Sally Herschorn, MD, is Director of the Breast Imaging Division at the University of Vermont Medical Center.

Last month, I shared with you some information designed to help you assess your own risk of breast cancer, as well as some proactive tips for maintaining breast health.  This month, I want to provide you with a little more detail about some of the early detection methods available and how to choose the facility providing them.

Increase your chances of early detection

Mammography: All women 40 and over should have annual mammography. The pros and cons of this were discussed in an earlier blog.

  • Digital mammography has a higher detection rate for breast cancer in most women. Look for a mammography facility that has digital equipment and for a radiology team that reads a high volume of mammograms.  All mammography facilities are quality-certified by the FDA.  At the UVM Medical Center, we interpret over 25,000 mammograms a year; more than any other facility in the region.
  • Computer aided detection can help mammographers find more breast cancers as can the practice of double reading mammograms. At the UVM Medical Center we use computer aided detection when reading mammography and double reading for difficult cases.

Supplementary Screening: While mammography has been proven to save lives, it still suffers from being imperfect; and failing to detect cancers that are present, but are masked by normal tissue. This is especially true in women with dense breasts and in those who are at increased risk based on family history. If you have dense breasts or are at increased risk based on family history, you should discuss with your physician whether you wish to have a supplementary screening in addition to mammography. This may include hand-held ultrasound, whole breast ultrasound, molecular breast imaging or MRI. Each of these tests has its pros and cons. Not all of these are available at every Breast Center.  At the UVM Medical Center we perform supplementary screening, when indicated, with ultrasound, for those who don’t meet criteria for screening MRI; and with MRI, for those who have an estimated 20-25% or greater lifetime risk of breast cancer. MRI supplementary screening is recommended for certain women with a high risk based on family history, genetic mutations, or prior history of radiation to the chest for cancer.

Breast Magnetic Resonance Imaging (MRI): MRI provides a detailed image of the breast and uses no ionizing radiation. There is great variability of image quality and technique and of skill in interpretation. Your best bet is to find a facility accredited to perform breast MRI by the American College of Radiology (ACR):

Many facilities have general MRI accreditation, but a specific accreditation for breast MRI will ensure your exam is of the highest quality and that they can perform an MRI guided biopsy if there is a need.  Accreditation only opened in May 2010, and the UVM Medical Center is among the first facilities to receive this accreditation.

Breast Imaging Center of Excellence: Seek out an ACR-accredited facility carrying the Breast Imaging Center of Excellence. This means the facility provides the highest quality care in mammography, breast ultrasound, ultrasound guided breast biopsies and stereotactic breast biopsies. The UVM Medical Center has been a Breast Imaging Center of Excellence since 2009.

Wrapping up
Finally, if you don’t have health insurance and are concerned about the cost of the mammogram, ultrasound or biopsy that was recommended, there’s help on hand. Ladies First (http://healthvermont.gov/prevent/ladies_first.aspx) will cover screening costs for Vermonters who qualify and will cover costs of subsequent treatment when needed. This federally funded program has been very flexible in covering applicants; sometimes even covering retrospective costs for those who qualify.

I would be happy to answer any of your questions regarding individual imaging techniques or breast cancer screening in general.

To read Part One of Taking Control of Your Breast Health, click here.

Sally Herschorn, MD, is Director of the Breast Imaging Division at the University of Vermont Medical Center and Associate Professor of Radiology at the Larner College of Medicine at UVM.

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