It’s common knowledge that a yearly mammogram can be a lifesaver, but recent news suggests that a mammogram isn’t always enough. The American Cancer Society (ACS) now recommends the use of magnetic resonance imaging (MRI) as an additional screening tool for breast cancer for selected high-risk individuals. In addition, new mammography technology, such as digital mammography, is increasingly available.

A mammogram is an x-ray of your breast tissue. And for most women, an annual mammogram beginning at age 40 is enough to ensure that breast cancer, if it develops, is caught early, when it is most treatable. The mammogram, however, is not perfect: It may not detect up to 20% of breast cancers (particularly if a woman’s breasts are dense). In some instances, the more sensitive MRI test is recommended.

Unlike the mammogram, which picks up images of tumors in the breast, MRIs can discern blood vessel activity in tumors, thereby detecting tumors that a mammogram might miss. MRIs are not recommended for all women for the same reason. Says Nagi Khouri, M.D., Associate Professor of Radiology and Oncology at Johns Hopkins and Director of Breast Imaging at the Johns Hopkins Avon Foundation Breast Center, “The test is so sensitive that it produces a lot of false-positive diagnoses of cancer. These false positives lead to unnecessary anxiety and to invasive biopsies that uncover noncancerous tissue.”

MRIs aren’t the only new option for breast cancer screening.

• Ultrasound. “Ultrasound is another extremely helpful tool," says Dr. Khouri. "Many patients may end up having a mammogram, an MRI test, and an ultrasound test.” Ultrasound testing uses sound waves to create an image of the breast and is especially useful for women with dense breast tissue.
• Computer-aided detection. Another technological advance that allows improved evaluation of suspicious findings detected by mammograms is the use of computer programs to examine x-rays. This process is called computer-aided detection (CAD).
• Digital mammography. A digital mammogram is another option. “Currently only 10–12% of imaging centers in the United States use digital mammography, but we think it is the wave of the future,” says Dr. Khouri. A digital mammogram creates an electronic image of the breast tissue that can be stored on a computer, where the image can then be adjusted for contrast and magnified. By altering the image, radiologists may be able to find “hidden” tumors.

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Screening Recommendations from the American Cancer Society (ACS)

Mammogram
The ACS recommends a yearly mammogram for all women starting at age 40.

Magnetic Resonance Imaging (MRI)
An MRI is recommended in addition to a mammogram for women with a lifetime risk of breast cancer of 20% or greater. Factors that can put you at high lifetime risk include:

• Strong family history of breast cancer (multiple relatives who have had breast cancer, particularly a mother or a sister)
• A mutation in the BRCA1 or BRCA2 gene or a parent, child, or sibling with a mutated BRCA1 or BRCA2 gene
• Hormonal, menstrual, and childbirth histories and results of a prior biopsy may suggest a higher risk
• Radiation treatment to the chest for Hodgkin’s disease between the ages of 10 and 30

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