Screening Mammography Heidi K Henry, MD

UP Health System Marquette

Screening mammogram

  Asymptomatic patients

  Standard 4 images--CC and MLO views of each breast

What does breast cancer look like Examples

Signs of malignancy Spiculated mass

Signs of malignancy Focal asymmetric density

Signs of malignancy Architectural distortion

Signs of malignancy Clustered micro calcifications

Malignant calcifications Regional

Signs of malignancy Asymmetric density

Diagnostic mammogram

  Patient is symptomatic ( lump, nipple discharge, focal pain or swelling)

  Includes necessary additional views ( magnification views or compression views)

  Follow up an abnormality

Patient with lump

Ordered correctly as a diagnostic

mammogram reveals invasive lesion

Call backs

  Finding seen on screening mammogram that requires additional views

  May need spot compression views, mag views or ultrasound

  Approximately 1o% of patients

  Patient stress and anxiety

Call back for modular density Simple cyst

Call back for small mass Spot compression views help assess borders

Small invasive carcinoma Small solid mass

Ultrasound often used to assess densities, distortion and masses Performed same day as additional views

Screening mammography Sorting through the chaos

Risk vs benefit Balancing act

Risks

  Patient anxiety/stress

  Cost

  Over diagnosis

Overdiagnosis

Benefits

  Early detection saves lives

  1/3 reduction in breast cancer deaths since screening mammography became widespread since 1990

Beginning annual

mammography at 40 saves the

most lives All groups agree on

this. Disagreement is on balance of harm vs

benefits.

Percentage of new breast cancer by age

Size matters Mammography finds lumps 1/8 the size than

occasional self exams

Benefits of starting screening at 40 ACR, SBI, ACCG, NCCN

Screening high risk patients Guidelines

34 year old. BRCA 1 Example screening

34 year old screening MRI

Allows for targeted ultrasound biopsy If not seen by ultrasound, then do MRI biopsy

38 year old screening Mother breast cancer at 42

Previous biopsy of ADH

Screening MRI

38 year old High risk patient

Targeted ultrasound Reveals suspicious mass

Ultrasound guided biopsy

Michigan's new breast density law Patients informed of their breast density, it's

limitations, and increased risk

Dense breasts relative risk .

Familiar scene UP winter

Guidelines for women with dense breasts

Case by case

What else is new in mammography? Breast tomosynthesis

3D mammography

Tomosynthesis Reduces call back rate

Improved detection in dense breasts

Cancer detection rates And recall rates

One size does not fit all Mammography is becoming more tailored

Breast imaging team UP Health System Marquette

Thank You!