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!