Breast Imaging Update

Gaelyn Scuderi, M.D.

Jacksonville VA Outpatient Clinic

Objectives

Outline existing multiple recommendations for

screening mammography.

Summarize the current controversies surrounding

screening mammography.

Introduce new imaging technologies and define

parameters for usage of alternate screening modalities.

Answer common questions regarding the breast

imaging workup.

Controversies in Screening

Mammography

Age When to start?

When to stop?

Frequency Annual

Biennial

Breast density Increased risk?

Supplemental screening? Payment?

Overdiagnosis

BENEFITS vs. HARMS

Controversies in Screening

Mammography

Multiple Guidelines

American College of Radiology (ACR)

Society of Breast Imaging (SBI)

American Cancer Society (ACS)

US Preventative Services Task Force (USPSTF)

USPSTF

ACS

ACR/SBI

Less imaging

More imaging

Controversies in Screening Mammography

Yearly screening beginning at age 40

for average risk females

American College of Radiology and

Society of Breast Imaging

Controversies in Screening Mammography

Yearly screening beginning at age 30 for females with 20% or greater lifetime risk BRCA 1 or 2 positive

family history risk calculation

premenopausal first degree relative)

or ten years earlier than the youngest family member diagnosed with breast malignancy, not before age 25

Yearly within 8 years of mantle irradiation, not before age 25

Yearly in all women with biopsy-proven breast cancer or ovarian cancer

American College of Radiology and

Society of Breast Imaging

Controversies in Screening Mammography

Continue screening indefinitely as long as:

5-7 years of remaining life expectancy

Willing to undergo additional testing including

biopsy

Would undergo at least limited treatment of breast

cancer if diagnosed

American College of Radiology and

Society of Breast Imaging

Controversies in Screening Mammography

Yearly screening from ages 45-54

for average risk females

American Cancer Society

Controversies in Screening Mammography

Access to annual screening

for women 40-44 years

American Cancer Society

Controversies in Screening Mammography

Biennial screening in women >55 years

for average risk females

OR

Access to annual screening

American Cancer Society

Controversies in Screening Mammography

Continue screening indefinitely as long as life

expectancy is 10 years or longer

American Cancer Society

Controversies in Screening Mammography

USPSTF

Controversies in Screening Mammography

American Society of Breast Surgeons

Controversies in Screening Mammography:

Benefits vs. Harms

Benefits

Mortality reduction

Extension of life expectancy

Improved quality of life aka QALY

quality-adjusted life years gained

Harms

“Overdiagnosis”

Patient anxiety related to false positive exams

False negative exams

Breast density

Controversies in Screening Mammography:

Adjunctive Screening

Breast MRI

Whole Breast Ultrasound

3D Digital Breast Tomosynthesis

Common Breast Imaging Questions

Breast MRI

Whole Breast Ultrasound

3D Digital Breast Tomosynthesis