Our Optimal Screening Guidelines

Overview:

This section deals with breast cancer screening in women who do not have a breast lump or any other breast problem. The goal of screening is to detect early-stage breast cancers in asymptomatic women. When breast cancers are detected on screening asymptomatic women, the survival rate is 98% (Ref. 1 and Breast Screening Guidelines).

Routine yearly mammographic screening reduces breast cancer mortality rates. However, routine screening has one major limitation. Yearly screening fails to detect 20% of breast cancers that are present at the time of screening. (Ref. 2). Most of these “missed” cancers occur in young women with dense breasts (Ref.3 and Breast Density). New imaging technology can markedly reduce the risk of missing a hidden breast cancer. For example, 3D technology can detect early-stage breast cancer that is not visualized on standard 2D technology (Ref. 4). When artificial intelligence (AI) is used in combination with 3D imaging, the rate of missed cancers is reduced even further (Ref. 5 and link to Artificial Intelligence).

Women who have dense breasts (60% of young women and 40% of women over age 50)
are advised to have additional imaging to improve their odds of early detection. Women with dense breasts and no family history of breast cancer are advised to have an additional yearly screening breast ultrasound (Ref. 6). Women with a strong family history of breast cancer are recommended to have an additional yearly screening MRI (Ref. 7).

We recommend that women in their twenties review their family histories of breast cancer with their primary care physician. Women with a strong family history of breast or ovarian cancer should be referred to a risk assessment clinic. We also advise that all women start mammographic screening by age 35 (Ref 8 and Breast Screening Guidelines). Women with dense breasts are advised to continue yearly screening. Women with a fatty breast pattern on mammogram are given the option to delay yearly screening until age 40.

Women with breast implants should follow the same guidelines as women without implants (Ref. 9). However, when scheduling their mammogram, these women should inform the scheduler that they have breast implants. Screening women with implants typically require more time to complete the screening process. In cases in which additional views are required and the schedular did not book sufficient time to complete the imaging process, women may be required to return to the imaging center for additional imaging.

Questions? Contact us.