mammogram because she has a problem with her breasts and she needs to be checked. However, most mammograms are part of a routine check–up in order to make sure that no cancer is present; this is called a screening mammogram.
At Smilow, we use tomosynthesis, or 3D mammography. Tomosynthesis allows the radiologist to view the breast in thin "slices" rather than as a whole and improves the detection of lesions and reduces false alarms due to overlapping normal tissues. The 3D imaging is performed simultaneously with the 2D mammogram so the length of the exam does not change. This new test does not change the patient’s experience; it feels the same as a regular mammogram. While tomosynthesis may involve a small increase in the radiation dose, the total radiation dose remains below the federal standards for mammography. Tomosynthesis improves not only the outcomes of screening, but also the accuracy of diagnostic radiology and biopsy recommendations. Tomosynthesis is available at all locations except the mobile mammography service.
Sometimes it is necessary to supplement the mammography findings with a breast ultrasound on one or both breasts. This is especially helpful in the case of dense breasts.* Connecticut law requires that all women receive information about their breast density in their mammography results. Women who have dense breasts (labeled as heterogeneously or extremely dense) may be offered a breast ultrasound in addition to their mammogram. Under Connecticut law, insurance companies must pay for this test.
What is breast density? *
Breast density describes the pattern of breast tissue that is seen on a mammogram. It is NOT something that can be felt through touch. Although dense breasts are common, particularly in women before menopause, having heterogeneously or extremely dense breasts makes it more difficult to read a mammogram and may increase a woman’s risk of breast cancer.
- MRI (Magnetic Resonance Imaging)
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. MRI does not use any x-rays so has no radiation dose. Breast MRI does require the use of a contrast agent through an intravenous line placed in the arm prior to the exam.
Who should have an MRI?
For women at higher than average risk
Women who are at an increased risk for breast cancer due to strong family history or certain other risk factors should discuss the option of screening MRI with their physician. These women should also continue with annual mammograms.
This includes women who:
- Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history
- Have a known BRCA1 or BRCA2 gene mutation
- Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation and have not had genetic testing themselves
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
For women at moderately increased risk
There’s not enough evidence to make a recommendation for or against yearly MRI screening for women who have a moderately increased risk of breast cancer (a lifetime risk of 15% to 20% according to risk assessment tools that are based mainly on family history) or who may be at increased risk of breast cancer based on certain factors, such as:
- Having a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
- Having dense breasts (“extremely” or “heterogeneously” dense) as seen on a mammogram
If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is a more sensitive test (it’s more likely to detect cancer than a mammogram), it may still miss some cancers that a mammogram would detect.
For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. But because the evidence is limited about the best age at which to start screening, this decision should be based on shared decision-making between patients and their health care providers, taking into account personal circumstances and preferences.