Beyond the Mammogram
The sooner breast cancer is caught, the more likely it is that treatment will be a success. Now there are more ways than ever to help detect it early.
Breast cancer vigilance isn't just about scheduling a yearly exam. Ensuring that the mammogram results you receive are accurate, as well as being aware of the newest screening tools out there, could save your life. Take charge of your health with our overview of the latest breast tests.
How it works: A technician compresses each breast between two plates to flatten out the tissue before X-rays are taken. A radiologist then reads the images, looking for unusual shadows, lumps, and any differences between the two breasts.
Who it's best for: The American Cancer Society recommends annual mammograms for women age 40 and over. These breast X-rays detect about 85% of cancers. Earlier screening is generally advised for high-risk women, such as those who have a strong family history of breast cancer or mutated BRCA1 or BRCA2 genes. When these women should get screened is still up for debate, but those who have a first-degree relative (mother, sister, or daughter) with breast cancer are often advised to have their first mammogram 10 years earlier than the age the youngest relative was diagnosed—but not before age 25.
Know before you go: Ask your primary care doctor to refer you to a high-quality facility where you know your mammogram will be read by a doctor you trust. On screening day you may want to take an over-the-counter pain reliever before your X-ray to ease discomfort. And make sure you do not wear deodorant or use lotions or powders on the breasts or underarms, as these products can show up as calcifications.
How it works: This relatively new procedure is similar to a standard mammogram except the X-ray is captured as an electronic image and stored on a computer rather than film. Doctors can then enlarge suspicious areas to explore them more closely or e-mail results to another physician for a second opinion. Think of it as the difference between a digital camera and one that uses film, says D. David Dershaw, M.D., director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York City. "The picture is the same," he says. "But the way you store it is different."
Who it's best for: A study published last year found that digital mammograms were more accurate than standard ones for women who are under 50 and for those of all ages with dense breasts. (If you've had a mammogram before, ask your doctor for your breast-density measurement: Results range from "fatty" to "extremely dense.") However, many experts say they want more proof before they deem this technology superior. "Whether the mammogram is digital or film isn't so important," says Dr. Dershaw. "It's quality that's the issue."
Know before you go: Only about 1 in 10 breast-screening facilities currently use the digital technology, though it's becoming more common. If you can't find a clinic that offers this option in your area, you may need to visit a major breast center in a nearby city.
Computer-Aided Detection (CAD)
How it works: After you've had a digital mammogram or a standard one that has been scanned, this special computer software analyzes your X-ray. It highlights suspicious areas for a radiologist to re-review. "CAD is like a spell check," says Carol H. Lee, M.D., a professor of diagnostic radiology at Yale University School of Medicine. "It helps point out things a doctor might want to look at."
Who it's best for: Women who want reassurance that nothing was missed can request CAD. However, it flags many spots that turn out to be nothing, so it requires a skilled radiologist who can make an expert decision after reviewing the questioned areas.
Know before you go: Some research suggests that CAD may detect up to 20% more cancers when used in conjunction with mammography than mammograms alone, so ask your doctor for a facility that uses it. It's inexpensive and increasingly covered by insurance.
How it works: With an ultrasound, also called a sonogram, a technician applies gel to the breasts and then moves a probe over them, using sound waves to create an image of the inside of the breasts on a computer screen.
Who it's best for: An ultrasound may be used when a mammogram reveals a lump and the doctor wants to determine whether the mass is a fluid-filled cyst or a solid structure that could be cancerous. For women under age 30 a doctor may make an exception and recommend ultrasound before a mammogram to evaluate a palpable lump, because breast X-rays in young women can be difficult to interpret.
Know before you go: In most cases ultrasound can't replace mammography, because used alone it may miss the tiny calcifications of ductal carcinoma in situ, an early stage of breast cancer in which malignant cells are confined to milk ducts. "You can have a normal ultrasound but a mammogram that detects early cancer," says Therese Bevers, M.D., a breast cancer prevention specialist at M.D. Anderson Cancer Center in Houston. Ultrasounds are increasingly available, but insurance coverage is variable.
Magnetic Resonance Imaging (MRI)
How it works: You lie facedown on a scanning table with your breasts resting on coils that contain signal receivers, then the table slides inside a machine that uses magnetic fields to produce a detailed image of the breasts.
Who it's best for: Doctors generally don't recommend MRIs as a screening tool for average-risk women. But when combined with mammograms, they're useful for high-risk women, says Rola Saouaf, M.D., who oversees the breast MRI program at Cedars-Sinai Medical Center in Los Angeles. One study found that MRIs detected 80% of invasive cancers in those at elevated risk. This imaging technique also may be used on breast cancer patients to look for additional lesions, says Dr. Saouaf.
Know before you go: MRIs are considered more effective than ultrasounds, but they also can miss calcifications that mammograms find. They aren't available at all breast-imaging centers, they're expensive, and insurance may not cover them.
How Good Is Your Radiologist?
Your results are only as accurate as the expert who interprets them, so ask your primary care doctor for a referral to a top-notch professional at a high-quality facility. Generally speaking, the more X-rays a radiologist reads, the better. All are required to read at least 480 mammograms per year, says Carol H. Lee, M.D., chair of the American College of Radiology's Commission on Breast Imaging. However, your best bet is to go to a doctor who reads many mammograms a day. It's also a smart idea to check that the breast-screening center is certified by the U.S. Food and Drug Administration and compliant with the Mammography Quality Standards Act. Go to:
- Notify your doctor immediately if you find any suspicious lumps, redness, or nipple discharge during your monthly breast self-exam. The best time to examine yourself is a week after your period starts. Go to breastcancer.org and click on Breast Self Exam for a step-by-step demonstration.
- Make an appointment to have your mammogram about a week after your period is expected to end, when your breast tissue may be less dense. "It's also more comfortable then, because your breasts aren't as tender," says Dr. Bevers.
- Be sure your radiologist has access to previous mammograms for comparison. If you've had digital mammograms in the past, your doctor may be able to give you a compact disc with the images.
- "Get a second opinion if you find a lump or another breast irregularity and your physician dismisses it too quickly. "Pursue it until you're satisfied you're getting the right answer," says Dr. Dershaw.
- Schedule next year's mammogram when you're at the radiologist's office, since there's often a long wait.