Understanding Updated Breast Cancer Screening Guidelines: TRA Medical Imaging's "Lucky Ones"
When Mary Nam of KOMO News was diagnosed with breast cancer, it came as a shock, but she’s “lucky.” Nam had no family history of breast cancer, was just 40-years-old and a test for any genetic mutations that might lead to cancer had come back negative. Her first regular two dimensional (2D) mammogram found no evidence of the disease but as one of many women with dense breast tissue, she was then offered a second mammogram using three dimensional (3D) technology with which doctors discovered five separate invasive lobular carcinoma tumors, for which she was subsequently treated.
Nam’s so-far fortunate story illustrates the importance of knowing your risk, understanding best recommendations, and the critical advantages of 3D mammography. At Olympia’s TRA Medical Imaging, 3D mammography is the norm for all patients, many of whom are grateful for their own early diagnosis. While there are many different groups making (sometimes confusing) recommendations, Dr. Grant Tibbetts of TRA recommends those of the American College of Radiology (ACR) and Society of Breast Imaging and appreciates the guidelines of the American Society of Breast Surgeons (ASoBS), which are even more specific for women of higher risk, and pointedly direct women to choose the advantages of 3D whenever possible. Those guidelines include the following recommendations:
Women 25-years-old and over should undergo formal risk assessment for breast cancer (the ACR recommends this by age 30). This assessment looks at seven key factors, and results help to determine at what age annual breast screening should begin. Women found to be at exceptionally high risk for cancer due to a known or suspected genetic mutation such as BRCA1 or BRCA 2 should begin screening by the time they are 30-years-old! Dr. Tibbetts explains, “These mutations are like signposts indicating very high risk for breast cancer.” In addition to these and family history, additional common risk factors include: obesity, smoking, nulliparity and breast density.
Women (like Nam) with an average risk of breast cancer should initiate yearly screening mammography at 40-years-old. This is earlier than some guidelines recommend, but with good reason. Breast cancer is the number one cause of cancer death in women 35- to 54-years-old and catching it early saves lives: mammography has been proven to reduce deaths due to breast cancer in women who began screening at 40-years-old.
Women with a higher-than-average risk of breast cancer should undergo yearly screening mammography and be offered yearly supplemental imaging. This risk is knowable. Modern medicine now recognizes several high risk groups and your doctor should be able to help you understand these and make appropriate recommendations. Recently highlighted, for example, we now know African-American women are 42 percent more likely to die of breast cancer than others, suggesting a more aggressive course. These are other high risk patient groups should begin screening earlier and may benefit from supplemental imaging. The ACR strongly endorses screening MRI in addition to mammography in patients for whom that risk is greater than 20 percent, while others may also benefit in some cases.
One further recommendation, according to TRA’s Dr. Tibbetts, echoing the ASoBS: “Use 3D mammography whenever possible. In recent years, studies in the literature have consistently shown that 3D improves detection and reduces call-backs for false positives,” he explains. “In many cases like Nam’s, we may not have seen the cancer on a standard 2D examination.”
All TRA sites offer 3D mammography from the very first visit, often allowing earlier cancer detection. This breakthrough tool provides patients with peace of mind due to its increased level of accuracy. Studies have shown a 10 to 30 percent increase in overall breast cancer detection through using 3D mammography and also show that fewer patients get called back for further investigation, the best of both worlds. “I sleep better at night knowing we are using the best tool available,” says Tibbetts.
If you would like to schedule a mammogram at TRA’s Olympia office on Lilly road, give them a call or drop on in to the Memorial Medical Plaza. You may reach TRA’s offices at 360-413-8383 where they will be happy to get you in soon.
Nam realizes that things could have gone a very different direction. “If the radiologist had said, ‘Nah she’s only 40, she doesn’t have history, and she’s healthy – this can wait until she’s 45 or 50’…I shudder at the thought,” she says. “I am one of the lucky ones.” For more information about Mary Nam’s story, click here).