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Mammograms Matter
Digital Mammography Superior to Film Mammography for Some WomenOAK BROOK
Access to Prior Mammograms Helps Radiologists Detect Breast Cancer
American Cancer Society (ASC) Advises MRIs for Some at High Risk of Breast Cancer
Mammograms Matter
The best way to find breast cancer early is with a mammogram. If you are a woman age 40 years or older, be sure to have a screening mammogram every one to two years.
Getting a mammogram is one of the best things a woman can do to protect her health. This simple test can find breast cancers early, when they're smaller, easier to treat, and chances of survival are higher.
If you're 40 or older, you should get a mammogram every year. Don't wait. Call your doctor to obtain a referral and call and schedule one today at one of our locations.
American Cancer Society (ACS) recommendations for early breast cancer detection
The ACS recommends the following guidelines for finding breast cancer early in women without symptoms:
Mammogram: Women age 40 and older should have a screening mammogram every year and should keep on doing so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.
Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, at least every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts look and feel like.
Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to a health expert right away.
Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it's OK not to do BSE or not to do it on a fixed schedule.
The goal, with or without BSE, is to see a doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.
Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best screening plan for them. This might mean starting mammograms when they are younger, having extra screening tests (such as an MRI), or having exams more often.
News from the RSNA Journal Radiology
January 29, 2008
Digital Mammography Superior to Film Mammography for Some Women, OAK BROOK, Ill. - For some women, digital mammography may be a better screening option than film mammography, according to newly published results from the Digital Mammographic Imaging Screening Trial (DMIST). The results appear in the February issue of Radiology. The study found that digital mammography performed better than film mammography for pre- and perimenopausal women under age 50 with dense breasts.
"We looked at a cross-section of characteristics," said DMIST principal investigator, Etta D. Pisano, M.D., Kenan professor of radiology and biomedical engineering at the University of North Carolina School of Medicine in Chapel Hill. "This paper confirms that if you are under 50, pre- or perimenopausal, and have dense breasts, you should definitely be screened with digital rather than film."
DMIST enrolled 49,528 women at 33 centers in the U.S. and Canada. The women underwent both digital and film mammography. Breast cancer status was determined for 42,760 women.
"The original DMIST results showed that digital was statistically similar to film in the overall screening population but performed better than film in pre- and perimenopausal women under 50," Dr. Pisano said.
For this paper, the researchers sought to retrospectively compare the accuracy of digital mammography versus film mammography in subgroups defined by combinations of age, menopausal status and breast density, using either biopsy results or follow-up information.
They compared results in 10 different subgroups of women: pre- and perimenopausal women under age 50 with fatty breasts, pre- and perimenopausal women under age 50 with dense breasts, postmenopausal women under 50 with fatty breasts, postmenopausal women under 50 with dense breasts, pre- and perimenopausal women between the ages of 50 and 64 with fatty breasts, pre- and perimenopausal women age 50 to 64 with dense breasts, postmenopausal women age 50 to 64 with fatty breasts, postmenopausal women age 50 to 64 with dense breasts, women over age 65 with fatty breasts and women over 65 with dense breasts.
The results confirmed the trial's original findings in favor of improved diagnostic accuracy of digital mammography over film for pre- and perimenopausal women under 50 years old with dense breasts. The findings also showed a trend toward improved diagnostic accuracy of film over digital mammography for women over 65 with fatty breasts. However, this finding was not statistically significant, and further investigation is needed to determine the reason that film performed slightly better in this subgroup. For other groups evaluated, there was no significant difference.
At A Glance
• Women who are under age 50, pre- or perimenopausal and have dense breasts should be screened with digital mammography,
according to the results of a study of 42,760 women.
• The Digital Mammographic Imaging Screening Trial (DMIST) included 33 centers in the U.S. and Canada.
December 19, 2006
Access to Prior Mammograms Helps Radiologists Detect Breast Cance,r OAK BROOK, Ill. - Viewing prior mammograms in association with current mammograms significantly improves radiologist performance and may decrease unnecessary recalls by up to 44 percent, according to a study in the January issue of Radiology.
"Prior mammograms should always be used when available," said the study's lead author, Antonius A. J. Roelofs, Ph.D., from the Department of Radiology, Radboud University Nijmegen Medical Center in the Netherlands. "Limiting the availability of prior mammograms to cases selected by the reading radiologist appears to significantly reduce the beneficial effect shown when using prior mammograms in all possible cases," he said.
With the impending transition from film mammography to digital mammography, conventional film image viewing equipment is being replaced with digital image reading equipment.
"Generally, diagnosis is based on the most recent mammograms and on prior screening round images," said co-author Sander van Woudenberg, M.S. "The use of prior mammograms recorded on film in comparison with current digital mammograms poses a challenge, as reading digital images in combination with film images is difficult and may lead to loss of efficiency."
One solution that has been considered is the digitization of prior screening mammograms. However, this would require a considerable effort, which should be balanced by the medical benefits provided by the use of prior mammograms in the screening process. Another possible solution would involve limiting the number of prior mammograms used, according to the study authors.
For the study, twelve experienced screening radiologists studied 160 mammograms to retrospectively determine the influence of comparing current mammograms with prior mammograms on breast cancer detection in screening and to investigate a protocol in which prior mammograms are viewed only when deemed necessary by the radiologist.
Eighty mammograms were obtained from women in whom breast cancer was diagnosed later. The other 80 mammograms had been reported as normal or benign. All cancers were visible in retrospect. The reviewers remained unaware of the pathologic nature of the lesions until the whole study was completed. Readers located abnormalities, estimated likelihood of malignancy for each finding and indicated whether prior mammograms were considered necessary.
The results showed that without prior mammograms, many more suspicious findings were noted. Reading performance was significantly better when prior screening mammograms were available. The 12 radiologists reported 1,935 findings when prior mammograms were unavailable, for an average of 1.01 findings per case per radiologist. When prior mammograms were available, 1,715 findings were reported, for an average of 0.89. The total number of localized lesions detected without and with prior mammograms was 636 and 672, respectively.
The findings also showed that prior mammograms were primarily used for assessment and did not play an important role in the initial detection of abnormalities. On average, additional information obtained from the prior mammograms led to better decisions with radiologists marking 44 percent fewer nonmalignant findings as suspicious, resulting in a corresponding reduction in recall rates.
"Women should make sure that if they are moving to another place, their screening mammograms and files are moved as well," Dr. Roelofs said.
At A Glance
• Availability of prior screening mammograms reduces false positives by up to 44 percent.
• Comparing current mammograms to prior mammograms significantly improves radiologist performance.
• Prior mammograms should always be used for comparison when available.
American Cancer Society (ASC) Advises MRIs for Some at High Risk of Breast Cancer
Get Scans Along With Mammograms, Not Instead of Them
Article date: 2007/03/28
Certain women with an especially high risk of developing breast cancer should get magnetic resonance imaging (MRI) scans along with their yearly mammogram, according to a new American Cancer Society guideline. The two tests together give doctors a better chance of finding breast cancer early in these women, when it is easier to treat and the chance of survival is greatest.
MRI scans are more sensitive than mammograms, but they are also more likely to show spots in the breast that may or may not be cancer. Often there is no way of knowing whether or not these spots are cancerous short of a follow-up biopsy or some other invasive procedure. That is why the test is not recommended for women with an average risk of breast cancer, the guideline says.
"As with other cancer screening tests, MRI is not perfect and in fact leads to many more false-positive results than mammography," explains Christy Russell, MD, chair of the ACS Breast Cancer Advisory Group and co-author of the new guideline. "Those false-positives, which can lead to a high number of avoidable biopsies, can create fear, anxiety, and adverse health effects, making it imperative to carefully select those women who should be screened using this technology."
For women at average risk, ACS recommends getting annual mammograms and breast exams by a physician, beginning at age 40. Most high-risk women should begin getting MRIs and mammograms at age 30, the new guideline says, unless they and their doctor think it's better to begin at a different age.
Better Evidence for Many Situations
The new guideline is published in the latest issue of the ACS journal CA: A Cancer Journal for Clinicians. It recommends MRI screening in addition to mammograms for women who meet at least one of the following conditions:
• they have a BRCA1 or BRCA2 mutation
• they have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
• their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that
look at family history and other factors
• they had radiation to the chest between the ages of 10 and 30
• they have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based
on a history in a first-degree relative
The recommendations are based on studies that were published after the ACS last revised its breast cancer early detection guidelines in 2002-2003. At that time, the panel concluded there was not enough evidence to recommend for or against MRI in high-risk women, so the guideline advised these women to make the decision after talking with their doctor. Now there is more solid evidence that MRI is useful for certain women.
"These guidelines are a critical step to help define who should be screened using MRI in addition to mammography, a question of significant importance as we discover women at very high risk of breast cancer can be diagnosed much earlier when combining the two technologies rather than using mammography alone," says Russell, co-director of the University of Southern California/Norris Cancer Hospital Lee Breast Center.
More to Be Learned for Other High-Risk Situations
For some women, however, the jury is still out on whether MRI screening is beneficial, even though they have conditions that do give them a higher-than-average risk of breast cancer. The guideline says there still isn't enough evidence to recommend for or against MRI screening in women who:
• have a 15%-20% lifetime risk of breast cancer, based on one of several accepted risk assessment tools that look at family history & other factors
• have lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
• have atypical ductal hyperplasia (ADH)
• have very dense breasts or unevenly dense breasts (when viewed on a mammogram)
• have already had breast cancer, including ductal carcinoma in situ (DCIS)
Screening MRIs are not recommended for women with a lifetime risk of breast cancer below 15%.
MRI Also Useful in Contralateral Diagnosis
Although the ACS guidelines find screening MRIs of uncertain value for breast cancer survivors, a newly published study shows the scans can be useful for finding tumors in the opposite (contralateral) breast of women newly diagnosed with the disease.
As many as 10% of women with breast cancer develop a new tumor in the opposite breast, even though nothing is found when they are checked with mammograms and physical exams at the time of their original diagnosis. Finding these cancers earlier could help women make treatment decisions (some women with cancer in just one breast opt to have both breasts removed as a precaution), and might spare them from extra rounds of surgery and chemotherapy later.
Researchers from the University of Washington Medical Center in Seattle studied 969 newly diagnosed breast cancer patients to see if MRIs could find contralateral cancers that mammograms and physical exams missed. The scans found 30 early-stage tumors the other tests could not detect, and missed only 3.
"This study gives us a clearer indication that if an MRI of the opposite breast is negative, women diagnosed with cancer in only one breast can more confidently opt against having a double (or bilateral) mastectomy," says John E. Niederhuber, MD, director of the National Cancer Institute, which sponsored the study.
The results appear in the New England Journal of Medicine. The study was released to coincide with the publication of the new ACS guidelines for MRI screening in high-risk women. |
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