Breast cancer screening

September 29, 2011 By Alison L. Chetlen, Pennsylvania State University

It can be difficult to sort through the many messages regarding breast cancer screening. Fancy billboards seen along the highways, recommendations made by your neighbor or the local newscaster, or mixed messages throughout the internet can cause confusion. What is the best way to screen for breast cancer?

The easy answer is that is the only imaging method that has been proven to decrease mortality from breast cancer. Three decades of research show that mammography saves lives.

Although there have been some controversial studies on what age to begin , the largest breast cancer screening trial ever performed involved a million women over 16 years and proved that screening mammography reduced breast cancer deaths in women ages 40 to 49 by 29 percent. A more recent Swedish study demonstrated a statistically significant reduction in breast cancer death rate by 30 percent of screening women ages 40 to 74 after these 130,000 women were followed for 29 years. Just recently, the American College of stated its position in support of screening women beginning at age 40, which now corresponds with the positions of the , American College of Radiology, Society of , American Society of and many other major medical associations with demonstrated expertise in breast cancer care. Hence, women should begin getting annual mammograms at age 40.

Recent research has examined the use of whole and MRI exams for breast cancer screening in addition to mammography. Breast ultrasound is used frequently to further evaluate a suspicious area seen on mammography, but it is not widely accepted as a screening tool. For women of sufficiently high risk for the development of breast cancer, the American Cancer Society recommends annual mammography plus MRI screening. Screening with mammography plus MRI has consistently outperformed mammography plus whole breast ultrasound for very high risk women.

Tomosynthesis is a 3-D screening method recently approved by the Food and Drug Administration (FDA) for use along with digital mammography, but not as a replacement. Multiple images of the breast are acquired at different angles during a sweep of the X-ray tube, allowing radiologists to see around overlapping structures.

Additionally, there are newer FDA-approved methods such as molecular breast imaging and positron emission tomography, which are physiologic studies to assist in detection or diagnosis of breast cancer.

Molecular breast imaging, also called breast-specific gamma imaging, is a nuclear medicine procedure where radiopharmaceutical agents are injected intravenously and concentrate in the breast. A high-resolution, breast-specific camera measures the amount of the activity that gets localized in the breast. A focal area with more radioactivity indicates higher metabolic activity and may correspond to a cancer. This method is sometimes use to evaluate patients when breast MRI is indicated but not possible.

Positron emission mammography (PEM) has been used to image larger tumors, but has generally been less successful at identifying the small tumors that are the subject of screening efforts. PEM involves the use of a pair of dedicated gamma radiation detectors placed above and below the breast and mild breast compression to detect coincident gamma rays after administration of a positron-emitting radionuclide. Refinements in technology are still under way to improve the value of these methods. Most importantly, these newer technologies cannot replace mammography and do not ultimately replace biopsy for tissue diagnosis.

Finally, another method women may hear about is thermography. Thermography produces an image of the breast showing the pattern of temperatures at or near the skin surface. On June 2, 2011, the FDA issued a safety communication warning women and health care providers that thermography is not a safe alternative to mammography. The warning was issued in response to inappropriate claims by thermography facilities and websites promoting thermography as a replacement for mammography. The American Cancer Society, National Cancer Institute, and Society of Breast Imaging all have stated that no study has ever shown that thermography is an effective for finding breast cancer early and that thermography should not be used as a substitute for mammograms.

“Something old, something new” captures the essence of screening. Although there are new and exciting methods being developed and refined, ‘good old’ mammography remains the standard of care for .

Explore further: ACR, SBI support updated ACOG recommendations that women begin annual mammograms at age 40

Related Stories

ACR, SBI support updated ACOG recommendations that women begin annual mammograms at age 40

July 20, 2011
The American College of Radiology (ACR) and Society of Breast Imaging applaud and support updated American College of Obstetricians and Gynecologists' (ACOG) recommendations that women begin getting annual mammograms at age ...

Recommended for you

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

Presurgical targeted therapy delays relapse of high-risk stage 3 melanoma

January 17, 2018
A pair of targeted therapies given before and after surgery for melanoma produced at least a six-fold increase in time to progression compared to standard-of-care surgery for patients with stage 3 disease, researchers at ...

Dulling cancer therapy's double-edged sword

January 17, 2018
Researchers have discovered that killing cancer cells can actually have the unintended effect of fueling the proliferation of residual, living cancer cells, ultimately leading to aggressive tumor progression.

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

More evidence of link between severe gum disease and cancer risk

January 16, 2018
Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by epidemiologists ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.