Ask the Expert

Digital Mammography and Other Life-Saving Imaging Techniques

This month's Ask the Doc is brought to you by Dr. H. Hannah Kim , Director of Breast Imaging for Suburban Hospital and GCM-Suburban Imaging.  Dr. Kim conducted her residency at George Washington University Medical Center and her fellowship in women's imaging at Western Pennsylvania Hospital .

I just read an article about digital mammography. Does this have advantages over traditional mammography?

Yes. At GCM-Suburban Imaging in the Suburban Outpatient Medical Center, we are happy to offer patients digital mammography, a new technology that is transforming patient care by decreasing patient exam time and call backs, potentially reducing radiation exposure, and improving visualization of abnormalities in dense breasts and near the skin line of all breasts.  The recent government-sponsored study you may have read about did find that digital mammograms were significantly better than traditional film mammograms at helping physicians detect breast cancer in certain groups of women. 

Was digital mammography helpful to all women in the study?

Digital mammography was found to be most helpful in women with dense breast tissue, women under age 50, and pre-menopausal and peri-menopausal women.  For all other women, film and digital were equivalent.

How was the study conducted? Is it comprehensive?

This study is one of the most comprehensive government studies ever conducted.  During a two-year period, nearly 50,000 women were recruited to participate in the study at 33 sites across the country.  All participants underwent both digital and traditional film mammography.  The results showed that digital technology detected 15 percent more cancers in women with dense breasts, 21 percent more cancers in women who had not gone through menopause, and 27 percent more cancers in women under age 50.

If I am in one of these groups, should I consider getting a digital mammogram?

As a result of this study's findings, the American Cancer Society and the National Cancer Institute are now recommending that women in the above mentioned groups seek digital mammography.

I've also heard about breast MRI. What is it?

Breast MRI, or magnetic resonance imaging, is a technique that improves the quality of breast cancer assessment, enabling a patient with breast cancer, or at high risk of developing breast cancer, to have both breasts examined in a single MRI test.  It is an adjunctive tool to screening mammography in women who are at high risk for breast cancer and a great tool for evaluating the extent of disease in women who have recently been diagnosed with certain types of breast cancer, allowing for better surgical planning and treatment.

How does MRI compare to mammography or ultrasound?

Mammography is still the best test for screening women for breast cancer.  Ultrasound is a good adjunctive tool to further evaluate a lesion detected on a mammogram or a lump that someone feels.  A biopsy determines whether a lesion or lump is cancerous or not.  If it is in fact cancerous, it will need to be determined if the patient has only one lesion and is a candidate for a lumpectomy, or whether she has numerous lesions and may require more aggressive treatment like mastectomy, chemotherapy, or radiation therapy.  MRI is best to detect additional tumors in those women.  MRI has also proven to be a good additional screening tool for women at a high genetic risk for breast cancer.  And with MRI, there is no radioactivity.

Since I can have an MRI, should I completely forego my traditional mammogram?

No. Breast MRI is a good additional tool but should not replace standard screening mammograms, physical exams performed by your doctor, or self breast exams. Although it is very sensitive and has been shown to pick up cancers that may be missed by mammograms and ultrasound, it may not detect certain types of very small calcifications, which on a mammogram can be an early indication of cancer.

Are there other diagnostic tools for detecting breast cancer?

Yes.  Suburban Hospital 's new MRI-guided breast biopsy system is the latest tool in the fight against breast cancer.  It's helping patients who have had an abnormal MRI for whom mammogram- or ultrasound-guided biopsy is not an option.

How is it helping?

MRI-guided breast biopsy allows us to more readily diagnose cancers that are detected only by MRI.  While Suburban has been performing state-of-the-art breast MRI for several years, it is only recently that we have been able to localize a lesion seen only by MRI for biopsy or surgery.

Is this the end all to be all for breast cancer detection?

Breast MRI is not designed to replace annual mammograms, nor does it replace ultrasound in the workup of an abnormal mammogram or palpable lump.  It does, however, promote detection of some breast cancers that may have been missed using these routine imaging methods.

Who is eligible for breast MRI?   Who is eligible for MRI-guided breast biopsy?

Candidates for breast MRI include women who have already been diagnosed with breast cancer and some women who are considered high risk for the disease.  Candidates for MRI-guided breast biopsy are those patients who have a lesion detected by breast MRI that is not or not as readily seen by mammogram or ultrasound.

Is MRI-guided breast biopsy a complicated procedure?

Performed at the hospital by a specially trained radiologist, this outpatient procedure takes less than an hour and requires only a local anesthetic. The lesion is located on MRI and, while most other facilities must manually estimate where to place the needle, Suburban Hospital uses special software that allows for a faster and more accurate sampling of the tissue.  MRI-guided breast biopsy improves our ability to diagnose cancer at an earlier stage, thereby improving survival rates.

To learn more about digital mammography and breast MRI at Suburban Hospital , call (301) 896-3939.  Click here for more information about the Suburban Breast Center .