Diagnosis

For Women between Ages 40 and 49. Whether premenopausal women should have routine mammograms is controversial. The areas of debate are as follows:

• Arguments against Regular Screening. Numerous studies report that any survival benefits from regular mammography in this group are likely to be small compared to breast examinations alone. Most of the arguments against mammography in this population are due its inefficiencies in this age group. The probability that woman in this age group with a suspicious mammogram will actually have breast cancer is only 2 - 4%. Frequent screening becomes very cost-inefficient and produces many unnecessary biopsies. In addition, breast tissue is dense in premenopausal women, and mammography often fails to detect breast cancers that are present. Breast cancers in this age group are also often aggressive, and 2-year intervals may not detect them early enough to affect survival.
• Arguments for Regular Screening. Breast cancer fatality rates are highest in women between ages 40 and 49. In spite of some negative studies, recent ones find some survival benefits for screening every 1 - 2 years. Advances in imaging techniques are helping to improve accuracy.

For Women Over 69. Most breast cancers appear in women over 70 and such women are more likely to be diagnosed at a later stage, most often because of less frequent screenings. Still, experts disagree about the benefits of regular screening in older women. Some evidence suggests that regular screening would prevent only about 1 death per 1,000 women screened. Elderly women are also particularly likely to have non-malignant abnormalities in their breasts and so undergo unnecessary biopsies.

Other Imaging Techniques

Magnetic Resonance Imaging (MRI) and Ultrasound. MRI and ultrasound techniques can detect very small tumors (less than half an inch). However, they are expensive and time-consuming procedures. Nevertheless, some experts believe they are important in identifying small tumors missed on mammography in women who are receiving lumpectomy or breast-conserving surgeries. Such findings would allow the surgeons to remove the optimal amount of abnormal tissue. Ultrasound may also be particularly important for women with dense breast tissue who show signs of breast cancer.

Scintimammography. In scintimammography, a radioactive chemical is injected into the circulatory system, which is then selectively taken up by the tumor and revealed on mammograms. This method is very accurate in detecting the presence or absence of breast cancer, and some experts hope that it might eventually reduce the number of unnecessary invasive biopsies.