Screening for Breast Cancer—New Tests Available to You

Breast cancer will occur in one out of every eight women in the United States, with the odds increasing if a woman has other family members who have had breast cancer. Because many celebrities have had breast cancer and shared their experiences, people feel they have a lot of information about this disease, but you may have missed the most recent updates.

In a prior column, I talked about how to check your risk for breast cancer, and to discuss it with your physician. The first thing your doctor may tell you is the importance of doing breast self-examinations. This will allow you to find the smallest lumps that might have been missed by your physician's examination or by screening tests. In addition, it is important to visit your physician once a year for a check of your breasts. But any time you ever feel a discomfort or detect a breast lump, no matter how small, you should see your doctor at once without delay.

Even in the absence of any symptom of breast pain, breast swelling, changes in the skin, or an actual lump, your doctor will probably order certain routine screening tests. If you are over the age of 40, an annual mammogram is usually important. In addition, if you have dense breasts, your doctor will consider adding an ultrasound to the mammogram, because mammograms may miss small cancers hidden in dense breast tissue (which ultrasounds can often find). Ask your doctor if you need annual mammograms, and if an ultrasound is warranted.

Now for important news. A test has recently been developed that is widely available throughout the country. This is called breast MRI, performed with an intravenous injection of a small amount of magnetic contrast material. (This is not iodine, so people who have an allergy to "routine X-ray contrast" which contains iodine should not be fearful of having the MRI test with the magnetic contrast). For certain women, the breast MRI is more sensitive in detecting breast cancer compared to just the mammogram. Since each of these two tests give slightly different views of the breast, each is separately important to you to make the diagnosis of early cancer. Doctors do not rely on either of these tests alone in these women.

To have a breast MRI, you will take the doctor's order to a specialized MRI center that has the proper antennas (called coils) that can detect breast tumors. These coils are cups that surround the breast during the course of the very brief MRI and result in the very detailed images of the inside of the breasts.

Does every patient need a breast MRI as a screening test? Not at the present time. By national recommendations, patients who should consider having a screening breast MRI include women with a strong family history of breast cancer, and women who are at higher risk of developing breast cancer. In addition, if your doctor has found a mutation of the BRCA1 or BRCA2 genes, that mutation can lead to a much higher risk of breast cancer, and most physicians order a screening breast MRI yearly. This annual screening usually starts at an age at least 5 years younger than the age at which anyone in the family has previously developed breast cancer. This may be as young as 20 or 25 years of age in certain families.

In women who have had a symptom in the breast (such as pain, swelling, thickening, or lump) and the doctor's examination, the mammogram and the ultrasound show no abnormality, then a diagnostic breast MRI may be necessary to diagnose cancer in its earliest stage. In addition, if a woman has previously had a breast cancer and comes back for an annual re-examination, a breast MRI may be considered by the physician. Your physician will know if you need a breast MRI to follow up after your cancer treatment.

Other types of tests have been developed such as thermography. However, thermography has not yet been shown to be a beneficial screening test in repeated clinical trials, and is not routinely recommended. Studies are under way to determine if digital mammograms are better than routine mammograms that use X-ray film.

By using these techniques, mammogram ultrasound, and/or breast MRI, most women should feel confident that they have not developed breast cancer. In addition, if breast cancer does unfortunately occur, these tests can make certain that it is diagnosed at the earliest stages: Stage 0 (not even infiltrating into the breast tissue) or Stage 1 (localized to the breast milk-producing lobule or milk transporting duct and surrounding breast tissue).

Do not be afraid to ask your doctor which tests are correct for you and always be certain that you get a complete answer to your question and not a brush-off from your physician. Insist on all of the information so that you can make the right decisions, get the right screening, and never have an advanced breast cancer.