When used for screening (i.e. the patient is not aware of any breast problem), mammography can reduce the number of deaths from breast cancer by finding cancer earlier and when it’s easier to treat. But screening is optional. Yearly screening beginning at age 40 reduces deaths from breast cancer the most, but even screening every other year from 50 to 74 is very helpful. Please be aware that 10 percent of patients are called back for additional imaging work-up after screening mammography but only about 1 in 20 of those called back actually turns out to have cancer.
When mammography is used for diagnosis, usually for a breast problem like a lump, it is often used together with breast ultrasound. Mammography can help exclude the possibility of cancer as the cause for symptoms, or show a suspicious area that requires biopsy. Since some cancers can’t be seen on mammography, it is important that the patient let the technologist who takes the mammogram know that they have a problem so that it can be appropriately investigated.
Offering Tomosynthesis (3D mammography)
Tomosynthesis, also known as 3D mammography, is increasingly being used as a part of mammography both for screening and diagnosis. There is good evidence that it improves the accuracy of mammography. It works by creating many slices of the breast similar to a CT scan, allowing the radiologist better see areas that may be hidden beneath overlying breast tissue. Unfortunately, not all insurers cover tomosynthesis at this time, and so patients may be required to pay an out-of-pocket expense (i.e. copay or deductible).
Contrast Enhanced Spectral Mammography (CESM)
Contract Enhances Spectral Mammography (CESM) is one of the newest breast imaging procedures to aid in the detection of breast cancer. There are only a few facilities in the region including the University of Minnesota Health Breast Centers that offer this innovative tool for early detection. Some women have inconclusive mammograms, often due to dense breast tissue. Dense breast tissue appears white on a mammogram, as does cancer, making is difficult to detect. This generally requires an MRI or biopsy to resolve the issue, however CESM is yet another tool that can be ordered by a radiologist to help detect breast cancer.
CESM is a special type of mammogram that is performed after an IV injection of contrast. CESM shows all of the information of a regular mammogram but also shows areas of increased blood supply. Breast cancer typically has a greater blood supply than normal tissue so it is highlighted on the images. This procedure, performed by our experienced team, has been a useful tool in patient in need of imaging beyond standard mammography. For example, if a biopsy shows cancer, it is often helpful to get further imaging to make sure the size and extent of the tumor is known to the surgeon before surgery. CESM has also been helpful if mammogram and ultrasound are inconclusive.