While many women are aware that they should get routine mammograms, they may not be aware of the full range of tests that can screen and diagnose potential breast cancer. Currently, mammograms offer the best means for initial screening, but often traditional mammogram test results can be inconclusive. For example, women with “dense breasts” have a higher proportion of glandular breast tissue that makes identifying cancer difficult through a traditional mammogram. Since women with dense breasts are at a four to six times higher risk for developing breast cancer, accurate scans are important.1 Odds are high that a woman’s first mammogram will have inconclusive results, as according to the Mayo Clinic, nearly half of women younger than age 50 have dense breasts. Though dense breast tissue is a leading reason women seek alternative screening methods, other factors may also encourage women to find an additional test. Women at high risk for developing breast cancer, women looking for more precise results, or women concerned about a portion of the mammogram process, such as radiation exposure, may seek alternatives. The following are tests types that women can discuss as options with their primary health care providers.
Digital mammography is a common alternative screening that produces digital images of the breast to better focus on the questionable areas. It is preferred over traditional mammography for those who are younger than 50, who have dense breasts, or who are still menstruating. Benefits include the ability to manipulate the image to achieve a more conclusive view and a lesser dose of radiation during the screening process; approximately three-fourths the amount of a traditional mammogram. Digital mammography is still more expensive and not as widely available as traditional mammography.2
Ultrasounds, which use sound waves to create an image, are also commonly used with dense breasts, to guide a needle biopsy, or to check the lymph nodes under the arm. It is widely available, non-invasive, and less costly, but also less precise than the MRI. It is not used alone as it can miss cancers that are more visible on mammograms, and it can result in false positives, leading to increased needle biopsies.3
The MRI, magnetic resonance imaging, may be used for women already diagnosed, to measure or discover other tumors, or it may be used to screen high-risk women. Medical insurance companies often require proof of high risk to approve an MRI screening.4The procedure uses magnets and radio waves to provide a detailed view of an area as a result of contrast material that is injected into the body. An MRI is not for people with pacemakers, other ferromagnetic implants, claustrophobia, poor renal function, or gadolinium allergies.5 This test detects more cancers than mammograms or ultrasound, but is also approximately five times the cost of a traditional mammogram.6
Molecular Breast Imaging, the newcomer, uses a higher dose of radiation to light up areas likely to be cancerous, and therefore it is best used for pre-surgery planning, lymph node assessment, and monitoring chemo responses and breast cancer recurrence.7 MBI surpasses the mammogram in detecting invasive ductal carcinoma, ductal carcinoma in situ, and invasive lobular carcinoma.8 It provides a better image than a mammogram and has numerous benefits. MBIs are more effective for dense breasts and identify three times as many cancers than the traditional mammogram.
It also applies only one-third of the breast compression of mammograms, but does have a 25 times higher dose of radiation than the mammogram.9 With dual head systems, the detection rate with MBI is higher than an MRI.10 MBI’s radioactive tracer lights up the areas scanned, and the breast cancer cells absorb this material and present on the special cameras. Molecular Breast Imaging includes both breast-specific gamma imaging (BSGI) and positron emission mammograms (PEM) and examines molecular activity, as opposed to anatomy, like the mammogram, ultrasound, and MRI. Requiring fewer images than an MRI, the interpretation of an MBI is faster, and has fewer false positives than an MRI. Moreover, a PEM can be followed by a whole body PET using the same injection to search the body more broadly for other cancer pockets.
Overall, new developments in breast cancer screening continue to present better options to patients across their lifespan. Ultimately the best way to decide upon the exam that’s right for you is to engage in an informed discussion about your health with a primary care provider. Since many people’s unique health circumstances will prohibit them from fully utilizing certain methods, establishing safe and effective alternatives is critical to care and will help set the standards of tomorrow.