Who needs what and when: Screening for breast cancer in 2015

Published 5:46 pm Saturday, October 3, 2015

From Brenda Peacock, M.D.

Current screening mammography guidelines for women in the United States have not changed, contrary to what you may have heard. The American College of Obstetricians and Gynecologists, the American College of Surgeons, the American College of Radiology and other organizations providing healthcare to women still recommend annual clinical breast exams, practicing self breast awareness and annual mammography beginning at age 40. The United States Preventative Task Force recommendations remain simply that — recommendations only, based on cost effectiveness and reliability of previous studies regarding mammography and diagnoses of breast cancer with less frequent screening. Screening earlier than age 40 would apply to women with hereditary cancer syndromes or other significant risk factors. Continuing annual screening after age 75 with a negative history has no evidence to support that practice.

Now that we know the basics of who and pretty much when, what about different imaging options available? Good old-fashioned mammography as considered 2-D, is almost exclusively digital now, and has been proven to be an effective means of identifying breast cancer in those age groups mentioned. Additional imaging is not routinely recommended unless a woman does have an increased lifetime risk, that is greater than 20 percent, versus current lifetime average of about 12 percent.

The newer technique is 3-D, or digital breast tomosynthesis. It is really added on to the old 2-D study, cost is not significantly different, and radiation remains minimal as far as exposure — less than 10 percent more at most. However, there is currently inconclusive evidence that it is more effective at diagnosing breast cancer in the average risk woman. Breast MRI has not been shown to be cost-effective as a screening tool, and is reserved only for those women at significantly increased risk, such as those with hereditary cancer syndromes, previous chest irradiation, or with known disease to determine plans for surgical management.

So how do you know if you are at average or increased risk? During the past several years, over 20 states (North Carolina included) have passed laws requiring facilities to advise the patient if indeed they have “dense” breasts. There are four categories of breast density — entirely fat, scattered fibroglandular densities, heterogeneously dense and extremely dense. Standard 2-D mammography is less sensitive if the breast is felt to be heterogeneously or extremely dense, but these findings can be somewhat subjective, and are found in at least 40 percent of women undergoing mammography. You may be advised to discuss your risk with your provider as there is an associated slight increased risk of breast cancer in women with dense breasts.

You may be familiar with the GAIL risk model to calculate one’s risk of breast cancer, taking into consideration age, race, family history, previous biopsies, and other pertinent factors. There are risk-calculating tools available now that also include the category of breast density. If your risk is outside the parameters considered average over the next five years, you could potentially benefit from some type of additional of study. Currently the American College of Obstetricians and Gynecologists recommends that even if a woman has dense breasts, if there are no additional risk factors, there is no indication for exclusive use of 3-D mammography or other additional imaging. However, there is a fair amount of evidence that 3-D mammography has decreased the need to return for additional studies due to incomplete imaging, even in breasts that are not considered dense. It is felt to be more sensitive in detecting changes in dense breasts because of the additional dimension evaluated. This technology remains relatively new though, and additional evidence is needed before 3-D replaces standard 2-D studies. Estimated lifetime risk of breast cancer of 50 percent or more is really only determined by genetic testing, with risk reduction surgery reserved for this group only. At younger ages, these women would indeed benefit from additional diagnostic imaging in conjunction with mammography.

3-D mammography is currently available in our area at Eastern Radiologists, and will soon be available at Vidant Women’s Care Washington, 1204 Brown St. The best protection remains early detection for most women, but know your risk factors. Talk to your provider regarding your risk of breast cancer, or you may consider doing your own risk calculation @brightpink.org.

Brenda Peacock, M.D. is a gynecologist at Vidant Women’s Care Washington located at 1204 Brown St.



Vidant Women’s Care Washington

1204 Brown St.

Saturday, Oct.10, 9 a.m.–noon


Vidant Family Medicine–Belhaven (Allen Street)

245 Allen St., Belhaven, 252-944-2218

Tuesday, Oct. 20, 5:30–7:30 p.m.


Vidant Family Medicine-Aurora

151 Third St., Aurora

Wednesday, Oct. 21, 2–4 p.m.