Breast Cancer Screening

How I Practice Video Series
Sharon Mass, MD, FACOG


There are different options for technology to screen for breast cancer. Mammography remains the gold standard for screening for most women. However, for some women who are of high risk, there may be other screening modalities that are important to discuss. For example, if a woman has a greater than 20% lifetime risk of breast cancer, or a greater than 15% lifetime risk of breast cancer and extremely dense breasts, MRI or magnetic resonance imaging may be an option for her. MRI will detect more breast cancer than traditional mammography. However, it may do so at the risk of requiring more biopsies in more women that ultimately end up not being cancer. A new modality is that of digital breast tomosynthesis, also known as three dimensional mammography. Three dimensional mammography, instead of providing two images of the breast, provides multiple images thereby removing overlapping tissue images that may confuse the reading of the mammogram. Digital breast tomosynthesis can increase cancer detection while decreasing biopsies and recalls for that patient and thereby potentially decrease patient anxiety and cost about her screening for breast cancer. Finally, ultrasound is a modality that can be used both as diagnostic and screening manner. For a woman who has a finding on a mammogram, ultrasound is frequently used diagnostically to try to qualify the lesion that’s seen on mammogram, and to determine if it’s a cyst or a solid lesion that might require biopsy. Recently, many radiologists have advocated for whole breast screening ultrasound for women with dense breasts. The problem with that is that for every 1,000 women screened, 300 of them are going to require a biopsy. And very few of those are ultimately going to be shown to be cancer. Overall, mammogram is our gold standard, but it’s important to discuss with patients what screening modalities are right for that individual patient. This is how I practice.


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