Which Is Better for Breast Cancer Screening?

What is a mammogram?

A mammogram is a breast examination technique done by using low-dose X-rays. A screening mammogram is made up of four pictures (two of each breast) that are used to check for breast cancer in women.

A mammogram is done as screening for breast cancer for women who are with and without symptoms, such as a lump or nipple discharge.

The most efficient technique to identify breast cancer early is with a high-quality mammogram combined with a clinical breast exam performed by the doctor. Early detection of breast cancer considerably enhances a woman’s chances of effective treatment. A mammogram is cost-efficient and is feasible for most women.

A mammogram shows abnormal changes in the breasts, such as:

• Lump: The size, shape, and margins of a lump can sometimes help physicians identify whether it is cancerous. A benign (noncancerous) growth on a mammogram frequently appears smooth and spherical, with a clear, defined outline. Breast cancer is frequently characterized by a jagged edge and an uneven form.
• Calcification: Calcium mineral deposit in the breast tissue. On a mammogram, calcifications show as little white dots.
  • These are of two types:
    1. Macrocalcifications: Enormous calcium deposits that are frequently the result of aging. These are not generally a symptom of cancer.
    2. Microcalcifications: Calcium specks that can be detected in areas of rapidly proliferating cells.

If calcifications cluster in a certain pattern, it may be a symptom of malignancy. The doctor may recommend additional testing based on the number of calcium specks and their size and appearance. Calcium from the diet does not cause calcium deposits in the breast.

3 disadvantages of mammogram

1. Radiation exposure: Mammogram uses X-rays for imaging, and frequent radiation exposure may cause cancer. However, various studies have found that the risk of breast cancer from radiation released during a mammogram is extremely low among women aged 50 to 69 years who engage in screening.
2. Waiting for additional investigations: Some women may be found with small irregularities in the images, which makes them go for further examinations and investigations to get the ultimate diagnosis. This waiting time can increase anxiety among such women.
3. Missed diagnosis: Mammograms may fail to detect minute cancers that were underdeveloped during the time of screening. These left-out cancers later develop into serious conditions.

What is an MRI breast?

Magnetic resonance imaging (MRI) breast is a technology that employs a magnetic field to build a picture of breast tissue by taking hundreds of photographs rapidly. It does not employ radiation or X-rays in the same way as a mammogram does. An injection into a vein in the arm is frequently required for a breast MRI (contrast MRI).

MRI breast is the best screening test for breast cancer in women.

9 indications of MRI breast

1. Women with a high risk of breast cancer, who have a family history of breast, ovarian, or fallopian tube cancers
2. Women who have genetic mutations in the BRCA1 or BRCA2 gene
3. Women younger than 50 years who have thick breast tissue
4. Learning more about cancer that has already been discovered in the breast
5. After cancer has been identified in one breast, check for cancer in the other breast, which appears to be healthy
6. Monitoring the response to treatment, such as chemotherapy before surgery to the breast and lymph nodes
7. Seeking new tumors after earlier breast cancer therapy
8. Monitoring breast implants for symptoms of leaking
9. Looking for changes in the breast when suspicious nodes are discovered in the armpit

Even though MRI sounds more sophisticated, it is not a replacement for a mammogram. Although an MRI can detect abnormalities that a mammogram cannot detect, certain cancers can only be detected by a mammogram. Women who are at high risk of breast cancer should get a mammogram every year, ideally at the same time as the MRI.

2 limitations of MRI breast

1. Not cost-effective: An MRI is an expensive examination that is not affordable for most people, unlike a mammogram.
2. Overtreatment: Breast cancer may occasionally be overtreated as a result of MRI.

If an MRI reveals that there is more cancer in the breast than predicted, the medical team may propose a mastectomy rather than breast conservation surgery. This may be unneeded if the alterations detected on the MRI are not connected to the malignancy. Thus, it is crucial to confirm abnormalities seen on the MRI with a biopsy.

Evidence suggests that further surgery is not necessarily required for tiny regions of MRI-detected malignancy. Almost all women who have breast-conserving surgery will have radiation. Radiotherapy may effectively treat these little additional areas of cancer.

Some features of an MRI

• Noisy machine: The MRI scanner is quite loud, and the interior of the machine might seem tight. The women will be given earplugs to help decrease noise and a button to push if wanted assistance.
• Narrow space: MRI machine tunnel is narrow, which makes it difficult for women with larger bodies to fit in properly. Women who are claustrophobic or uncomfortable in tight spaces may be unable to have an MRI scan because it increases anxiety.
• Longer waiting time: If the scan is required in women who are uncomfortable going through with it, oral or intravenous sedation may be used. This requires planning to do the scan securely, and it increases the waiting time for an appointment.
• Breast implants: Women who undergo MRI must inform about breast implants. Though an MRI does not cause any harm to the implants, the necessary settings of the machine are to be changed to go on with the scan.
• Allergic to contrast: A contrast will be injected into the veins of the women who undergo an MRI. Some women may be allergic to such chemicals. So, they must be informed earlier about the use of contrast, and they should inform the same to the doctor or the technician before the examination.

The guidelines for breast cancer screening in women

Various guidelines are proposed by several organizations and physicians.

Here are the guidelines by the American Cancer Society:

• Women aged 40 to 49 years with an average risk
  • These women should begin breast cancer screening with a mammogram one time a year if it is their preference. The risks of screening should be balanced against the possible advantages.
• Women aged 50 to 74 years with an average risk
  • Usually, a mammogram should be performed on women aged 50 to 54 years old one time a year.
  • Mammogram screening is advised one time every two years or a year for women aged 55 years and older. These women may be given the option to continue screening yearly or every two years.
  • Clinical breast examination to test for breast cancer is not indicated for women at moderate risk.
• Women aged 75 years or older with an average risk
  • Women aged 75 years and older should maintain mammogram screening if their overall health is satisfactory, and they have a life expectancy of 10 years or more.
• Women with dense breasts
  • Women with dense breasts are usually advised magnetic resonance imaging (MRI) screening for breast cancer. However, no sufficient evidence recommends yearly screening with MRI.
• Women at high risk
  • The guidelines to screen for breast cancer in high-risk women vary. Different screening guidelines may be recommended for women who have risk factors, such as:
    • A BRCA1 or BRCA2 mutation
    • An untested family member of someone who has a BRCA1 or BRCA2 mutation
    • A history of mantle or chest radiation before the age of 30 years
    • A lifetime breast cancer risk of 20 percent or higher based on their family history