Breast cancer screening should be individualized depending on breast density.
All women should know their breast density so they can choose the right breast cancer screening tool for their breasts and their level of risk. High breast density is a stronger risk factor for breast cancer than having a mother or a sister with breast cancer. Women with dense breasts get more breast cancers that are hard to find on a mammogram. Mammography alone is not sufficient screening for early detection in these women.
How can you find out your breast density? If you have ever had a mammogram, the radiology report documents your breast density. Ask you doctor for a copy of your mammogram report and you will know your breast density. If you have dense breasts, tell you doctor that a mammogram is not sufficient as a screening or diagnostic tool. If you are at high risk for breast cancer due to high breast density, you need to do more than have a mammogram to accomplish early breast cancer detection.
Women with fatty or low density breasts can still use mammograms with confidence knowing mammography will find their early tumors more than 80 percent of the time. You may have to educate your doctor in order to get the right breast cancer screening test for you.
If you have dense breasts, and more than 50 percent of all women do, then your risk of breast cancer is increased and mammograms will miss early breast cancer 75-80 percent of the time -- making mammograms almost worthless in detecting cancer to women with dense breasts. Most postmenopausal women using Hormone Replacement Therapy have dense breasts, making mammograms a poor technology in a group of women with high rates of breast cancer.
What does early detection mean? When breast cancer is detected early, lives are saved. We want to be able to find a tumor the size of 1 centimeter or less. Ninety percent of women who receive the right breast cancer screening and accomplish early detection will live.
This month in the Journal of Radiology Breast Cancer Prevention expert , Dr. Deborah Rhodes, M.D. and her colleagues will publish research on this new technology, Molecular Breast Imaging (MBI), that finds three times more breast tumors than mammograms. Dr. Rhodes is an expert at managing breast cancer risk. She works at Mayo Clinic testing a gamma camera that can see tumors that get missed by mammography.
In fact the gamma camera finds 83 percent of all tumors in women with dense breasts. It can find a tumor as tiny as 3 millimeters. In one study, when MBI was combined with mammograms 92 percent of all tumors were found. This is in contrast to to one study in which 75 percent of all tumors were missed using mammography in women with dense breasts.
In one patient with dense breasts a 5cm tumor the size of a golf ball was missed by a mammogram but found by the gamma camera. This is astonishing. Now, why don't we have access to this screening tool? Dr. Rhodes states that, "the breast has become a very political organ" and that forces of the status quo are against and hamper the progress of new technologies, such as this, due to political and financial interests. Welcome to Medicine in America: Medicine for Profit.
This new technique, which would complement (not replace) mammography, is sensitive enough to pick up a mass two-ﬁfths of an inch in diameter. Molecular breast imaging requires patients to be injected with a radioactive drug, but it is much more comfortable than the vise-grip mammogram and is expected to cost only slightly more. Today Breast MRI technology is exquisitely sensitive at finding tumors, but due to its very high cost (10 times the cost of a digital mammogram), most insurers will not approve a Breast MRI for women who have never had breast cancer. So, we cannot use Breast MRI for prevention or early detection in today's insurer controlled health care system. And there are few radiologists today experienced at reading Breast MRI films with a high level of skill and accuracy. While Ultrasound and Thermography are also used, both technologies are not as highly specific and may result in increased numbers of biopsies, which are either not necessary and can increase the risk of spreading an existing cancer.
Dr. Rhodes states:
This new technology MBI (Molecular Breast Imaging) detects three times as many breast tumors as mammography in high-risk women. Although it would not replace mammograms, it might become an additional tool for screening, especially in higher risk women with a dense tissue that makes tumors hard to spot.
Because this new FDA Approved MBI technology continues to be studied and is not widely available and because Breast MRI technology is infrequently approved by insurers Dr. Rhodes recommends the following guidelines:
- Know your breast density (so you can choose the correct screening exam)
- If premenopausal, have your mammogram during the first half of your menstrual cycle when your breasts are less dense
- Demand additional imaging studies if you notice persistent changes in your breast tissue
- Have an annual mammogram if you are over 40
She also states that while mammograms are not perfect, they save lives and are accessible and affordable. Use them.
As with many changes in health care, these changes in the use of new, better, cost effective technologies are often consumer driven. That means, that if we, as patients demand that this FDA approved technology, as accurate as a Breast MRI at a fraction of the cost, be made widely available, it is far more likely that we will have access sooner than later. If money talks, then consumer/patient demand will continue to be a force in the health care marketplace.
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