Breast Cancer Imaging
Our Breast Screening Guidelines
Current guidelines recommend women start screening at age 40 or older. Recent studies have concluded that some women should start screening in their 30s (ref. 1-2). The two major indications to start screening in the 30s are family history and breast density (ref. 3-4). The challenge of identifying women in their 30s who have either risk factors is twofold. First, most young women have only vague knowledge about their family history. Second, the only way to determine breast density is to do a mammogram. Breast density cannot be determined by doing self-examination or clinical examine by a physician. The only way density can be determined is by doing a mammogram.
We are convinced that the most effective strategy for reducing breast cancer mortality in young women is to start screening mammography by age 35. The rationale to start screening women in this age group is that we now have new technology, including 3-d mammography, screening ultrasound and screening MRI that can detect small breast cancers that are not detectable using standard 2-d mammography (5-8). To take advantage of the new advances in imaging technology, we recommend all women have a baseline 3-d mammogram by the age 35. The exception, is women whose mother or sisters were diagnosed with breast cancer before the age 45, would start screening ten years earlier than for average risk women. For example, if the mother was diagnosed at 43 the daughter would be advised to start screening at age 33.
We recommend dividing women into 4 risk groups:
Women with dense breasts on baseline mammogram and no family history of breast cancer:
- Baseline 3D mammogram at age 35 and repeat it yearly if in good health.
- A yearly screening ultrasound is also recommended.
Women with dense breasts and a family history of breast cancer
- Baseline 3D mammogram and age 35 and continue yearly screening if in good health.
- Consider the option of substituting a yearly MRI as an alternative to the yearly screening ultrasound.
Women with a non-dense pattern on the mammogram (i.e., fatty breasts) and no family history are at low risk
- These women can postpone their next yearly mammogram to age 40 and to continue having a yearly mammogram if in good health.
- These women do not need additional screening with ultrasound or MRI.
- A screening 2D mammogram is a reasonable alternative for these women.
Women with a “fatty pattern” on her mammogram and family history of breast cancer.
- These women are advised to obtain additional information on their personal risk of developing breast cancer at a center specializing in risk assessment. If they are at increased risk, the option of an added yearly MRI should be discussed.
- Screening ultrasound is not advised for women for women with fatty breasts.
Ref. 3. Family History
Ref. 6. 3D mammogram – Mayo Clinic.
What age to stop screening:
Although most current screening guidelines recommend women stop screening at age 75, a recent publication provided a rationale for healthy women with dense breasts to continue yearly screening as long they remain in good health, and we are in agreement with this policy.
Women at Very High Risk:
Women with a known high-risk mutation such as BRCA1/2 or women who have a history of chest wall radiation, such as women treated for Hodgkin’s disease, should have a baseline MRI at age 25 regardless of breast density. Yearly screening with a 3D mammogram should start at age 30 (11).
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