Annual Mammograms may not be Enough

Breast cancers revealed earlier with more screens

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) In the constantly swirling debate about breast cancer screenings, recommendations are always changing. The controversies surround age to start mammograms, frequency and whether to have mammograms at all.

In a new wrinkle, more tests may be appropriate for some women.

Researchers have found that women who are at high risk of developing breast cancer and those with dense breasts may benefit from adding screening ultrasound and magnetic resonance imaging (MRI) to their annual breast health check-ups.

"Ask your doctor about the best breast cancer screening tests for you."

These additional tests increased the number of breast cancers detected, researchers found in a study published April 4, 2012 in JAMA (Journal of the American Medical Association).

Wendie A. Berg, M.D., Ph.D., formerly of the American College of Radiology Imaging Network, led the study to determine the impact of supplemental testing on detecting breast cancers among high-risk women.

The article states that annual ultrasound screening may find cancers not seen with mammography, and that MRI can detect breast cancers that both mammography and ultrasound miss.

For the study, 2,809 women from 21 screening facilities underwent three annual mammography and ultrasound screens in randomized order.

Just over half (54 percent) of the participating women had a history of breast cancer and the median (in the middle) age was 55.

After three rounds of both screenings, here's what researchers found:

  • 110 women had 111 incidences of breast cancer.
  • Of these cases, mammography found 59 cancers; ultrasound only found 32.
  • MRI discovered nine cancers after the other screens failed to detect cancer.
  • 11 cancers were missed by all imaging methods.
  • For each annual screen beyond mammography, 4.3 cancers per 1,000 women were found, increasing detection with each annual screen beyond that of mammography.

While the increased sensitivity may be helpful for high-risk women, the authors conclude, that "the addition of screening MRI rather than ultrasound to mammography in broader populations of women at intermediate risk with dense breasts may not be appropriate, particularly when the current high false-positive rates, cost, and reduced tolerability of MRI are considered." 

The study was funded by the Avon Foundation and grants from the National Cancer Institute.

A number of authors disclosed financial relationships with various companies. 

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Review Date: 
April 3, 2012
Last Updated:
April 3, 2012