Best Practices

The standard recommendations for breast cancer screening are annual mammogram, clinical breast exam (exam by your physician), and breast self-exam. All have limitations, and none are perfect. Screening mammography generally should begin at age 40, but may begin earlier in women with a family history of early breast cancer. The American Cancer Society and the American College of Radiology recommend yearly screening. I usually recommend that women try to obtain their mammograms at a facility offering digital mammography, which has been shown to improve the rate of cancer detection in younger women and in women with dense breast tissue. It is also important that the radiologist compare current with prior mammograms as the changes may be very subtle.

In young women, women with dense breast tissue, and women at high risk (such as BRCA 1 and 2 mutation carriers), ultrasound and MRI with mammography should be used. However ultrasound and MRI are not meant to be stand-alone screening tests.

It is important to remember that approximately 10-15% of breast cancers will not show up on a mammogram. Ask about your breast density (it is included in most mammogram reports) and know your family history - based on these factors, ask your physician if you should also get an ultrasound and/or MRI. And so not ignore something that you feel, even if you are told that your mammogram is "normal". Make sure any abnormality gets fully evaluated.

Finally, there are many unanswered questions about screening mammography, brought to light in the past year or so with the US Preventative Task Force recommendations to start screening at age 50. Concerns were for "false alarms", unnecessary procedures, and detection of some cancers that might not require treatment. However there is plenty of data demonstrating that screening mammography does reduce the risk of death from breast cancer, so I do continue to recommend annual screening starting at age 40 in most of my patients. Some of the controversy is addressed in the following ABC news story: http://bit.ly/jIVW1d The standard recommendations for breast cancer screening are annual mammogram, clinical breast exam (exam by your physician), and breast self-exam. All have limitations, and none are perfect. Screening mammography generally should begin at age 40, but may begin earlier in women with a family history of early breast cancer. The American Cancer Society and the American College of Radiology recommend yearly screening. I usually recommend that women try to obtain their mammograms at a facility offering digital mammography, which has been shown to improve the rate of cancer detection in younger women and in women with dense breast tissue. It is also important that the radiologist compare current with prior mammograms as the changes may be very subtle.

In young women, women with dense breast tissue, and women at high risk (such as BRCA 1 and 2 mutation carriers), ultrasound and MRI with mammography should be used. However ultrasound and MRI are not meant to be stand-alone screening tests.

It is important to remember that approximately 10-15% of breast cancers will not show up on a mammogram. Ask about your breast density (it is included in most mammogram reports) and know your family history - based on these factors, ask your physician if you should also get an ultrasound and/or MRI. And so not ignore something that you feel, even if you are told that your mammogram is "normal". Make sure any abnormality gets fully evaluated.

Finally, there are many unanswered questions about screening mammography, brought to light in the past year or so with the US Preventative Task Force recommendations to start screening at age 50. Concerns were for "false alarms", unnecessary procedures, and detection of some cancers that might not require treatment. However there is plenty of data demonstrating that screening mammography does reduce the risk of death from breast cancer, so I do continue to recommend annual screening starting at age 40 in most of my patients. Some of the controversy is addressed in the following ABC news story: http://bit.ly/jIVW1d