Are Extra Screenings Necessary for You? How to Figure it Out.
Breast cancer is a significant concern for many women, and regular mammograms are a critical tool for early detection. However, some women might need additional tests beyond mammograms to catch any signs of cancer early.
These extra tests, known as supplemental screenings, can sometimes find more cancers but also have downsides, such as false alarms that lead to unnecessary worry.
Dr. Bethany Niell, an expert in breast imaging, explained the different options for those who may need additional screenings. She emphasized that the right choice depends on a woman’s specific risk factors, such as family history, breast density and genetic mutations.
Here are some notes on her discussion at the National Comprehensive Cancer Network (NCCN) annual conference.
Understand risk levels and how they pertain to you.
• Average Risk: Women with a lifetime breast cancer risk under 15%.
• High Risk: Women with a lifetime risk over 20%, including those with BRCA1 or BRCA2 gene mutations, which significantly increase the risk.
Know your options for supplemental screenings.
• Digital Breast Tomosynthesis (3D Mammography): Offers a clearer, three-dimensional view of the breast and is particularly good for women with dense breasts. It can detect more cancers and reduce false positives compared to standard mammograms.
• Ultrasound: Useful for women with dense breasts but has a higher rate of false positives, meaning it often shows non-cancerous issues that lead to more tests.
• MRI: Highly effective at finding cancers and not influenced by breast density. It’s particularly good for women at high risk but comes with more false positives and is more expensive and time-consuming.
Which test is right for you?
• Women with dense breasts and average or intermediate risk might consider 3D mammography or MRI, with or without contrast.
• High-risk women with dense breasts have multiple options, including 3D mammography, MRI, and ultrasound.
• The choice should balance the benefit of finding more cancers with the drawback of potential false alarms and unnecessary biopsies.
Her tips for experts:
• Don’t rely solely on family history to estimate risk. Many women with no family history still have significant risks.
• Use online risk models to get a more accurate estimate of breast cancer risk.
• Tests that use contrast material (injections to highlight breast tissues) tend to find more cancers than those that don’t.
Dr. Niell also mentioned that ideally, women should have these tests spaced out every six months for the most effective monitoring, but it’s not always practical due to travel and scheduling issues.
While mammography remains the standard for routine breast cancer screening in average-risk women, supplemental screening options such as digital breast tomosynthesis, ultrasound, and MRI are important for those at higher risk or with dense breast tissue. Each supplemental modality has its benefits and drawbacks, including varying rates of cancer detection and false positives. Decisions on additional screening should be based on individual risk factors, including family history, breast density, and genetic predispositions. Understanding these nuances and using validated risk models can help optimize breast cancer detection and minimize unnecessary interventions.
