What do I need to know about risk factors, breast density and more screening?
KNOW: Breast density is one of many known risk factors for breast cancer. Greater density not only increases the risk of cancer, but also makes it more difficult to detect cancer with a mammogram. There are additional screening tools available, and factors to consider for each. Additional screening may lead to additional testing (such as follow-up or biopsy) for findings that ultimately are not cancer. Insurance coverage may also vary.
DO: Print and complete the Patient Risk Checklist and discuss your personal risk(s) with your health care provider.
ASK: Has your health care provider determined that you are at “high risk” for breast cancer (based on your personal or strong family history, disease-causing BRCA mutation or chest radiation before the age of 30 and at least 8 years ago), YES or NO?
NO, I have not been told I am at "high risk"
Do you know if you have dense breasts (either heterogeneously or extremely dense)?
I do not know if I have dense breasts:
Ask your health care provider for the report sent from the facility that performed your mammogram. Your category of breast density should be included in it. If not, or if it is unclear, call the facility that performed your mammogram.
I do not have dense breasts:
Routine mammography is recommended with 3D mammography (also known as tomosynthesis). In combination with 2D mammography (which, depending on age and risk factors, detects 2-7 cancers per thousand women screened), 3D detects an additional 1 to 2 cancers per thousand women screened.
I do have dense breasts:
Routine mammography is recommended with 3D mammography (also known as tomosynthesis). In combination with 2D mammography (which, depending on age and risk factors, detects 2-7 cancers per thousand women screened), 3D detects an additional 1 to 2 cancers per thousand women screened. 3D improves cancer detection in most breasts, however, in women with extremely dense breasts, studies have shown mixed results as to whether 3D mammograms find more cancers than 2D mammograms. 3D also reduces the need for recall for additional imaging for findings that are not cancer.
Discuss your Risk Checklist, including your breast density, with your health care provider to determine if additional screening is recommended now or at the time of your next mammogram. This may include:
- Breast ultrasound (US, also known as sonogram) in combination with 2D or 3D mammography detects an additional 2 to 3 invasive cancers per thousand women screened. Ultrasound detects more “findings” than 3D mammography, though most of those findings turn out to be false alarms – and are referred to as “false positives.”
- Other examinations** which increase cancer detection more than ultrasound or 3D may be offered to women at high risk, including those who have a personal history of breast cancer (diagnosed by age 50 or with dense breasts): contrast-enhanced MRI, molecular breast imaging, or contrast-enhanced mammography.
YES, I have been told I am at "high risk"
Recommend annual screening with contrast-enhanced MRI begin at age 25-30,
to include screening with mammography also beginning at least by age 30.
If you are at high risk and cannot have an MRI*, and you have dense breasts (either heterogeneously or extremely dense), consider adding screening ultrasound to annual mammography.
* Contrast-enhanced MRI is not recommended if you are pregnant, have a pacemaker, have a non-MRI compatible metallic implant near vital structures (such as an aneurysm clip), or have decreased kidney function