Diagnostic Radiologist Carol Lee Answers Questions about Breast Imaging Methods

By Memorial Sloan Kettering

on Wednesday, October 10, 2012

Pictured: Carol Lee Diagnostic radiologist Carol Lee

During Breast Cancer Awareness Month, Dr. Lee discusses mammography, breast MRI, and breast ultrasound.

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 at the Evelyn H. Lauder Breast Center and 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.

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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.

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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.

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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.

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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.

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I have become a pretty big supporter of this month and what it stands for. The mother of one of my oldest friends, her name is Chrissy, is a breast cancer survivor, and she is still with us because they were able to identify the disease at an earlier stage. I think that is one of the most important aspects about this month, helping to remind women and men everywhere of how crucial breast cancer screening and early detection are. So in honor of this month, I would like to share with you a brand new breast cancer awareness infographic which can be viewed at: http://www.knowcancer.com/blog/breast-cancer-awareness-month-infographi…

I was suppose to have cyst. Well, they werent cyst but cancer. It was too late and I had Stage IV Breast Cancer. Its been 4 years but I can feel it catching up to me. I had liver mets and now brain tumors.

Does Sloan-kettering offer FAST MRI as a screening for breast cancer yet. If not are there plans in the near future to offer that type of screening?

Corinne, we forwarded your question to Dr. Maxine Jochelson, Director of Radiology at our Breast and Imaging Center, and she responded, "We at MSK are very interested in "FAST" or abridged MRI and in fact have published on the topic. At this point, however, we do not offer FAST MRI because we believe that there is not yet enough data to confirm that it is as good as or nearly as good as a full MRI. We do, however, plan on taking part in future research testing FAST MRI. Once we are convinced that it is accurate enough, we will offer it here." Thank you for your comment.

Is there any benefit to having a 3D mammogram as a routine screening tool? What is your recommendation on that?

Thank you for reaching out. This question was posed before on a different blog story and Dr. Lee responded: "The experience with tomosynthesis (the actual name of the so-called 3D mammograms) is still early. Some studies have shown a better cancer detection rate but others have not compared it with the regular digital mammogram. All of the studies so far do show a decrease in false-positive readings with tomosynthesis."

You also may be interested in thisQ & A with Dr. Lee on breast density:


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