Breast Imaging in 2007

By Valerie Andolina, RT(R)(M)(ARRT)

There has been quite a bit of coverage in the news lately regarding recommendations for film versus digital mammography, the benefits of MRI as a breast screening exam, and all the new technologies on the horizon that will make mammograms obsolete. For most women, all this contradictory information can be very confusing. This article will attempt to make some sense of this information by organizing it into the recommendations that real doctors give to their patients

Mammograms
Mammography is still the gold standard of breast imaging. Women over the age of 40 should have one every year. Digital mammography is recommended for some specific women based on age, medical history, and breast tissue composition, but if digital mammography is not available, film mammography should still be performed.

ACRIN DMIST Results
(American College of Radiology Imaging Network - Digital Mammography Imaging Screening Trial)

DMIST showed that digital mammography had similar diagnostic performance to film mammography for the entire population of women in the study. However, the performance of digital mammography was significantly better for the following groups:
women under age 50
women with heterogeneously dense or extremely dense breasts
premenopausal women and perimenopausal women (women who had a last menstrual period within 12 months of their mammograms)

MRI
Recently, the American Cancer Society updated their recommendations to include annual screening breast MRI studies and mammograms for certain high risk women beginning at age 30. This includes women with BRCA1 or BRCA2 genetic mutations and women whose parent, sibling, or child has this mutation, those with a lifetime risk of greater than 25% of developing breast cancer (based on an accepted risk assessment tool that includes family and personal history), and women who received radiation treatments to the chest prior to age 30. Women who are at increased risk for developing breast cancer should discuss the benefits of MRI with their primary physician to determine if they should consider this exam. Many insurance providers will not cover payment of this exam for screening purposes.

Another recently released study recommends breast MRI for women recently diagnosed with breast cancer that was found on a mammogram or ultrasound, or with a clinical exam. MRI can help locate any additional areas of involvement that may be too obscure or small to see even on a mammogram. This information can help doctors plan the course of treatment and may save the patient from facing the heartache of a future finding that requires additional treatment.

Breast Tomosynthesis and Breast CT
As the world becomes more focused on digital imaging and the amazing things computer programs can do with those images, it is only natural that breast imaging be included. These technologies are looking for ways to manipulate digital breast images into 3-D representations that will find the tiniest cancers. Breast CT and Breast Tomosynthesis are still in the research stages and are not readily available to most patients.

ROCHESTER RESOURCE
Elizabeth Wende Breast Clinic
170 Sawgrass Dr.
Rochester
(585) 442-2190
www.ewbc.com