A Combination of Tests Increase Breast Cancer Detection Rates

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Interview with Dr. Berg

Decoded Science had the opportunity to interview Dr. Berg about her study. When asked about which test or combination of tests that best detected breast cancer, Dr. Berg said,

MRI scans proved to be the single best test for detecting breast cancer. Photo by: Jan Ainali

“As a single test, MRI is the most sensitive.  There are still some cancers seen only by mammography, so the combination of MRI and mammography detects the most cancers.  That said, MRI requires intravenous contrast, and some women are claustrophobic or have metal implants or a pacemaker or have other reasons why they are not able to have an MRI. Ultrasound is much better tolerated than MRI, and the combination of ultrasound and mammography detected many more cancers than mammography alone in the women in our study, all of whom had dense breasts and at least one other risk factor for breast cancer.  Based on the results of our study, it appears that the combination of mammography and ultrasound offers a good balance of tolerability and detection of early invasive breast cancers.”

Decoded Science asked Dr. Berg about the false positive rate that was associated with the additional testing and Dr. Berg explained,

“This would be true any time we add a second test that uses different information to detect cancer, as no test is perfect. False positives are most common the first time a test is used, and decrease in subsequent years.  In years two and three of our study, 7% of women were recommended for extra testing because of ultrasound.  Because this study was tightly conducted, with specified interpretive criteria, we learned a lot about many very low suspicion lesions we see on ultrasound that do not require follow up or biopsy, such as multiple similar benign-appearing masses in both breasts. With ultrasound, another study I was involved with tested elastography, which is available on many current machines, which tests the stiffness of a mass on ultrasound.  Benign masses tend to be soft, and this can help avoid unnecessary biopsy for low suspicion lesions. 

Extra testing is even more common with MRI than with ultrasound, with 20% of women needing extra testing with a single MRI. This rate decreases with subsequent screening MRI examinations, but remains higher than the rates seen with ultrasound.”

Based on the results from this study, Decoded Science asked Dr. Berg about her recommendations for women regarding which test or combination of tests is best.

“All women over age 40 who are otherwise in good health should be getting annual mammograms.  In women who have fatty breasts, mammography is a very good test.  

For women who are at high risk because of a known BRCA-1 or -2 mutation or suspected genetic mutation, or who have a very strong family history of breast and/or ovarian cancer or prior chest radiation therapy before age 30 and at least 8 years earlier, annual MRI is recommended in addition to mammography, starting by age 30. MRI also increases cancer detection in women with a personal history of breast cancer.

For intermediate risk women with dense breasts, or high-risk women with dense breasts who cannot or do not want to get an MRI, adding ultrasound to mammography has been validated by our study, provided the woman is willing to accept the risk of false positives. If a woman chooses to have an MRI, there is no benefit to also having screening ultrasound.”

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