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Breast Cancer Screening

  • Diagnostic tests including mammograms and ultrasounds to check for cancer
  • The American Cancer Society and other organizations recommend screening beginning at 40
  • Regular follow-ups or a biopsy may be the next steps
  • Involves breast imaging, breast center

Overview

For women, breast cancer is the second most common form of cancer after skin cancer and the second-deadliest cancer after lung cancer. Breast cancer is likely to strike one in eight women in the United States. That is why breast cancer screening is so crucial for women’s health.

Breast imaging at Yale Medicine is performed by dedicated breast specialists and technologists who are specially trained, and the breast radiologists interpreting these studies are nationally recognized experts. “The whole idea of screening is to positively impact people’s lives and decrease mortality,” says Liane Philpotts MD, a Yale Medicine radiologist, specializing in breast imaging.

What are common breast cancer screening tests?

Women are encouraged to undergo regular screening so that there is a greater chance that breast cancer will be found early, when it is more easily treated.

Mammogram:  A mammogram is an X-ray image that allows radiologists to see whether cancer is present in the breast tissue.

Digital Breast Tomosynthesis (DBT) - 3-D Mammography:  Yale Medicine offers women the most recent advancement in mammography: digital breast tomosynthesis. In breast tomosynthesis, the mammogram machine travels over the breast in an arc, producing multiple images that radiologists can view on a computer screen as thin individual layers.

Breast Ultrasound: Breast ultrasound screening uses sound waves to image the breast tissue. In general, it is used to further evaluate focal areas of the breast, or as a supplement to mammograms in the 40 percent of women who have dense breast tissue that can make it harder to detect cancer on a mammogram. At Yale Medicine, breast ultrasound is performed by experienced, skilled technologists using state-of-the-art technology. 

Breast MRI: Magnetic resonance imaging, or MRI, uses radio waves generated by a powerful magnet to produce detailed pictures of breast tissue. As a screening tool, MRI is largely reserved for women who are at high risk for breast cancer – those who have greater than a 20-to-25 percent lifetime risk of developing the disease. That includes women who have one of the BRCA1 or BRCA2 gene mutations associated with breast cancer, and women with a family history of the disease. “Women at low, normal, average, or even intermediate risk aren’t appropriate for screening with MRI,” Dr. Philpotts says.

When should women get a breast cancer screening?

The age at which women should begin screening for breast cancer and how often they should be screened are a matter of debate. Many reputable organizations agree that annual mammograms between age 40 and 55 have the greatest life-saving benefit.

Given the controversies over screening, women should be sure to discuss their personal health history, as well as their risk factors for breast cancer, with their physicians. These personalized discussions enable Yale Medicine doctors to make the most appropriate screening recommendations for each patient.

What are the benefits of 3-D mammography?

The Yale Medicine Breast Imaging Program is a national leader in 3-D mammography and was one of only five centers in the country to pioneer the technology.

Through that vast experience, radiologists have seen two significant benefits of 3-D mammography.

First, 3-D mammograms provide a more complete view of the breast tissues, so there is less need for additional testing. “On a 2-D mammogram, if you see an area of density, you do not know if there’s something underlying that or not,” Dr. Philpotts says. “In those cases, you have to recall the patient for a workup – additional mammogaphic views and ultrasound."

"Thanks to 3-D mammograms, we can better see in front of, behind, and through these tissues so that many false positives are reduced," says Dr. Philpotts. "The densities that are really just superimposed normal tissue are seen a lot better, so we don’t have to recall those patients.”

The second major advance of 3-D is that it allows radiologists to identify more invasive breast cancers. Also, 3-D images give radiologists the opportunity to detail invasive cancers they might have missed with less extensive 2-D images.

What are the risks of breast cancer screening?

False positives: “Unfortunately, mammography is not a perfect science and all breast cancers don’t always look really obvious,” Dr. Philpotts says. In those cases, women undergo more tests, which can provoke a lot of anxiety. A lot of women “automatically think they have breast cancer, but of course the majority of them do not,” says Dr. Philpotts.

Yale Medicine has found that its use of 3-D mammography has reduced the number of false alarms. Though 3-D mammography is not yet widely available throughout the region (or even the country), women seeking the most accurate screening are choosing to come to us.

Over diagnosis: Women may hear that breast cancer screening leads to over-diagnosing the disease.  With improved cancer detection, doctors may be finding early-stage cancers that would never harm a woman or affect her life. This is a controversial topic in radiology. 

The advanced screening techniques used by Yale Medicine help to limit overdiagnosis.

“With mammography, we cannot tell the difference between a really bad cancer and a not-so-bad cancer,” Dr. Philpotts says. “They often look the same. At Yale Medicine it’s a matter of finding them, biopsying them, diagnosing them, and then, not over-treating them.”

There is no data to suggest that cancers regress if left untreated, says Dr. Philpotts, adding that most women will choose to have their cancers treated appropriately.

Radiation: As with any X-ray, the body is exposed to radiation when having a mammogram. But the dose is quite small and not considered harmful. With the use of the synthesized 2-D mammogram generated from the 3-D data-set, the radiation dose for tomosynthesis is reduced to the same as that of a 2-D mammogram.

What makes Yale Medicine's approach to breast cancer screening unique?

Yale Medicine performs all breast imaging in a center staffed by dedicated breast specialists. The technologists are specially trained, and the radiologists who interpret these studies are nationally recognized experts.

Many Yale Medicine breast screening technologists are trained in mammography and ultrasound. “Expertise is important and does make a difference,” Dr. Philpotts says.

As one of the five original testing sites for 3-D mammography, Yale Medicine doctors are ahead of the curve in learning how to use the technology to best help women.

Another unique feature at Yale Medicine is that radiologists are able to view and analyze imaging tests and, in most cases, provide women results after just a short wait. Plus, 3-D mammography reduces the need for additional imaging.