Smilow Cancer Hospital Screening Summit 2016: Breast
Liane Philpotts, MD
Professor of Radiology and Biomedical Imaging; Chief, Breast Imaging
Breast Cancer Screening
Who should be screened for Breast Cancer?
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, you should discuss the screening schedule that is best for you with your health care provider.
Who is at increased risk of breast cancer?
Some women are considered to be at increased risk of breast cancer due to strong family history, known genetic mutations that are associated with breast cancer, and/or received chest radiation for other cancer or conditions between the ages of 10 and 30.
Are you at average risk for breast cancer? If so, we recommend:
• Start mammography screening no younger than age 40 and no later than age 50
• Continue with mammography screening until at least until age 74
• Get a mammogram at least once every 2 years and as often as once a year
Are you at increased risk for breast cancer?
• Talk to your doctor about your level of risk
• Discuss when to start and stop screening
• Discuss whether you should receive a mammogram every year or every two years
• Discuss whether you would benefit from other types of tests, such as an MRI or supplemental ultrasound testing due to dense breast tissue (see below for more information)
This discussion should address your personal preferences, the benefits and harms of screening, your overall health, as well as your age. Ask Questions!
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- even if you have had a mammogram or are due for one soon.
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, Park Avenue Medical Center in Trumbull and at the Shoreline Medical Center in Guilford as well as through our mobile mammography service.
• Mammogram or 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.
• Tomosynthesis
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. This test does not change the patient’s experience; it feels the same as a regular mammogram. Tomosynthesis involves only a small increase in the radiation dose compared with standard 2D 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.
• Breast Ultrasound
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:
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, you should discuss the screening schedule that is best for you with your health care provider.
Who is at increased risk of breast cancer?
Some women are considered to be at increased risk of breast cancer due to strong family history, known genetic mutations that are associated with breast cancer, and/or received chest radiation for other cancer or conditions between the ages of 10 and 30.
Are you at average risk for breast cancer? If so, we recommend:
• Start mammography screening no younger than age 40 and no later than age 50
• Continue with mammography screening until at least until age 74
• Get a mammogram at least once every 2 years and as often as once a year
Are you at increased risk for breast cancer?
• Talk to your doctor about your level of risk
• Discuss when to start and stop screening
• Discuss whether you should receive a mammogram every year or every two years
• Discuss whether you would benefit from other types of tests, such as an MRI or supplemental ultrasound testing due to dense breast tissue (see below for more information)
This discussion should address your personal preferences, the benefits and harms of screening, your overall health, as well as your age. Ask Questions!
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- even if you have had a mammogram or are due for one soon.
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, Park Avenue Medical Center in Trumbull and at the Shoreline Medical Center in Guilford as well as through our mobile mammography service.
• Mammogram or 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.
• Tomosynthesis
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. This test does not change the patient’s experience; it feels the same as a regular mammogram. Tomosynthesis involves only a small increase in the radiation dose compared with standard 2D 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.
• Breast Ultrasound
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.
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.
Contact Us
For more information, or to schedule an appointment, please call (203) 200-3030 or email screening@ynhh.org
Are you Dense? Breast Health video in Spanish
This video in Spanish with English Captions features Latina Leaders, a breast cancer survivor and a physician talk Breast Health and the impact of Dense Breast Tissue on missed, delayed and advanced-stage breast cancer.