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Beyond the mammogram: Finding breast cancer early

SUSAN BRANTON

By Susan Branton

Proper screening is important for detecting cancer early – when it is most likely to be curable. According to the American College of Radiology, mammography has helped reduce breast cancer deaths by nearly 40% since 1990.

Mammography is the most common type of breast exam used to detect breast disease in women. It is a quick, noninvasive x-ray that can find abnormal or changing breast tissue, and potentially detect cancer. Screening annual mammogram gives you the best chances of detecting cancer early. The American College of Radiology says that changes in breast tissue can be seen on a mammogram up to two years before a patient can feel them.

3D Mammography for Dense Breasts

A recent advancement in mammography is the use of Breast Tomosynthesis or 3D mammography. 3D mammography has helped improve the chances of finding breast cancer in women with dense breasts and in other high-risk patients. Breast density is divided into four categories from (1) entirely fat – very little density; (2) scattered fibroglandular densities – minimally dense; (3) heterogeneously or moderately dense; and (4) extremely dense. Women in the latter two categories are identified as having dense breasts. Nearly one-third of women have dense breast tissue, making traditional 2D mammography less accurate.

Advantages of 3D mammography for women with dense breast tissue include:

–Less need for recalls looking at “suspicious” areas

–Fewer false-positives

–Fewer invasive tests

–Potential for earlier detection and treatment of breast cancer

If my

mammogram is abnormal

Having a mammogram annually is essential because it detects changes in breast tissue, not just cancer. Your doctor is first and foremost looking for suspicious areas that have changed over the last year. But don’t fear an abnormal mammogram.

If your radiologist detects changes in your breast tissue, you will likely have further testing that could include:

–Additional mammography views. Getting called back after a screening mammography is common-it doesn’t always mean you have cancer. Sometimes the image isn’t clear, or you have a cyst that needs to be measured for follow-up. If you do not have previous mammograms for the doctor to compare an irregular tissue with, you are likely to be called back for additional views.

–Breast ultrasound. If your radiologist finds a suspicious spot or you have dense breast tissue, they may order an ultrasound of your breast. An ultrasound uses sound waves to exam breast tissue that make it easier to see abnormalities in dense breasts.

–Breast MRI. An MRI of your breast is typically used if you are at high-risk for breast cancer-strong family history of breast cancer or genetic mutation such as BRCA1 or BRCA2.

–Breast biopsy. Having a biopsy does not mean you will have cancer but is the best way to find out if you do have cancer. A biopsy removes a small piece of tissue that a pathologist can examine for cancer cells. The biopsy can typically be done in an imaging suite using a small needle to collect tissue sample. A small clip or marker will then be placed in the area so it can be found easily in future mammograms and if surgery is necessary.

Genetic

testing for breast

cancer

It is rare to carry a genetic mutation and testing positive is not a guarantee that you will develop breast or ovarian cancer. However, genetic mutations if present are an indicator that you are at risk.

If you have genetic testing and a mutation is found, doctors recommend regular mammograms and breast MRIs. Not having a mutation does not guarantee that you will not develop breast or ovarian cancer. In fact, these mutations are only responsible for ten percent of all breast cancer cases.

Most doctors recommend starting an annual mammogram at age 40, even if you have no family history. If you have had relatives that have had breast cancer at a young age or you have tested positive for a breast cancer related gene, talk to your doctor about starting your annual screening before the age of 40.

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Susan Branton, MD, FACS, is the medical director of the Kathryn Candor Lundy Breast Health Center at UPMC Susquehanna. A graduate of Temple University School of Medicine, she completed her residency at Abington Memorial Hospital and a fellowship at Mayo Clinic in Jacksonville, FL. UPMC Susquehanna offers mammography and breast health screenings at multiple locations. For more information, call the Breast Health Center at 570-326-8200 or visit UPMCSusquehanna.org/breast.

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