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Medical Edge Newspaper Column from Mayo Clinic

IMPLANTS OR NOT, MAMMOGRAPHY REMAINS TOP METHOD
FOR BREAST-CANCER DETECTION

DEAR MAYO CLINIC: What is the best way to detect breast cancer in women with breast implants? Are new technologies superior to the mammogram? — Via e-mail

ANSWER: The tests recommended for detecting breast cancer are the same for all patients, whether or not they have breast implants. These tests include mammography, high-resolution breast ultrasound and breast MRI (magnetic resonance imaging).

A mammogram is a special X-ray of the breast. Mammogram machines are different from all other X-ray machines, as they produce “soft” X-rays that do not penetrate as deeply as regular X-rays. Mammography is the only approved method for screening the general population, and it is very effective in detecting early breast cancer in most patients. Mammography is still the only reliable method of detecting tiny calcium deposits, which can be cancerous or pre-cancerous.

Breast implants obscure the breast tissue on standard mammography, and so extra images — with the implants pushed out of the way — are needed. This means increased radiation exposure for the woman. In addition, when the fibrous capsule around the implant becomes hard, it’s difficult to get the implant out of the way. As a result, much less breast tissue is seen, especially if the implants are in front of the pectoral muscle.

Usually, doctors recommend a breast ultrasound or breast MRI only when a patient has an abnormal mammogram or is experiencing a breast problem, such as a lump or discharge of blood from the nipple. Ultrasound uses high-frequency sound waves to create an image. It can distinguish benign cysts from other abnormalities, and is frequently used as a guide for breast procedures such as a biopsy (tissue sampling) or cyst aspiration (fluid withdrawal).

Breast MRI is a highly technical and expensive test in which a very powerful magnet is used to obtain hundreds of images of the breasts, before and after an intravenous injection of dye material. During the study, which takes an average of 45 minutes, patients must hold very still, as any movement can make the test less accurate. Breast MRI is very sensitive and detects both cancerous and non-cancerous lesions. As some cancers and benign findings can appear similar, breast MRI can lead to unnecessary biopsies and undue anxiety.

Another test is a PET (positron emission tomography) scan, but it is used only in those patients already diagnosed with breast cancer. Radioactive glucose is injected intravenously and a special camera then takes images of the whole body. Recently, PET scanners have been merged with CT (computed tomography) scanners. The fused PET-CT images are able to locate an abnormality with greater precision.

Researchers continue to explore other ways of detecting breast cancer — for example, sestamibi scintimammography (SSM). Sestamibi is a radioactive substance used extensively to evaluate blood flow to the heart. Because intravenous sestamibi can also be taken up by breast tissue, it has been studied for many years as a possible way to detect breast cancer.

Until recently, SSM (renamed molecular breast imaging by some authors) could not reliably detect small cancers. Preliminary data with new specialized cameras suggests that it may be able to pick up smaller cancers that were previously missed. If substantiated by further research, SSM may be helpful in detecting breast cancer in combination with — but (ITALICS) not (END ITALICS) instead of — mammography, ultrasound and MRI.

Another experimental procedure is breast thermography, which uses an infrared camera to measure temperature differences on the breast surface. Although approved as safe by the U.S. Food and Drug Administration, it is not approved as a stand-alone screening test for breast cancer. Also, it is not recognized by the American Cancer Society or the American College of Radiology as a reliable diagnostic test, and currently is not covered by insurance.

There is no single perfect test for breast cancer. Although frequently maligned, mammography is the only test that has been proven to decrease mortality from breast cancer. Mammography not only remains the mainstay of breast-cancer detection, it is also critical to the accurate interpretation of all other breast-imaging studies.

— Patricia J. Karstaedt, M.D., Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz.

Additional Resources:
Mammography
Appointment Information
Breast Cancer
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.