Mammograms, ultrasounds, MRIs, thermography … you may have heard different recommendations for breast imaging and perhaps you feel confused about the best plan for you. Here, we’ll de-mystify the recommendations and help you make a plan (with your family doctor and your plastic surgeon) that makes sense for you.
Let’s begin with a few definitions:
Mammogram- A breast xray that uses low doses of radiation (like any xray). Useful in both screening and helping to diagnose breast problems.
Ultrasound – Ultrasound waves bounce off breast tissue and create an image of the deeper tissues. Can be combined with Doppler to assess blood flow. Often used to get additional information after mammogram.
Magnetic Resonance Imaging (MRI) – A strong magnetic field and pulses of radio wave energy form an image of breast structures. A more expensive tool, with good specificity. Usually reserved for problem-solving after imaging with mammogram and ultrasound, for screening of women with very high breast cancer risk (such as BRCA mutations), or imaging silicone gel implants. Thermography – Detects changes in heat near the skin surface. Breast cancers may have increased blood flow and inflammation, theoretically visible as temperature differences. Not approved by Health Canada or the FDA for breast cancer screening, and not recommended by Banff Plastic Surgery for our patients. Note: Don’t confuse thermography with tomography. Tomography is a useful 3-D technology that enhances mammograms by looking at serial sections of breast tissue.
What are current recommendations for breast cancer screening for the average woman?
This is a controversial topic, as different agencies have different recommendations.
Canadian Cancer Society:
- Age 40-49: Talk to your doctor about your risk of breast cancer / potential benefits
- Age 50-69: Screening mammogram every 2 years
- Age 70 and over: Talk to your doctor about your risk and the potential benefit of mammogram
Canadian Task Force on Preventive Health Care:
- Age 40-49: No routine screening in average-risk women
- Age 50-74: Screening mammogram every 2-3 years
Canadian Association of Radiologists:
- Age 40-49: Screening mammogram yearly
- Age 50-74: Screening mammogram every 1-2 years
- Age over 74: Screening mammogram every 1-2 years
You can see that these recommendations vary to some extent, especially for younger women. It’s important to consider your family history and other risk factors, as more frequent screening may be recommended for women at higher risk. At the same time, overdiagnosis and false positives can be problems with screening programs, so over-testing is not always the best answer.
In Alberta and British Columbia, women between the ages of 50 and 74 can self-refer for screening mammograms, and don’t require a referral from a doctor.
I am having elective breast surgery (breast reduction, lift, or implants). What studies should I get before my surgery?
At Banff Plastic Surgery, we will discuss our imaging recommendation with you before your scheduled surgery. In most cases, we will recommend following the Canadian Cancer Society guidelines, and we may recommend screening mammography for some women between 40 and 49. In most women 50 and over, we will want a clear mammogram within not more than 2 yrs prior to surgery. Most women under age 40 will not require any breast imaging before elective surgery.
Women who have had a personal history of breast cancer or carry a BRCA mutation may be asked to have a clear mammogram within not more than 1 year prior to surgery.
How soon after surgery can I get a mammogram?
Another advantage of being up-to-date with your screening before surgery is that you’re less likely to need a mammogram soon after surgery. While it’s unlikely that a mammogram would damage your surgical result, the compression that’s necessary may not be comfortable for 6 months or more. Call us any time you have concerns about your breasts and we can help determine if any imaging is necessary.
I have breast implants –should I still get a mammogram?
For our many patients with breast implants, we still recommend following national screening guidelines. Some mammography centres may do “implant displaced” views, which are additional pictures that help the radiologist image augmented breasts. Mammograms are not the most accurate tool for diagnosing implant-related problems such as rupture. Your radiologist may recommend supplemental ultrasound, or rarely, MRI, to help visualize implant problems. There is no evidence that mammograms lead to implant rupture.
Can a mammogram tell me if my implants are ruptured?
While mammography will sometimes suggest implant rupture, it’s not very sensitive, particularly for ruptured implants that are contained within the capsule. When implant rupture is suspected, MRI may be suggested. If you are having problems with your breasts (such as capsular contracture) we may suggest just going ahead and treating the problem without further testing because surgery is the most accurate way to determine implant rupture.