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Breast Cancer Screening - Not Just Mammograms

As a hormone replacement physician who is helping optimize health for women daily, I feel breast cancer screening is extremely important and should be integrated into wellness plans. So often women are automatically generated an annual mammogram referral without ever having the opportunity to discuss the screening options. Women should be fully educated on what the screening recommendations are, what are the pros and cons of screening option are, so that THEY can decide what their cancer screening timeline will be.

Mammograms are the recommend form of screening for breast cancer. They are low dose xrays and can be 2D or 3D. Both 2D and 3D are similar in radiation doses, but 3D is slightly better for women with denser breasts and has a lower rate of call-backs for additional imaging. 3D imaging costs more, and your health insurance may or may not cover 3D mammograms.

There are countless studies showing reduced risk of breast cancer death with regular mammogram screenings, so the benefit it quite clear (especially in women ages 50+). Each society has their own screening recommendations, and they vary slightly.

  • The United States Preventative Services Task Force (which the CDC supports) recommends biennial screening for women ages 50-74.

  • The American Cancer Society recommends annual screening starting age 45, with optional screening beginning age 40, and continuing until less then 10 years of life is projected.

  • The American College of Obstetrics and Gynecology recommends annual or biennial screening beginning age 40 and continuing until age 75, after which age shared decision making is considered.

With mammograms there are small risks of call-backs (causing stress/anxiety), biopsies of benign tissue, false-negative images, and radiation. I find many women have declined screening mammograms because of the concern for radiation exposure, instead choosing other forms of cancer screening. Research has reported that, if you screen 100,000 women every year from ages 40-74, the radiation from mammograms is projected to cause 125 cases of radiation-induced breast cancer with 16 deaths, relative to the 968 breast cancer deaths avoided due to the screening. However, if the screening was changed from annual to biennial, the risk of radiation-induced cancer decreased 5-fold1.

Although self-breast exams and clinic breast exams are no longer formally recommended, they still have benefit (especially given that most breast cancers are found by women themselves!). They are quick, painless, and radiation-free cancer screenings that are often forgot about. Another option I get asked about is breast thermography. Thermography detects temperature changes in breast tissue. Cancerous cells are very metabolically active and can even make their own blood vessels, leading to an increase in temperature, which is picked up on thermography (detecting physiological changes in breast tissue vs anatomical). Although research results vary, thermographic detection of breast cancer is slightly inferior to mammography. Slightly being the key word here. For women who has chosen not to screen with mammograms, a combination of self-breast exams, clinical breast exams, and thermography is far superior to no screening. Unfortunately, thermography is often not covered by insurance.

Patients ask me all the time what my recommendations are for their breast cancer screening. I do give my honest, professional opinion, which is I recommend mammograms at least every other year ages 50-74, and any additional screening is optional. A nice screening protocol some patients have chosen is to do mammograms every other year with thermography on the off years. Regardless of what screening protocol women choose, I want to make sure they feel educated and supported in their decision.

Dr. Rueda practices functional medicine in Minneapolis, Minnesota. Please send a message through the contact form to learn more!

  1. Miglioretti DL, Lange J, van den Broek JJ, Lee CI, van Ravesteyn NT, Ritley D, Kerlikowske K, Fenton JJ, Melnikow J, de Koning HJ, Hubbard RA. Radiation-Induced Breast Cancer Incidence and Mortality From Digital Mammography Screening: A Modeling Study. Ann Intern Med. 2016 Feb 16;164(4):205-14. doi: 10.7326/M15-1241. Epub 2016 Jan 12. PMID: 26756460; PMCID: PMC4878445.


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