Which test will you do when it’s time to get your next mammogram to get your best mammogram: 2-D, 3-D, Computer Aided, Digital, Blend of 2-D and 3-D, MBI test? That’s not even discussing a breast ultrasound! For the most part your radiologist, based on the diagnosis codes your physician has assigned you will end up selecting the right test for you.
Much of the discussion has been around the 3-D mammogram and the newest study of this test. That suggests a single view of the tomosynthesis (the 3-D) may be better than the standard digital exam we have been using up to now.
Women who have small and not dense breasts have the best chances of getting a good mammogram. Women with larger and denser breasts will have over lapping tissue in their exams and may get overlapping tissue that could obscure areas of the breast from view.
fFor all women getting mammograms screening, the exact test and when to have a mammogram test should be discussed with your personal gyno. Shared decision making in the setting of cancer screening isn’t a new idea. Several countries, such as France, Switzerland, and the United Kingdom have moved mammography screening programs in that direction. And in some countries they begin later and stop sooner based on individual risk and comfort level with the exams.
Mammograms are designed to pick up changes in the anatomy, they don’t measure hormones, or the exact physiology of the breast, thus they cannot uncover every aspect of your breast health! However, when trying to be proactive before your visit here are a few facts to make that discussion cover what you need to discuss when wondering what mammogram test is best: Make a plan for breast exams, breast health maximization, and which screening tests to have should be worked out by you and your gyno.
Your current hormone status, whether you are after pregnancy, with certain medication use, with any reconstructive surgery, in light of your history, and as you age, your gyno needs to help you as an individual plan which tests to have. The goal is to be accurate, to find cancers when they are small enough for cure if treated, and lastly, an equally important goal, is to reduce the number of women who have to get called back for a repeat test.
Here are a few of the reasons currently we suggest you may want to get more advanced either DBT or 3-D Mammogram, or other versions!
- Those at Highest risk for Breast Cancer
- Those with Dense Breasts
- Those with Prior Abnormal Ultrasound
- Those with Prior Abnormal Mammogram
- Those with a Breast Lump
- Those with Very Cystic Breasts
- Those with Strong Family History
- Those with Breast Skin Changes
- Those who have had Early Menarche and Late Menopause
- Higher Body Mass Index (Obesity)
- Older Age at First Pregnancy
- Increased Alcohol Consumpiton
- Those who Did Not Breastfeed
Already there are changes in what tests are being done. Now the recommendation may be modified to a ‘Digital breast tomosynthesis” or “DBT” which uses some 2D slices and lets technology generate the 3D images so that a woman is exposed to less radiation.
The American College of Obstetricians and Gynecologists (ACOG) states in their position paper on tomosynthesis that “clinical data suggest that digital mammography with tomosynthesis produces a better image, improved accuracy, and lower recall rates compared with digital mammography alone.” Breast Tomosynthesis can improve screening women with dense breast tissue and high risk for breast cancer, although there are currently no specific guidelines regarding exactly when to order one instead of getting a standard digital mammogram. Your health care providers at Women’s Health Practice may suggest one for you, or the results of your mammogram may indicate that one should be done. It is more radiation than a standard mammogram, about twice the standard dose or slightly more, and there are no current recommendations as to how often you should have Breast Tomosynthesis verses a standard mammogram. If you have had one, there are are no current universal guidelines on frequency of use.
Breast MRI can also be used as a primary test for breast cancer screening and it is also a three dimensional view whereas mammograms are a 2D view. It can help further identify abnormalities found on either a standard or a 3D mammogram. Studies that use MRI for breast cancer screening indicate greater rates of breast cancer detection, but there are more “false positives” than mammography for detection of breast cancer in high-risk women. A false positive is an abnormal test when in reality there is no abnormality of the breast tissue. ACOG and the American Cancer Society specifically “recommends annual screening using MRI in addition to mammography beginning at age 30 years for women at high risk of breast cancer (greater than 20–25% lifetime risk). High-risk status is based on the woman having a BRCA1 or BRCA2 mutation, a strong family history of breast cancer or ovarian cancer, or prior chest radiation therapy.” Both Breast Tomosynethsis and MRIs would take preauthorization to assure coverage by your individual insurance. At www.womenshealthpractice.com
There is another new option: using nuclear medicine and an injected dye to help find a tumor that might pick up that dye. This test is called “Molecular Breast Imaging” or MBI, which also is a bit of extra radiation. In one study done at Mayo by Dr. Deborah Rhodes, of women with dense breasts, adding in this study moved from finding 1.9 cancers per 1000 women to finding 8.8 cancers per 1000 women!
At www.womenshealthpractice.com we offer yearly breast exams, can help you pick the right test at the right time, and discuss whether genetic screening or other therapies might be right for you.