Breast Screenings

By Tracy Wright

Breast cancer is the second most common cancer for women in the United States behind skin cancer and third killer of women to heart disease. Beginning in the 1980s, breast screenings became a prevalent part of women’s health as they age. The most common screenings are mammograms, ultrasounds and MRIs.

While breast cancer is most commonly associated with women, it is worth noting that men can also be at risk for breast cancer. Although the risk of men developing breast cancer is small, they carry a higher mortality rate than women mostly because men are less aware of the condition which can cause a delay in seeking treatment, according to the National Breast Cancer Foundation. Men who may feel a hard lump under the nipple and areola should visit their primary care provider to assess whether they need an appropriate screening.

When mammograms were on the rise in the 1970s, the recommendation by many medical outlets was for women over the age of 40 to get an annual breast exam. However, according to the American Cancer Society there are different stipulations depending on whether an individual is at an average risk for breast cancer or increased risk for breast cancer. An individual with no known family history or personal history of breast cancer is considered to be at average risk. An individual with a close family history (grandmothers or mother) of breast cancer is considered to have an increased risk. Today, there are some variations in guidelines for when regular mammograms should begin for women depending on their risk factors.

A common misconception is that screenings for breast cancer should begin at age 40, but this is contingent on the risk factors for each person. Screenings for individuals with an increased risk should begin 10 years earlier than when their family member was first diagnosed if they were diagnosed at a younger age, according to Dr. Julia Marshall, a board certified diagnostic radiologist at UF Health Women’s and Diagnostic Imaging-Springhill. “For women with genetic markers like the BRCA 1 or 2 mutation, we recommend regular clinical breast exams, but we caution that women begin screenings no earlier than 25 due to the exposure to radiation. Women can also visit a genetic counselor to determine if they want to be tested for the genetic marker.”

There are two types of traditional mammograms available to individuals that provide radiologist and doctors with front and side views of the breast. Screening mammograms are the first type of mammograms and according to the American Cancer Institute they use low-dose radiology for early detection. Screening mammograms have been shown to significantly reduce the number of women age 40 or older who develop and ultimately succumb to breast cancer. Diagnostic mammograms are the second type of mammograms and according to the American Cancer Institute they use higher doses of radiation for a more thorough image of the breast if something is found on the screening mammogram. For both mammograms, women place each breast on a plate while multiple X-ray images are taken for the radiologist and doctors to look at for any indications of cancer. Screening and diagnostic mammograms are the more traditional and conventional choices, but offices now offer a more modern approach to breast exams.

Modern technology has produced the 3D mammogram that takes an X-ray across the entire breast in an arc pattern and allows radiologists and doctors to see more of what may have been hidden on traditional mammograms. “3D mammogram technology is especially helpful for seeing through dense breasts,” Dr. Marshall said. “This type of mammogram is much clearer than a traditional one, but it is an extra charge if not covered by insurance.” If you are unsure of all three types of mammograms, you can choose an ultrasound screening.

Ultrasounds use sound waves that bounce back to create images of the breast. While ultrasounds are most often administered to individuals who have had irregularities found in their mammograms, ultrasounds may also be used for individuals under the age of 30 who find lumps in their breast(s) via self-exam or clinical breast exams.  Those looking to reduce their exposure to radiation may also choose an ultrasound over a mammogram. If mammograms and ultrasounds produce alarming results or are simply not an option for certain individuals, there is a third type of breast exam that can be utilized

A magnetic resonance imaging (MRI) exam uses radio waves and a powerful magnet connected to computer technology to create detailed pictures of each breast. Generally, an MRI is ordered under limited circumstance. If a woman has been diagnosed with breast cancer, an MRI provides intricate views of each breast for the doctors to be able to provide a better diagnosis.  Additionally, women with implants generally have to have an MRI since a mammogram offers limited views of a breast that has implants. However, mammograms are still recommended as they are less invasive and typically during a mammogram, the implants will be pushed back to try and get an accurate view of the breast, Marshall said. MRI exams may also be recommended over mammograms for younger women with the genetic marker as it does not expose the patient to a much radiation.

There are several reasons an MRI may not be recommended for women at average risk for breast cancer. “The MRI exam is more invasive, and many people do not like confined spaces, which could cause them great anxiety,” Marshall said. “However, with women at an elevated risk for breast cancer or women with implants, an MRI could prove to be very helpful with providing more accurate imaging.” Aside from mammograms, ultrasounds and MRIs, women should be doing self-exams at home, but not as often as thought.

Monthly self-exams are no longer recommended due to the anxiety a patient can experience, unnecessary medical bills from following-up with doctors and exposure to radiation. Experts advise women to know the view and texture of their breasts and alert their health care provider of any noticeable changes.

If an individual is unsure of when to begin screenings and how often they should be getting screenings, Marshall recommends women talk to their health provider and discuss their personal history, family history or general health concerns to go over their options and the various screenings available today.