In recent years, many advances in breast cancer diagnostics have been made, and there are more tools on the horizon. Daniel Herron, MD, the director of women's imaging at Mercy Imaging Centers, a service of Dignity Health Medical Foundation, shared some of the most recent advancements, along with misconceptions that are still commonly believed.
Misconceptions About Mammograms
The biggest misconceptions about mammograms are that this screening method can cause or spread breast cancer. Dr. Herron explained that there's no evidence that the mammogram machine's compression of breasts during imaging spreads cancer. Additionally, the mammogram's radiation is minimal.
"We don't have any evidence that mammograms cause breast cancer," he said. "If you walk around Sacramento, you get every three months — just from the environment — the equivalent radiation of one mammogram."
Another common concern is that mammograms are very painful. For the majority of women, Dr. Herron said, mammograms can be uncomfortable, awkward, and even inconvenient — but they aren't painful for most.
What About the Follow-Up?
A recent concern is that mammograms lead to excessive interventions. Rather than receiving a mammogram every year, starting at age 40, some people are pushing for every two years, starting at 50. But the lifesaving benefits of mammograms can't be denied.
If a woman has a mammogram every year, on average, she'll have to come back in for a follow-up appointment once every 13 years, said Dr. Herron. And of the women who consistently receive mammograms, one out of three will need a biopsy at some point in her lifetime, even if it ultimately reveals she's cancer free.
Additionally, getting a mammogram also reduces your chance of dying of breast cancer by half. "Many women, if they have those numbers, would say it's worth it," Dr. Herron said. "My argument is that women need to make that decision for themselves."
Mammograms have evolved a lot since becoming common in the 1980s — from film screens to 2D and now 3D imaging. While 2D gets two images of each breast, 3D gets up to 30 images per breast and can find about 30 percent more cancers. This improvement is especially helpful for women with denser breast tissue, as cancer can be tougher to find in that case. Right now, 3D machines aren't available everywhere.
Researchers are also looking into contrast-enhanced mammography, which involves injecting a contrast through an IV so cancers show up more clearly. However, a very small number of people may have a life-threatening reaction to the contrast, so this is still down the line.
Alternative Screening Methods
Ultrasounds are typically used if a woman gets a mammogram and needs a follow-up or in-office needle biopsy. But now, they're used increasingly as a screening technique to find cancers that mammograms might miss. This is especially true for women with dense tissue who have average- to small-sized breasts. "In our office, we may do screening ultrasounds for these women to double-check," said Dr. Herron.
Another option on the horizon is breast MRIs. They find more breast cancers than other methods, but they can be expensive, involve IV contrast, and take 30-40 minutes. Right now, they're mostly for high-risk women or those diagnosed with cancer who need to make sure it's not anywhere else in the breasts. Researchers are working on newer MRIs that take 10 to 15 minutes and don't require contrast.
Molecular Breast Imaging
Molecular breast imaging, a recent option for breast cancer screening, tags a molecule that's attracted to breast cancer cells. After being injected in your arm, the chemical goes to any cancer cells, and your breast is compressed and imaged. The imagining works just as well whether a woman has dense or fatty tissue. They do involve a fairly high dose of radiation, and an exam can take 40 minutes.
These tests are less expensive than an MRI but more expensive than a mammogram. Researchers are looking into ways to decrease the radiation involved, and would likely only recommend it for higher-risk women. "I think it's on the horizon, but there are some issues surrounding it that need to be fixed," Dr. Herron said.
Many new options are being developed for breast cancer diagnostics. In the meantime, Dr. Herron recommends healthier living to lower your risk, including exercising regularly, keeping a normal body weight, and eating more vegetables and fruits. And always reach out to your primary doctor if you have any concerns.