The purpose of routine screening with mammography is to detect cancers of the breast at the earliest possible stage. Depending on your age, risk factors, and personalized health assessment, we customize our screening recommendations to best suit your needs and personal preferences.
Many women mistakenly believe that a family history of breast cancer is the biggest risk factor. Although it is one of the major risk factors, most women who develop breast cancer, have no significant family history. Breast density – the proportion of fibroglandular tissue in the breast compared to fatty tissue – is one of the most significant factors in the development of breast cancer. Breast density can be determined with mammography or MRI however, it is not routinely reported with mammography in Canada.
Other factors that can influence risk of developing breast cancer include: past or present use of hormone therapies (including oral contraceptives and hormone-IUDs), genetic factors that can be inherited or acquired (i.e. carriers of the BRCA1, BRCA2, COMT or PTEN gene mutations) and alcohol consumption.
The effectiveness of mammography is determined by several factors. One factor is the proportion of dense-to-fatty tissue in the breast. Another factor is the degree of calcification that can be a defining feature of some abnormal lesions.
Mammography has a greater sensitivity of cancer detection in fatty tissue and lesions that are characterized by calcifications in the breast. Dense tissue on the other hand, appears opaque on a mammogram, resembling cancerous lesions and making it difficult at times to distinguish between normal dense tissue and abnormal tissue. However, with recent advancements in digital mammography, there is slightly better detection of cancerous lesions in dense tissue. For women who know they have moderate to extremely dense tissue, it is advisable to supplement routine screening with breast MRI or breast ultrasound, but this is not always a routine practice in Canada. A recent study of European women found MRI to be superior than mammography and ultrasound in high-risk women (i.e. strong family history, genetic carriers of BRCA1/2 or other inherited mutations and women with dense breasts).
Ductal carcinoma in situ (or DCIS) is best diagnosed by mammography. If a mammogram has a suspicious finding, it is often followed with a diagnostic mammogram, which provides several views of the breast to better characterize the lesion or area of concern. If needed, a biopsy (sample of the breast tissue) is performed to determine if there are cancerous or pre-cancerous cells.
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