What are my options for breast cancer imaging screening?

October is Breast Cancer Awareness Month, and the gold standard for screening for breast cancer remains a mammogram. Mammograms can be either two-dimensional or three-dimensional. Rutland Regional Medical Center uses three-dimensional mammograms, which show greater detail within the breast and help to find breast cancer that might be hidden from overlapping breast tissue on two-dimensional mammograms. Mammograms use a small dose of radiation to make pictures and are felt to be the best screening tool.

Ultrasound of the breast uses sound waves to make images of breast tissue. Once the mammogram has found a density, an ultrasound can be obtained to determine whether the density is suspicious enough to require a biopsy. Ultrasound can also be a valuable screening study when combined with a mammogram, especially in women who have dense breasts.

Breast MRI scans can also be done to image the breasts. This study is not often used for routine screening because it is more expensive, takes longer to perform, and requires an injection of contrast. Instead of looking at differences in density, breast MRI studies examine the enhancement and metabolism of breast tissue to look for cancer. These studies are commonly performed to evaluate an abnormality seen on a mammogram or to help plan treatment when a patient has a newly diagnosed breast cancer. Breast MRIs can also be performed as a screening study combined with mammograms, specifically in women who have a strong family history or are at high risk for breast cancer.

Imaging studies can only detect abnormalities in the breast but cannot themselves diagnosis cancer. For the diagnosis, a biopsy is recommended and is often done under ultrasound guidance. Mammograms and MRIs can also be done to guide biopsies for lesions that are only seen by those tests.

As mammograms, ultrasound and MRIs are used in varying ways depending upon the patient’s risk factor for breast cancer, each patient can seek medical advice from their primary care provider if screening is right for them or from a radiologist on which test is most applicable to their circumstances.

Rutland Regional now has expanded hours for mammograms. Appointments are available 7 a.m.-7 p.m. on weekdays and 7:30 a.m.-4 p.m. on Saturdays.

This week’s Health Talk was co-written by Andrew Boyer, MD, radiologist, Diagnostic Imaging Department, Rutland Regional Medical Center, and Richard Lovett, MD, radiation oncologist, Rutland Regional Medical Center and UVM College of Medicine.

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