Breast Cancer Screening Decoded: What Every Woman Should Know

Gone are the days when breast cancer screening meant one thing: a mammogram. Today, women are bombarded with messages on social media encouraging them to choose an alternative, such as breast ultrasound, MRI or contrast-enhanced mammography (CEM). If you’re struggling to navigate the options, Baptist Health Cancer Care experts can provide clarity. 

“It’s completely understandable that women are confused about screening mammograms,” says diagnostic radiologist Juliette The, M.D., with the Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health. “It’s not as clear-cut as it once was.” 

There is a best option for every woman, she says, and it may not be the same for you as it is for your best friend or even your sister. “It’s really important to have a conversation with a professional, whether that’s your primary care doctor, your OB/GYN or a breast specialist to determine the best screening for you,” Dr. The says. 

Generally, however, most women begin screening with a mammogram. “The reason is that scientific evidence shows us that 3D mammography, or digital breast tomosynthesis, is still the gold standard for screening,” she explains. 

3D Mammography

Guidelines from the American College of Radiology and the American Society of Breast Surgeons recommend that women at average risk for breast cancer start screening at age 40 and continue annually. 

“Our other supplemental tools have not undergone the rigorous testing and meta-analysis that mammography has. Mammograms have been shown to decrease breast cancer mortality,” Dr. The says.  

But how do you know where your risk for breast cancer falls? Women at higher risk may have one or more of the following: 

• A family history of breast or ovarian cancer, particularly a first-degree relative with a diagnosis at age 45 or younger. 

• A known genetic mutation that predisposes them to breast cancer (those include mutations in the BRCA1, BRCA2, ATM, BARD1, CHEK2, RAD51C, RAD51D, PALB2, CDH1 and TP53 genes). 

• Dense breasts, which make it harder to detect cancer (more common in younger women). 

• A previous breast cancer or lymphoma diagnosis and/or radiation to the chest wall. 

• Older age. Although the incidence of breast cancer has been rising in younger women, most cases are still discovered in women aged 50 and above. So, as we age, our likelihood of breast cancer goes up. 

At Baptist Health, 3D mammography is enhanced with assistance from artificial intelligence (AI). Because breast radiologists can review thousands of images in a day, they use AI to flag subtle abnormalities that might otherwise escape even the most experienced or fatigued eyes. AI doesn’t take the place of the physician but brings awareness to areas that may need more investigation by the doctor. 

Breast Ultrasound

Breast ultrasounds use sound waves to create images of breast tissue and are often recommended as a supplemental screening tool, particularly for women with dense breasts. Like many additional screening tools, it does not replace mammography but is typically used in conjunction with mammography, Dr. The says.  

Some women at risk will be advised to alternate between a mammogram and an ultrasound every six months. Others may have the two tests on the same day. 

If you’re uncertain if you have dense breasts, the first place to check is your last mammogram report, if you’ve had the test done before. Most centers indicate breast density in the notes. That can be a starting point for a conversation with your doctor about the best screening for you. 

“Ultrasound can pick up certain types of cancers that aren’t seen as easily on a mammogram, and has been shown to find cancers earlier, which is important because if cancer is found when it is smaller, you have the potential of decreasing mortality, improving quality of life and avoiding more complex treatment,” Dr. The says. 

Breast Magnetic Resonance Imaging (MRI)

Breast magnetic resonance imaging (MRI) is used for many reasons but in the case of screenings it is usually reserved for the highest-risk women – generally considered those who have a lifetime risk of 20 percent or higher. 

 “We may suggest MRI for women who have genetic mutations that place them at high risk or even for a woman who had breast cancer in the past and underwent lumpectomy,” Dr. The says. 

Not every woman can have an MRI, however. Those with metal in their bodies, such as pacemakers, neurotransmitters and aneurysm clips, are advised not to have an MRI, as are women who have poor kidney function (doctors will check blood work before doing an MRI). In addition, women who are claustrophobic often cannot tolerate the long, narrow enclosed space they must enter for the 30 to 60 minutes the test requires. 

Contrast-Enhanced Mammography (CEM)

The newest advancement in breast cancer screening technology combines mammography with the enhanced detection capabilities of contrast imaging. The test is available at several Baptist Health locations. 

While it has been approved by the U.S. Food and Drug Administration as a diagnostic tool, CEM has not yet received approval for screening use. “We are using it in the diagnostic setting for women who have some clinical concerns but cannot have an MRI for whatever reason,” says Felipe Franco, M.D., a diagnostic breast radiologist with Baptist Health Miami Cancer Institute. “Early studies show that it has the same diagnostic accuracy as MRI.” 

Dr. Franco expects the use of CEM to grow rapidly as it has several advantages over MRI. These include a significantly faster testing time, a lower cost and the availability and accessibility of mammography machines compared with MRI. 

Making the Right Choice for You

With multiple screening options available, the key is working with your healthcare provider to determine which approach best fits your individual risk profile, medical history and personal circumstances. 

VisitBaptistHealth.net/Mammoto learn more or schedule your breast cancer screening this Breast Cancer Awareness Month.