Breast Imaging for Breast Cancer Prevention

When it comes to cancer, early detection is key to minimizing treatment and increasing survival rates.  However, the medical profession has struggled with creating clear guidelines for improving outcomes in breast cancer.  The big questions are:

When to start? – The medical community struggles with whether to start mammograms at age 40 0r 50.

This is because a lot of breast cancers are missed between the ages of 40-50 due to the density of younger breast tissue.  There is debate as to whether to use ultrasound as a screening tool either alone or in conjunction with mammography.  However, health professionals are now required to inform you if you are a person with dense breasts who’s mammograms may not be as accurate.

How frequently should a mammogram be done? – The medical community says every 1-2 years.

Since ionizing radiation has the potential to increase cancer risk, some medical professionals will recommend spreading mammograms out a bit more, while others still feel that the annual mammogram is better at reducing risk of negative outcome from breast cancer.  Depending on the type of cancer, some are slowly growing and can wait 2 years to be detected.  These would be low risk cancers anyway that may not require much treatment.  The more aggressive and dangerous cancers need to be addressed in weeks, not months, so even screening annually would not be frequent enough to catch these in time.  In general, I tend to think that less is more when thinking about mammograms depending on an individual’s personal risk for breast cancer.

What is the best type of imaging?- Mammogram, ultrasound, or thermography?

Mammograms are the standard of care currently.  The concern for mammograms is that they deliver ionizing radiation directly to the breast tissue.  It is hypothesized that 1 in every 1000 women will develop breast cancer due to receiving mammograms.  They also are not as accurate for dense tissues either due to young age of the woman or fibrocystic breasts.  They also only find about 79% of cancers that are present, and will miss 6-46% of invasive cancers.  Currently it is estimated that there has been a 19% reduction of breast cancer death due to screening.

Ultrasound is currently used to further screen more dense breast tissue or positive mammogram results.  There is debate in the medical community as to the benefit of this practice. There was a study done in 2003 showing that women under age 45 undergoing ultrasound found 13% more cancers that were missed on mammogram1.  The problem with routine ultrasound is that there is a much higher false positive rate (3x that of mammograms) than there is for mammograms, which leads to many more unnecessary biopsies and anxiety. However, ultrasound is better at differentiating cysts from masses and can also pick up masses that have no calcification.  This means there is a better chance that an ultrasound will find a tumor that is actually there.  There is no risk or radiation involved in the procedure itself.  I think ultrasounds are a safe alternative to mammograms, especially in the younger population.

Thermography is a screening technique that utilizes heat differences in the tissue to tell if there is inflammation or a cancerous mass present.  Cancer requires increased blood supply which will show up as a “hot spot” on this imaging.  Small studies have shown mixed results, but recently a larger study was completed that demonstrated a 97% ability to detect cancers that were present in the breasts with a 17% false positive rate2.  Since this has yet to become the standard of care, a positive thermography would be followed up with a mammogram and/or ultrasound before an area is biopsied.  There is no risk or radiation involved in the procedure itself.

I am concerned with the risks involved in receiving mammograms.  I also find that in my practice, most women will find breast cancer themselves, regardless of whether they have had regular imaging done of their breasts.  So I always recommend self breast exams done at the same time every month.  Thermography is an excellent adjunct to the self breast exam because it gives us not only information about breast cancer, but also inflammatory changes that may be a precursor to cancer or other dysfunction.  My patients and I make individualized decisions about the benefits of having or forgoing mammograms and/or ultrasounds to keep risk to a minimum.

References:

1. Houssami N1, Irwig L, Simpson JM, McKessar M, Blome S, Noakes J. Sydney Breast Imaging Accuracy Study: Comparative sensitivity and specificity of mammography and sonography in young women with symptoms.AJR Am J Roentgenol. 2003 Apr;180(4):935-40.

2.Rassiwala M, Mathur P, Mathur R, Farid K, Shukla S, Gupta PK, Jain BEvaluation of digital infra-red thermal imaging as an adjunctive screening method for breast carcinoma: a pilot study.Int J Surg. 2014 Dec;12(12):1439-43. doi: 10.1016/j.ijsu.2014.10.010. Epub 2014 Nov 7.

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