Each year, more than 200,000 American women receive a breast cancer diagnosis, but exactly who should be screened varies depending on a woman’s age and other risk factors like family history. In 2013 and 2014, around two-thirds of women age 40 and older reported having had a mammogram within the previous two years.

Women with insurance and women with more years of education were more likely to have had a mammogram. Improvements in screening and treatment are leading to declining death rates from breast cancer, but how can medical imaging specialists help screening work as well as possible?

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Many factors influence a particular woman’s risk of developing breast cancer.

Nearly half of states require doctors to inform women if they have dense breasts, because this puts them at higher risk of breast cancer, and those cancers can be harder to find because of how mammograms look. But now researchers are determining which women with dense breasts have higher enough risk to warrant further medical imaging exams using ultrasound or MRI.

Breast Density Is Only Part of the Equation

Denser breasts have more glandular or connective tissue in proportion to fatty tissue. This type of tissue shows up white on mammograms, but tumors also show up white, which means dense breast tissue may conceal them. Conversely, breasts that are non-dense are
primarily made of fat, which shows up dark on mammograms. Tumors are easier to see in mammograms of women with non-dense breasts. There are four density categories that range from “extremely dense” to “almost entirely fatty.”

A group of researchers led by Dr. Karla Kerlikowske, professor of medicine at the University of California, San Francisco set out to find whether subgroups of women with dense breasts had higher risk of developing cancer before their next mammogram. These tumors are usually discovered manually by a patient or her doctor, and may be present, but not detected on a mammogram. Researchers took into account the risk of breast cancer based on a risk calculation app.

Calculating Breast Cancer Risk

Breast cancer risk is calculated based on several factors, including family history, ethnic background, and age. Breast density is also a factor, and Kerlikowske and her team wanted to find out what combination of factors indicated a woman with dense breasts should undergo additional medical imaging studies.

Using the online calculator that evaluates a woman’s risk over the next five years based on history, age, ethnicity, and breast density, the risk of developing breast cancer for over 360,000 women was calculated and categorized as “low,” “average,” “intermediate,” “high,” or “very high.” Average to low risk would be 1.66% or lower, while more than 4% is considered very high risk.

Determining When Extra Medical Imaging Studies Should Be Done

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Doctors must weigh the risks and benefits of supplemental medical imaging studies for diagnosing breast cancer.

The study reported that women with particular combinations of breast density and five-year risk levels had higher probability of a breast cancer diagnosis before her next mammogram. One group consisted of women whose five-year risk according to the calculator was at least 1.67%, and who had “extremely dense” breasts.

Another high risk group consisted of those with a five-year risk of 2.5% or more and mammography showing “heterogeneously dense” breasts. Women with a five-year risk of at least 2.5% and heterogeneously or extremely dense breasts were most likely to be diagnosed with cancers that were advanced. These are the women who are most likely to benefit from additional medical imaging tests beyond a normal mammogram.

Determining how great an increased risk justifies additional medical imaging requires breast imaging specialists to use their judgment and experience. At SteleRAD, radiologists Dr. Lisa AbramsDr. Michael J. AlboucrekDr. Terrence J. Barrett, and Dr. Deborah Guilbaud are breast imaging specialists who have comprehensive experience and stay apprised of the latest research in order to make the most informed recommendations to their patients. Identifying higher risk groups for breast cancer is expected to lead to studies about which supplemental screening types work best, typically ultrasound or MRI.

SteleRAD’s Experience in Breast Imaging

Medical imaging saves lives by detecting breast cancer in earlier, more curable stages. Being able to assess all risk factors a woman has and advise about the best screening frequency and whether supplemental medical imaging studies should be made requires radiologists with experience in breast imaging and the determination to keep up with the latest research in which types of breast imaging work best in which women.

The owner-operator radiologists of SteleRAD are all Board-certified radiologists, and several specialize in breast imaging. SteleRAD provides exceptional medical imaging services to hospitals, practices, and imaging centers throughout South Florida. To learn more, please call us at 954-358-5250 or contact us online. We would be happy to answer your questions.