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Breast Cancer Detection: The Best Test

by Dr. Virginia Herrmann

What is the best method of breast cancer detection?

There are a number of good tests available to detect breast cancer, each with particular indications, advantages and disadvantages. A monthly breast self exam is the easiest and least expensive method of breast cancer detection. While recommended for all adult women, a breast self-exam is not as sensitive in detecting breast cancer as breast imaging.

What about mammograms?

Good quality mammography remains the most effective method of breast cancer screening in this country. Regular screening mammograms reduce the death rate from breast cancer among women who are 40 and older. Recently, there has been a decline in women having annual screening mammograms, particularly women with lower incomes, less education and no insurance. Screening mammography is recommended every year for women over 40. If a woman has a sister or mother who developed breast cancer before menopause, screening mammography is recommended 10 years earlier than the age the relative developed breast cancer. For example, a woman whose mother developed breast cancer at age 35 should begin screening mammography at 25.

Digital mammography offers several advantages over standard mammography. With digital technology, the image of the breast is seen on a computer monitor and the radiologist can enlarge or zoom-in on a particular area of concern. The Digital Mammographic Imaging Screening Trial was designed to compare standard film and digital mammography. While the overall accuracy was similar for both methods, digital mammograms were more accurate in women under 50, women with very dense breasts, and women 50 or younger. The improved accuracy and the ability to zoom-in on areas of concern reduces the number of follow-up procedures needed. Images or pictures of the breast can be stored more easily on a computer, and uses a slightly lower dose of radiation than standard film mammography.

Ultrasound of the breast is an excellent tool using high-frequency sound waves that bounce off the tissue and produce an image, or sonogram. Breast ultrasound allows us to evaluate areas of concern seen on a mammogram, and is very helpful to visualize a lump or density in the breast that the patient or physician can feel but is not seen on the mammogram. Ultrasound is not used as a regular screening tool in most women, and is not a substitute for regular screening mammograms.

Magnetic resonance imaging (MRI) scanning uses a magnet linked to a computer to create sophisticated images of the breast. Breast MRI is not recommended for routine breast cancer screening. However, MRI is particularly useful for screening young women who are at very high risk of developing breast cancer, and to evaluate breast implants for leaks or ruptures. MRI is used selectively in women who have a lump or density that is not seen on mammogram or ultrasound. In women with breast cancer, MRI may be used to help determine the extent of the disease. MRI scanning is very sensitive, but may have difficulty distinguishing benign from cancerous problems. MRI is a very useful tool, but is not a substitute for regular screening mammograms.

What’s new?

Digital tomosynthesis creates a three dimensional picture of the breast using X-rays. Multiple pictures of the breast are taken from many angles, with minimal pressure applied to the breast. A computerized 3-D image of the breast is then created. Tomosynthesis is especially useful in women with very dense breasts, and is more comfortable than standard mammography. This newer method of breast cancer detection is being studied extensively at major breast centers. While not yet approved by the FDA for general use, it is likely we will see more of breast tomosynthesis in the future.

Reprinted with permission from Bluffton Today


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