Beyond Mammograms: Next Steps for Breast Cancer Screening

By:
Karen Leckey

Reviewed By:
Martin E. Liebling, M.D., FACP

For most women, mammograms are the gold standard for detecting breast cancer. Though they may be uncomfortable, they are necessary after age 40, or even earlier if you have a family history or other risk factors for the disease. But how do you know if a mammogram is the best detection method for you?

Here's a hint: It is. Yes, there are newer screening methods out there. But most are still experimental. And even those now recommended for high-risk women to improve diagnosis don't replace mammograms. Nothing does.

A mammogram x-ray is able to identify breast abnormalities such as lumps or microcalcifications (tiny deposits of calcium, usually noncancerous), which may later be diagnosed as breast cancer. It can also identify some breast cancers before a lump can be felt. Traditional mammograms have been used for several decades, and their effectiveness as an early warning system has helped reduce the risk of dying of breast cancer by up to 28 percent, according to a British study. Newer digital mammograms can be enhanced more than traditional mammograms and may be a better choice for some younger women with denser breasts.

Learn your risk

As effective as they are, mammograms aren't a perfect screening method. For this reason, several other screening methods for breast cancer are also being studied, although for now, many of these techniques are available only in clinical trials or for women at high risk for breast cancer. To understand your risk:

1. Know your family history and discuss it with your doctor. Having a mother, sister or daughter diagnosed with breast cancer puts you at higher risk for the disease.
   
   
2.  If you fall into this category, you may also want to find out if you have a genetic mutation associated with the disease, such as BRCA1 or BRCA2.
   
   
3. You also may want to consider BRCA blood testing if your family history includes multiple women or any man with breast cancer, any women diagnosed under age 50 or multiple women diagnosed with ovarian cancer, which is also associated with the BRCA gene mutations.
   
   
4.  If you are considering genetic testing, ask your doctor what is involved and if you should be referred to a genetic counselor as well. Such a specialist can explain the benefits and risks of testing and provide more context for the results if you decide to get the test.
   
   

Screening methods for higher risk

If you fall into a higher-risk category, you may want to ask your doctor about other detection methods, which include:

1.  Magnetic resonance imaging (MRI). MRIs may provide images for some breast lumps that can be felt, yet not identified on a mammogram. However, MRIs cannot identify microcalcifications, which may be cancerous. They also produce a number of false-positive results, which result in costly and time-consuming biopsies that show no cancer. The American Cancer Society recommends an annual breast MRI in addition to mammogram for women at high risk for developing breast cancer. But no studies have shown MRI to be better than mammograms for women at average risk.
   
   
2. Molecular breast imaging (MBI). Also known as scintimammography or a technetium sestamibi scan. In this test, tagged radioactive molecules are injected into the patient’s arm and the breast is viewed with a nuclear scan to see where the tagged molecules concentrate, which may indicate cancerous tissue. MBI may be used in certain cases when a suspicious area is seen on a mammogram.
   
   
3. Digital tomosynthesis. This method uses multiple x-ray images to create a three-dimensional image, much the same way a CAT scan does. Studies have shown that it produces comparable results to some mammograms. Digital tomosynthesis is currently available only for research studies.
   
   
4. Electrical impedance scanning. Also known as a T-scan. This method uses a handheld device, a patch and a computer screen to pass an electrical current through the breast, much like an electrocardiogram. The device is approved to be used with mammograms to classify tumors and identify areas of abnormality.
   

Many other methods are also being studied, but remain expensive and no more effective than mammograms for most women. For example, the combined PET/CAT scan is more commonly used to identify the spread of cancer, but some studies have demonstrated that the scan shows some promise as a diagnostic tool, though it remains prohibitively expensive. Ultrasound imaging also has a role in breast cancer, not to detect the disease but to differentiate cysts from lumps and to guide needles during biopsy.

For most women, mammograms are still the best screening method. For all the other methods, cost can be a factor: They are expensive, and your health insurance probably won't pay for them unless you are at increased risk for breast cancer. Talk to your doctor about your risk factors and the steps you can take to protect yourself. Knowing your risk factors can help you plan what methods are best to keep up with breast cancer screenings.