When it’s time for your next mammogram, you might wonder which test is best: 2-D, 3-D, computer-aided, digital, or a blend of 2-D and 3-D, and even MRI. There’s also the option of a breast ultrasound. Typically, your radiologist selects the right test based on the diagnosis codes your physician assigns.
3D Mammograms
Much discussion revolves around the 3-D mammogram and recent studies suggesting that a single view of tomosynthesis (the 3-D exam) may be better than the standard digital exam we’ve used up to now.
Women with smaller, less dense breasts tend to get the clearest mammograms, while those with larger, denser breasts may have overlapping tissue in their exams, which can obscure abnormalities. For all women, the best approach to mammogram screening—whether it’s the type of test or the timing—should be discussed with your gynecologist. Shared decision-making in cancer screening is becoming more common, as seen in countries like France, Switzerland, and the United Kingdom. In the U.S., many women begin screening at 40, while some may start in their 30s.
Anatomical Changes Are Not Full PIcture of Breast Health
Mammograms detect anatomical changes but don’t measure hormones or capture the full picture of breast health. When planning your next visit, be proactive about discussing which mammogram test is best. Work with your gynecologist to create a plan for breast exams and health maximization.
Your gynecologist will consider your hormone status, pregnancy history, medication use, reconstructive surgery, personal and family history, and age to determine the best tests for you. The goal is to accurately detect cancers when they are small enough for a cure and minimize the need for repeat tests.
Dense Breasts
There are reasons you might opt for advanced tests like DBT or 3-D mammograms, or even add or switch to breast MRI. You may be at higher risk if you have dense breasts, genetic risks (BRCA or GeneType), prior abnormal mammograms or ultrasounds, breast lumps, very cystic breasts, or a strong family history. Other risk factors include early menarche, late menopause, higher BMI, older age at first pregnancy, increased alcohol consumption, smoking, and not breastfeeding.
Technology is evolving, and digital breast tomosynthesis (DBT) now combines 2-D and 3-D imaging, exposing women to less radiation. The American College of Obstetricians and Gynecologists (ACOG) notes that DBT offers better imaging, improved accuracy, and lower recall rates than digital mammography alone, particularly for women with dense breasts. However, DBT involves more radiation than standard mammograms, and there are no universal guidelines on how often you should have this test versus a traditional mammogram.
Breast MRI
Breast MRI can also be used for screening, offering a 3-D view, compared to the 2-D view of a mammogram. Studies show MRI can detect more cancers, but it also produces more false positives. ACOG and the American Cancer Society recommend annual MRIs starting at age 30 for women at high risk, including those with BRCA mutations or strong family histories. Both breast tomosynthesis and MRI may require insurance preauthorization.
Breast MBI
Another option, Molecular Breast Imaging (MBI), uses injected dye and nuclear medicine to detect tumors. A Mayo Clinic study showed that MBI increased cancer detection from 1.9 to 8.8 per 1,000 women with dense breasts.
Mammograms are designed to pick up changes in the anatomy, they don’t measure hormones, or the exact physiology of the breast, thus they cannot uncover every aspect of your breast health! However, when trying to be proactive before your visit here are a few facts to make that discussion cover what you need to discuss when wondering what mammogram test is best: Make a plan for breast exams, breast health maximization, and which screening tests to have should be worked out by you and your gyno.
Your current hormone status, whether you are after pregnancy, with certain medication use, with any reconstructive surgery, in light of your history, and as you age, your gyno needs to help you as an individual plan which tests to have. The goal is to be accurate, to find cancers when they are small enough for cure if treated, and lastly, an equally important goal, is to reduce the number of women who have to get called back for a repeat test.
Here are a few of the reasons currently we suggest you may want to get more advanced either DBT or 3-D Mammogram, or even add or switch to MBI of the breast.
- Those at Highest risk for Breast Cancer
- Those with Dense Breasts either on exam or mammogram
- Those with genetic risks from BRCA or GeneType testing
- Those with Prior Abnormal Ultrasound
- Those with Prior Abnormal Mammogram
- Those with a Breast Lump
- Those with Very Cystic Breasts
- Those with Strong Family History
- Those with Breast Skin Changes
- Those who have had Early Menarche and Late Menopause
- Higher Body Mass Index (Obesity)
- Older Age at First Pregnancy
- Increased Alcohol Consumption
- Smokers
- Those who Did Not Breastfeed
At www.womenshealthpractice.com we offer yearly breast exams, can help you pick the right test at the right time, and discuss whether genetic screening or other therapies might be right for you.
