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What are the current options available for breast cancer screening?


Technology is always changing. I’m hoping that every year we will get better at screening for breast cancer.

The standard options regularly available are:


(Described above.)

Gynecologist Exam

A professional exam at your annual gynecological appointment. Or, schedule an appointment with a breast surgeon or at a breast center if you have a question or concern from your self-exams.


Historically, we’ve relied heavily on mammograms. One positive aspect of mammograms is that they are reproducible every year. The pictures are shot in the same way so that the breast, and any changes, can be compared year to year.

Mammograms work better on fatty breast tissue (or, non-dense breast tissue) because the breast tissue appears dark and tiny cancers appear as white spots.

They are not as effective with dense breast tissue because both the breast and cancer appear white, so it’s harder to see what you’re looking at. A dense breast doesn’t mean that it’s firm to the touch; it just refers to the way the X-ray passes through the breast and gets obstructed by the tissue. Young women tend to have more dense breasts, but you can have dense breast tissue at any age. Women with dense breasts have a greater risk for breast cancer in their lifetime.

Mammograms are not ideal for women with implants. Silicone gel implants appear very dense in mammograms and can potentially hide small cancers. Also, while mammograms in general are uncomfortable—you feel like you are being hung up by your breast—women with implants may experience more discomfort. Some worry about damage to their implants (the pocket can tear or break). The risk of damage or pain, and cost of potential re-operation sometimes prevents women from getting adequate screening.

“Men are at an increased risk if they (like my son) have first-degree relatives with premenopausal breast cancer. Many men at risk are unaware that they also need to be screened.”

Mammograms are not ideal for women whose breasts are not a standard shape or who have abnormalities in their chest wall.

Mammography can also be less than ideal for screening small-breasted women and men at risk—it’s difficult to get the breast tissue into the scanner. Breast cancer is rare in men (the lifetime risk is about 1 in 1,000) but men can get breast cancer. Men are at an increased risk if they (like my son) have first-degree relatives with premenopausal breast cancer. Many men at risk are unaware that they also need to be screened.

The other issue with mammograms is the potential toxicity concern. Mammograms today use a 3D technology, which gives off more radiation than previous mammograms. We tend to tell our most at-risk patients to get regular mammograms starting at age twenty-five, but data shows mammograms before age thirty is associated with an increased risk of cancer. These patients are also encouraged to get annual MRI’s with gadolinium-based contrast agents to screen for cancer. Which means that by the time they are fifty, they have had significant doses of ionizing radiation. Gadolinium deposits have been found in the brain of patients who have had just four MRIs, so the FDA is investigating what the risk and any potential effect may be.

Handheld Ultrasound

A handheld ultrasound of the breast is done the same way we look at growing babies in the uterus.

One advantage of ultrasound over mammogram is that the ultrasound can view a larger area of breast tissue. With an ultrasound wand, you can view breast tissue up in the armpit, which a mammogram cannot do as thoroughly.

A disadvantage is that handheld ultrasounds are not done in regimented, reproducible ways. A human technician is twisting and turning the tool. If you’re looking at the resulting pictures, you wouldn’t necessarily know exactly what angle you’re looking at, so it’s not made for comparing results year to year.

For that reason, handheld ultrasound is typically used to hone in on and amplify data. If a lesion is spotted on another test, or you feel something, you might get a handheld ultrasound to see if there are cancerous features.

NOTE: Ultrasounds and X-Rays see things differently and create different pictures of the breast; both can potentially be informative. Some women may get both mammogram and ultrasound screenings. Some physicians recommend alternating every six months, year, etc. between mammogram and ultrasound depending on the patient. Decisions around the right screening method and cadence should be made on a case-by-case basis with physicians who can determine how useful or not a mammogram is for a given patient depending on the density of the breast (and other factors mentioned above), and who can also consider any potential risks, particularly for patients who are already at an increased risk for developing breast cancer.

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