On Cancer: Diagnostic Radiologist Carol Lee Answers Questions about Breast Imaging Methods

At Memorial Sloan-Kettering, a team of more than 80 physicians and nurses provides care to women diagnosed with breast cancer. To detect this disease at its earliest, most curable stages, we also offer diagnostic services through our Breast Screening Program and at the Breast Examination Center of Harlem.

We recently asked our Facebook fans to submit questions about breast imaging – including mammography, breast MRI, and breast ultrasound – for diagnostic radiologist Carol H. Lee. Dr. Lee answers these questions below.

Do you recommend breast MRI before surgery for women with breast cancer?

MRI has been shown to be useful in some women with a new diagnosis of breast cancer to help better determine the size of the cancer and to help find other potentially cancerous areas in either breast. This type of imaging can also help surgeons plan the most appropriate operation.

There are, however, cases in which MRI does not add any useful information. In addition, there is a chance of a false-positive reading. This means that something is seen on the MRI that might require a biopsy, but the biopsied tissue is found to be benign. Whether MRI scans should be done before breast cancer surgery is a topic that should be addressed by a patient and her surgeon.

If a woman who has been treated for breast cancer is nervous about sensitivity and pain during a mammogram, could ultrasound be an alternative?

Mammography is the only test that has been proven to decrease the death rate from breast cancer, and it should be used in all women with a history of breast cancer. Ultrasound can be useful as a test in addition to mammography, but ultrasound can miss findings that mammography can detect. It should not be used in place of mammography.

My mother had breast cancer when she was in her 40s. When should I start getting a mammogram? Are there any other screening tests I should be getting as well?

Medical experts at Memorial Sloan-Kettering recommend that women at average risk of breast cancer start having screening mammograms at age 40. For high-risk women, including those with a family history such as yours, having mammograms earlier might be a good choice. Also, for women who are at very high risk, adding MRI screening to regular mammography may be recommended. You and your doctor should decide on the best screening strategy for you.

No one in my family has ever had breast cancer. Can I wait to have my first mammogram until I’m 50?

It is important to know that about three-quarters of all breast cancers occur in women without a family history of the disease. Also, about one in five breast cancers occur in women who are in their 40s, and nearly half of all the years of life saved through screening mammography occur in women who are diagnosed in their 40s. For this reason, we recommend that women – even those without a family history of breast cancer – start getting a mammogram at age 40 and have one every year.

Should a woman in her 80s with a history of breast cancer continue having regular mammograms?

Whether a woman with a history of successfully treated breast cancer – or any woman, for that matter – should continue to have regular mammograms depends on the state of the woman’s health. If a woman in her 80s is in good health, having a mammogram could be beneficial. She should make the decision in consultation with her physician.