Breast Cancer Screening: An Update

1. Screening Mammography is the ONLY modality proven to reduce breast cancer mortality based on multiple randomized controlled trials; to date 8 such trials have shown a 24% mortality reduction from Breast cancer in women aged 40-74 years undergoing screening mammography.

2. Mammography is the ONLY modality recommended for breast cancer screening by the American College of Radiology, American Cancer Society and numerous other national and International professional societies.

3. The most commonly used adjunctive modalities for Breast cancer screening:

MRI: Has been shown to be very sensitive in the detection of breast cancer but at the present time due to the cost and availability is recommended for screening in a select group of women who are at high risk for developing breast cancer

Ultrasound: has been shown in some studies to be of comparable sensitivity to mammography for screening but is limited amongst other things by cost and low specificity leading to increasing number of biopsies with an overall low positive predictive value. [8% compared to 25-35% for mammography]. It is not recommended as a screening technique for the general population.

4. Imaging modality that has been used less often than MRI and ultrasound as an adjunctive modality to Screening mammography i.e. for diagnostic studies

Breast Specific Gamma Imaging: This is a nuclear medicine breast imaging study where Sestamibi is injected intravenously. This technique has been studied in a relatively small number of women as a problem solving adjunctive tool and may be an alternate to Breast MRI when the latter is unavailable. It is limited by lack of acceptable guidance methods for biopsy of abnormal lesions identified on these studies.

Status of Breast Thermography

Thermography is a way of measuring and mapping the heat on the surface of the breast with the use of a special heat-sensing camera. It is based on the idea that the temperature rises in areas with increased blood flow and metabolism, which could signify a tumor

Thermography has been around for several decades, and some scientists are still attempting to improve the technology for use in breast imaging. However, no study has ever shown that it is an effective screening tool for the early detection of breast cancer. It should never be used as a replacement for mammograms.

The disclaimer on the home page of Breast Thermography Medical Imaging web site appears below:
Disclaimer: Breast thermography offers women information that no other procedure can provide. However, breast thermography is not a replacement for or alternative to mammography or any other form of breast imaging. Breast thermography is meant to be used in addition to mammography and other tests or procedures. Breast thermography and mammography are complementary procedures; one test does not replace the other. All thermography reports are meant to identify thermal emissions that suggest potential risk markers only and do not in any way suggest diagnosis and/or treatment. Studies show that the earliest detection is realized when multiple tests are used together. This multimodal approach includes breast self-examinations, physical breast exams by a doctor, mammography, ultrasound, MRI, thermography, and other tests that may be ordered by your doctor.''

Mahesh K. Shetty M.D.; FRCR
Fellow, Society of Breast Imaging
mshettymd@gmail.com

 

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Board-certified radiologists interpreting imaging procedures for women and newborns in Houston, Texas. Imaging interpretation services to inpatients and outpatients, including emergency services, at The Woman's Hospital of Texas.
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