There are many ways to evaluate breast tissue for cancer. 

Which modality is used in which situations when screening for breast cancer or evaluating a breast lump?  Thank goodness we have ways of evaluating for breast cancer. Many women are concerned about the amount of radiation involved in mammograms.

When an area of concern is found,

• what type of study is appropriate to fully evaluate this area?
• d0 we need to do anything at all?

For decades we have had conventional mammography which utilizes X-rays (radiation) to look for areas of increased density within breast tissue. This is how many breast cancers will appear, as an area of increased density within the less dense breast tissue.

Because their breast tissue is already very dense, mammograms are not as useful in young women who find a mass in their breast. It is more difficult to detect a difference in densities. This is one situation where ultrasound is useful.

Ultrasound utilizes sound waves to penetrate breast tissue. These sound waves bounce against different structures and give a characteristic “signal” which can help to determine if a lump or mass is solid or fluid filled. Fluid filled is usually benign, solid CAN be a cancer but may also be a fibroadenoma (a benign problem). Ultrasound is also used in menopausal and post menopausal women to further evaluate a mass, in addition to mammograms.

Digital mammogram is a newer technology with utilizes X-rays as in conventional mammograms, but is analyzed more effectively and gives a greater detail. Many radiology practices use digital mammography for routine screening as it is more exact. Digital mammography generally involves less compression, and is therefore less painful. It does tend to be more expensive but may very well be worth it as there is less follow-up for questionable areas not well seen on conventional mammography.

MRI of the breast. This gives the most detailed picture of breast tissue. The MRI machine is very large and logistically would be unable to screen the numbers of women that are regularly screened in mammography suites.  MRI utilizes a magnetic type process and does not involve radiation. It is used primarily in staging of breast cancer or in patients who are at a high risk for breast cancer. It is extremely expensive and unfortunately at this point in time, not practical for mass screening.

It is important to understand the reasons different screening modalities are chosen, and to understand that although mammograms do involve radiation, they are the most practical screening method to use.  Many experts report figures that indicate the standard radiation exposure of a mammogram is equal to 3 months of normal environmental exposure. This does not seem like much unless you are someone who has had a lot of radiation already, or have a very strong family history of cancer. It is important to know there are other options of evaluation of breast tissue and it is important to speak with your provider to decide which method is best for you.

What has been your experience with breast cancer screening? Do you have questions about when to do it or how it is done. Let me know in the comments section.

Anne Vaillancourt