Which Breast Exam is Right for Me?

You Have Options

Technology is constantly evolving, making it hard to stay up-to-date on the right choices for health screenings. This can be especially true for breast screenings.

Although there are many tools available in the fight against breast cancer, a mammogram is still the gold standard in health care for detecting early signs of cancer.

But what if you have dense breasts? Or have breast implants?

Know your options
When it comes to breast cancer screening, it’s important to know your options and which one works best for you. You will either have a routine screening mammogram if you don’t have any symptoms or problems, or a diagnostic mammogram if you have symptoms or something is found during a screening.

2D and 3D mammograms

A screening mammogram is a low-dose X-ray of your breast that helps doctors look for changes in breast tissue. The main types of breast changes found with a mammogram are:

• Asymmetries
• Calcifications
• Distortions
• Masses
  

There are two different types of screening mammograms:

• Digital mammography (2D) – produces a two-dimensional image of the breast. The digital image produced can be lightened, darkened and enlarged for a comprehensive inspection, making it easier for a radiologist to see any abnormal changes.
• Three-dimensional mammography (3D) - takes several low-dose images in small slices from different angles around the breast to create a full 3D picture. Also known as tomosynthesis, this type of 3D scanning technology is especially useful for finding tumors in women with dense breast tissue.
  

There’s no difference in how either mammogram is performed. The difference is in how the image is created.

Screening mammograms for women with breast implants

Breast implants, either saline or silicone, can obscure breast images, making it harder for a  mammogram to reveal breast cancer. To help the doctor see as much breast tissue as possible, women with implants need four extra pictures (two for each breast), as well as the four standard pictures taken during a screening mammogram.

The extra pictures, called implant displacement (ID) views, are taken by pushing the implant back against the chest wall while pulling the breast forward and over it as it’s compressed. This helps get a better image of the front part of each breast so the doctor can get a better look at the breast tissue.

Breast magnetic resonance imaging (MRI)

A breast MRI is a diagnostic mammogram that uses magnetic fields to create an image of the breast. Often used for screening women at higher risk, a breast MRI can increase the likelihood of detecting breast cancer. It is not recommended for women of average risk and can have drawbacks, such as:

• Being more invasive because contrast is given through an IV before the procedure.
• Having more false positives than a screening mammography.  
• Causing issues for women who are claustrophobic (fear of confined spaces).
• Being more expensive and not always covered by insurance.
  

Molecular breast imaging (MBI)

MBI can supplement a diagnostic mammography by helping detect breast cancer in women with dense breast tissue, and those at higher risk of breast cancer.

Unlike other breast scans, MBI focuses on cellular activity in the breast tissue. You are injected with a small amount of a molecular tracer that brightens highly active breast cancer cells. This allows the camera to tell them apart from normal cells and lets the radiologist compare different images from similar perspectives. 

MBI exams are similar to mammograms, but the compression is less intense so patients experience less discomfort during the exam. Patients are also able to sit comfortably during the procedure. If an abnormality is detected, an ultrasound may be needed to further examine the finding. A physician referral is required for an MBI.

Whole breast ultrasound

This is a complete ultrasound of both breasts. It’s a supplementary screening used with a mammogram to evaluate dense breasts. It is not a substitute for a mammogram.

For women with dense breasts, a whole breast ultrasound can help detect small cancers that a mammogram could miss.

Biopsy

If a diagnostic mammography finds something, a biopsy is the final test to determine if you have cancer. This is the removal of tissue to look for cancer cells. There are several types of biopsies, ranging from fine needle to surgical. Depending on where the fluid or tissue is located, your doctor will select which biopsy option will work best for you.

Get screened

Different organizations recommend different ages to start screening. The American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend that women receive annual mammograms starting at age 40. Women at high risk for breast cancer may need to begin screening earlier. In most cases, standard preventative mammograms are covered at no charge.

It’s important to talk to your doctor about your risk of breast cancer, as well as which screening is best for you and when you should start screenings. Early detection is the goal of screening mammography.