Death rates from breast cancer have been on the decline since 1989, thanks in large part to better detection. So, when the American Cancer Society updated its screening guidelines for the disease in October 2015, many women -- and even some health care providers -- were surprised.
The new recommendations state that women with an average risk should begin annual mammograms at age 45, rather than at 40, as once thought. They should keep getting them until they're 54, and then every other year after that. The ACS also dropped its support of clinical breast exams, where a doctor or nurse feels the breast for lumps.
Why would the ACS suggest that women get fewer mammograms, when we know that early detection is key? Shouldn’t we be more safe than sorry?
Actually, it’s not that simple. Before you choose any breast cancer screening method, be sure to weigh the benefits and drawbacks. For example, a mammogram will expose you to a small amount of radiation. What’s more, the results can be hard to read, and may even lead to inaccurate "false-positive" results and unnecessary biopsies.
“There is good sense in reminding people that mammograms aren’t perfect,” says Harold Burstein, MD, a medical oncologist at Dana-Farber Cancer Institute at Harvard Medical School. “It’s important for women and their primary care providers to talk about pros and cons.”
What do these updated guidelines mean for you? That based on your personal set of risk factors, your doctor can help you make the best decision about when to begin screening for breast cancer. She can also help you choose which screening methods are most ideal for you. The good news: Experts have more ways to diagnose the disease than ever before.
If your radiologist finds a strange mass on your mammogram, some of these tools can also help provide extra information -- before going ahead with a biopsy.
This is just like a standard mammogram, except it produces digital rather than film images. It’s become a popular alternative to standard mammography.
Like a picture you’d take on your digital camera, your doctor can manipulate, enhance, or make it larger so it’s easier to read. This option can give more accurate readings for women under age 50 or those with dense breasts. And they’re easier to store than film.
Also called a digital tomosynthesis, this test is a lot like a 2-D digital mammo. The breast is compressed for X-ray imaging. But it doesn’t just take pictures from top-to-bottom and side-to-side. It sweeps across the breast, taking multiple low-dose images from many different angles to create a 3-D picture.
“On a 2-D detector, overlapping tissue can give the appearance that there’s something there when there really isn’t, or, more ominously, hide a cancer that’s present,” says Mary Newell, MD, an associate professor of radiology at Emory University. “With a 3-D image, we can go through the tissue millimeter by millimeter.”
One study found that, when used along with a digital mammogram, a 3-D mammogram can increase the number of cancers found and decrease the number of false positives. The downside: It delivers a higher dose of radiation than a standard mammogram.
If your doctor says you have a high risk for breast cancer, she may suggest adding yearly MRI screening tests to your mammograms. Or, if your annual test shows something suspicious, this procedure can provide more information before you have a biopsy.
MRI uses radio waves to make detailed images of the breast. Typically, your doctor will inject a dye into your veins beforehand.
“MRIs offer a substantially higher amount of detail. However, that means you also have more of a chance to observe a false-positive finding. That’s why we don’t want to use them all the time, across the board,” says Keerthi Gogineni, MD, an assistant professor of medical oncology at Emory.
If a mammogram shows a mass that doesn’t look normal, this test can give your doctor a better picture of what’s happening. And if you feel a lump in your breast, but the X-ray doesn’t find anything, an ultrasound can help him know for sure whether you need a biopsy. If you do, this test can even help guide the biopsy needle with pinpoint precision.
“Ultrasound is like sonar of the breast,” Newell says. “If the sound waves pass through the mass, that indicates that it’s cystic, or benign, while if the waves bounce back, that indicates a solid tumor.”
In this test, which is also called a scintimammography, a radiologist injects you with a dye that attaches to cancer cells. Your doctor can watch this through a special camera positioned outside your breast.
“It works well in dense breasts, and it’s very sensitive, but we worry about the radiation dose, which is much greater than what you’d receive in a mammogram,” Newell says.
That’s why, right now, you’ll probably get these tests only if you’ve been diagnosed with breast cancer and take part in a clinical trial. It’ll give doctors a way to measure how well your treatment is working.