There is probably more written about the subject of breast imaging than almost any other breast topic.
What imaging modalities are available?
-Mammograms are Xrays of the breast. They involve exposure to small amounts of radiation and are the most studied mode of imaging used for breast screening.
-Uses sound waves to image the breast
-Should be used in exceptional circumstances
The many other imaging modalities have not been shown to be effective and will not be discussed here.
Imaging of the breast should be utilised for two purposes:
Diagnosis. Any woman over 40 with a lump in her breast should have a mammogram and ultrasound to determine the nature of the lump. Most women under the age of 40 should have an US first and a mammogram if advised. The purpose of the imaging is to diagnose the lump and to look at the remained of the breast and the other breast.
Screening: this is controversial. The purpose of screening for any disease is to pick up the disease at an earlier stage than it would be detected naturally and so increase survival. Appropriate imaging can diagnose cancer at an earlier stage and may be able to pick up pre cancer. Adequate treatment of pre cancer may result in cancer being prevented.
Different countries have different policies as to when screening should start and how often it should occur. There are several principles that should be adhered to:
- Any woman who has a screening mammogram must also have a breast examination. Cancers may not show up on a mammogram. They are more likely to be missed in younger women (<50) and if the cancer is a lobular cancer.
- Generally screening should start at 50. In some countries, it is advised that screening should start at 40.
- Mammograms should occur at regular intervals. Exactly how often one should go for mammograms is unknown. The US recommends every year. The UK recommends every 3 years
- Women with a strong family history should start screening at a younger age and should go more regularly.
Written by Dr Jenny Edge