Mammograms: Early detection saves lives
While getting a mammogram may not seem like the most glamorous activity, Dr. Matt Miller, a radiologist at Allegheny Health Network, said it’s the “single biggest thing that a person can do to help them overcome a breast cancer diagnosis.”
Though a screening mammogram will not immediately diagnose breast cancer, the imaging is used to find changes in the breast that may or may not be suspicious. The scan typically includes four pictures, two of each breast.
While breast cancer can develop at any age, Miller said the disease often peaks around age 52. “You can get breast cancer at any age. The youngest I’ve seen was, I think, 18. My wife was 29 when she got it,” Miller said. “But of the vast majority of patients who get breast cancer, it peaks around 52.”
Since the disease’s bell curve is in the early 50s, experts recommend that annual mammograms begin around age 40. Age 40 is that sweet spot for screening because that’s when people start to approach that peak.
“You don’t want to start screening at the peak. You want to start years before the peak,” said Miller. However, if there is a genetic predisposition to the disease or high risk, earlier screening is recommended.
Earlier screening is not encouraged, partly because it’s uncommon among young people. “Anything before 40, you’re getting kind of diminishing returns because the incidence isn’t high,” said Miller. Another reason is that there’s a risk of inaccurate results due to the different anatomy of younger breasts. Younger breasts are typically denser, making a breast cancer mass difficult to detect, Miller said.
However, Miller emphasizes that having denser breasts doesn’t mean mammograms should be avoided, but rather accompanied by other studies, such as an MRI or screening ultrasound.
According to Miller, 10% of patients who get a screening mammogram get called back for additional screening. This doesn’t mean that they necessarily have breast cancer, but possibly a benign mass or cyst. Of those 10%, Miller said about a third go on to have a biopsy, and only a third of those patients are diagnosed with breast cancer.
Though the mammogram involves slight exposure to radiation, Miller emphasizes that the procedure is safe.
“The amount of radiation that we expose the breast to with a mammogram is not zero. But it is less than a trans-Atlantic flight to Europe,” Miller said. “No one’s canceling their European vacation due to radiation. People should not cancel their mammogram.”
The technology was developed during the 1980s and became the prevalent screening tool in the 1990s. Since the implementation of annual mammography in healthcare, the technology has saved countless lives.
“Mammograms have been around since, I think, the 80s. But we really started using them as a screening tool in the early to mid-90s,” said Miller. “And it was around that time that the mortality rate of breast cancer started dropping significantly. So, since the mid-90s, the mortality rate of breast cancer has dropped 50%.”
In other words, the number of people dying from breast cancer has been cut in half. While other factors — such as chemotherapy, radiation and hormonal therapy — have played a role, Miller said he believes the advent of annual screening is directly tied to this reduced mortality rate.
While mammograms have been the standard technology for diagnosing breast cancer since the 1990s, doctors have started implementing a newer technology.
Contrast-enhanced mammography, or CEM, is a screening process similar to a mammogram, but it can offer clearer results. The process was developed in 2011; however, it has only recently become available to patients.
While this type of screening isn’t available everywhere, many hospitals, including AHN and UPMC, are starting to incorporate it into their typical diagnostic routines. Dr. Terri-Ann Gizienski, a diagnostic radiologist at UPMC, said UPMC began offering CEM in May. Miller said AHN expects to start using this emerging technology in early 2027.
During this screening, contrast dye is injected into the patient’s veins through an IV, allowing the radiologist to see areas of the breast more clearly, said Gizienski. Similarly, the process uses the same machine as regular mammograms and takes about 30 minutes.
Gizienski emphasizes that the procedure is a solid option when other tests are not available. “For people who are claustrophobic or have a pacemaker and can’t get an MRI, it’s a really good option,” said Gizienski.
Rather than replacing mammograms altogether, CEM is a supplemental tool to produce better results. Current supplemental tools require separate screenings, such as ultrasounds, which can be uncomfortable and require additional time.
“So right now, supplemental screening is performed by a screening ultrasound, which is basically what it sounds like. You lie on a table, and a technologist or a machine runs an ultrasound probe over your breast and sees if they see anything suspicious,” said Miller.
Contrast-enhanced mammography approaches the same level of sensitivity as an MRI. However, it can be a more useful tool because you don’t have the uncomfortable nature of land on your belly it’s typically more comfortable for the patient.
