Mammograms can detect up to 90% of breast cancers. However, some patients may need additional screening depending on their medical and family history.
The American College of Radiology currently recommends annual mammograms beginning at age 40. Those with a strong family history of breast or ovarian cancer, or those with a history of Hodgkin’s lymphoma, are advised to begin annual screening between ages 25 and 30. Those with dense breast tissue should also consider adding ultrasound screening in addition to their mammogram.
What is a mammogram?
Radiologist Reni Butler, MD, Associate Professor of Radiology & Biomedical Imaging at Yale School of Medicine, says mammography is the “gold standard” for breast cancer screening. During this exam, the breast is compressed before a technologist takes two pictures of each breast.
What’s the difference between a 2D and 3D mammogram?
“A 2D mammogram is a conventional 2-dimensional picture. A 3D mammogram also has a 2-dimensional picture within it, but it has the capacity to be transformed with the click of a mouse into a stack of 1mm slices through the breast,” said Dr. Butler. “The radiologist first examines the 2-dimensional picture and then reviews each of the 1mm slices through the entire thickness of the breast. This allows the radiologist to see even more fine detail and detect small cancers that may not be seen on the 2D mammogram.”
Dr. Butler says a 3D mammogram is a better mammogram because it not only improves cancer detection, but it reduces false alarms. Patients screened with 3D mammograms had fewer advanced cancers, increasing options for less invasive treatment. At Yale New Haven Health, 3D mammograms are offered to all patients.
What is a breast ultrasound?
An ultrasound is a tool used in addition to mammograms that can be helpful for patients with dense breasts, which impacts how tissue appears on a mammogram.
“The analogy I like to use is that when a radiologist is reading a mammogram for a patient with dense breasts, it is like looking for a polar bear in a snowstorm. We would be trying to see something white against a white background. As you can imagine, this makes it difficult or impossible to see some tumors, especially small tumors. Ultrasound on the other hand is not limited by dense breast tissue and increases the detection of small, early cancers in women with dense breasts,” said Dr. Butler.
Dense breast tissue is not related to how tissue feels during a clinical exam. Therefore, only an initial mammogram can determine whether a patient has dense breasts and needs an ultrasound.
What is a breast MRI?
A breast MRI, when used in combination with a mammogram, is appropriate for those with known genetic mutations resulting in an increased risk for breast cancer, such as BRCA 1 or BRCA 2 mutations. It is also appropriate for those with a strong family history of breast or ovarian cancer diagnosed in multiple first-degree relatives at a young age or those with a history of Hodgkin’s lymphoma.
A breast MRI is a little bit more involved than a typical mammography appointment. The patient comes to the breast imaging center and an IV is placed. Then the patient is positioned on the stomach and the breast falls into a device for imaging. The patient receives a contrast injection through their IV during the exam. The entire exam takes between 30 and 40 minutes.
Misconceptions about breast cancer screenings
While mammography is a crucial screening tool, it cannot detect all cancers.
“Mammography is not 100% sensitive for all cancers. There are some cancers that, just because of the way they grow, do not form an abnormality that’s perceivable on a mammogram or ultrasound. They are thankfully the minority of cancers, but it is important to have that third component of clinical evaluation in addition to imaging for annual screening,” said Dr. Butler.
If patients feel a lump or any other abnormality in the breast, it’s important for them to follow up with their primary care provider. If there are suspicious findings, they may need a consultation with a breast surgeon, even if their mammogram or ultrasound appear normal.
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