Sponsored By Beth Israel Deaconess Medical Center

By Beth Israel Deaconess Medical Center Correspondent

A Q&A with Valerie Fein-Zachary, MD, and Michael D. Fishman, MD, Radiologists at the BreastCare Center.

What is the difference between breast cancer screening and diagnostic testing?

We screen healthy women without breast disease to look for signs of cancer. Women who come for breast cancer screening examinations do not have any symptoms.

However, if a woman has breast pain, a lump or mass, or nipple discharge, then she has a diagnostic work-up which typically includes a mammogram and ultrasound to assess the lump, mass or area of concern.

What are the most effective breast cancer screening tools?

Currently, the best way to screen for breast cancer for average risk women is mammography.

The latest technology update to two-dimensional (2D) digital mammography is called digital tomosynthesis. This new technology acquires a series of three-dimensional (3D) images that allows radiologists to evaluate breast tissue layer-by-layer.

This may be particularly helpful for patients with dense breast tissue that overlaps on 2D images. We know from recent research that 2D plus 3D finds slightly more cancers than 2D alone.

However, there is more radiation exposure with the addition of the 3D study. Patients and their healthcare providers should weigh the benefit of slightly increased cancer detection and the risk of slightly more radiation exposure to decide whether to be screened with both 2D and 3D mammography or with 2D mammography alone.

If a woman is high risk, then the best screening tools are mammography and breast MRI. Some women with dense breast tissue opt for screening with ultrasound in addition to a mammogram if their risk is not sufficiently high enough to warrant a breast MRI.

Why do screening recommendations differ among various professional organizations and to which should I adhere?

Each recommending society or organization has different criteria for screening that can usually be traced to their core mission statements. Hence, we have variations in screening recommendations.

We see every patient as an individual and base our recommendations on her/his particular needs. We know that about 21% (64,000 people) of breast cancers occur in women between the ages of 40 and 49, and some of these cancers would be missed without screening mammography. Most women who have breast cancer do not have a family history of the disease.

Therefore, family history is not reliable when determining the age at which screening should begin. In terms of frequency, yearly screening allows us to find faster-growing cancers in a timely manner, allowing us to make the diagnosis at an earlier stage than if screening was conducted every two years. With older patients, we look at life expectancy rather than age. Patients with life expectancies of greater than five years continue to benefit from screening, regardless of their age.

In the end, of course, it’s up to each woman to decide, with the help of her healthcare provider, what is best for her and her own peace of mind.

Are clinical breast exams and breast self-exams effective screening tools? Are they still recommended?

Yes, they are still recommended. Some patients come to us because they found a lump during a self-exam or clinical exam. Therefore, we encourage women with breast symptoms or findings on self-exams to visit their doctors or nurses for further evaluation and possible imaging

Who is at higher risk of developing breast cancer? Are screening recommendations different for them?

Women at high risk for developing breast cancer include those with BRCA gene mutations and their untested first-degree relatives, women who received radiation therapy to the chest between the ages of 10 and 30, and women with other genetic syndromes that increase the risk of breast cancer.

Mammographic screening should begin at an earlier age for these women. Screening MRI is also recommended. MRI screening may be recommended for women with a personal history of breast cancer or other risk factors, as well. Screening breast ultrasound may be recommended for women with dense breast tissue or as an alternative for women who cannot have an MRI.

What are the benefits and risks of breast cancer screening?

The primary benefit of breast cancer screening with mammography is that it saves lives through early detection.

The risks of breast cancer screening include false-positive (inconclusive) mammograms and radiation exposure. For every 1,000 women who have a screening mammogram, 100 are recalled for more mammography or ultrasound images, 20 are referred for needle biopsies and 5 or 6 are diagnosed with breast cancer. Being recalled and having a biopsy may result in short-term anxiety.

While mammograms expose women to a small amount of radiation, the benefit of lives saved by early breast cancer detection outweighs the minimal risk from radiation.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2016