Creating a personalized approach to breast screening guidelines

One-size-fits-all guidelines for breast cancer screenings are giving way to a more personalized approach, based on an individual’s risk factors, to determine the age, frequency and type of breast cancer screening that will be most effective. These changes don’t mean women should automatically skip their recommended annual screening mammogram, but they should talk to their doctor or advanced care provider for shared decision-making about potential risks and options. Here, Dr. Susan Branton of Susquehanna Health’s Breast Health Center answers common questions about breast cancer screening.

Are annual screening mammograms no longer necessary?

The traditional 2D screening mammogram is a very important test, as it is associated with a 28 -36 percent or more reduction in breast cancer deaths. Annual screening mammograms are still covered by insurance. These should not be skipped without consulting with your physician or advanced care provider first.

Has either the age for a first mammogram or the frequency of mammograms changed?

The answer isn’t the same for every woman. The best age to begin screening is based on individual risk-low, average or high-as determined by your doctor or advanced practice provider. If there is no history of breast cancer in your family, you should begin to discuss your risk factors with your doctor in your mid-to-late 30s to help determine when to begin screening for breast cancer. Risk factors and findings both determine the type and frequency of follow-up screening mammograms.

What kinds of information will my doctor need to determine my risk level?

Details of your family’s history of breast cancer going back two-to-three generations on both your mother’s and father’s side of the family are important. Find out who has had breast cancer and his or her age at the time of diagnosis, if possible. Also, positive results of genetic testing are important to share, as is any personal history of biopsies or cancer findings.

What other risk factors are important?

Other factors that help your doctor determine your overall risk level include: gender, age, inherited genetic defects and certain genetic changes, race and ethnicity, having dense breast tissue (more on this later), having certain benign breast conditions, starting and ending age formenses, radiation to the chest, exposure to Diethylstilbestrol (DES), alcohol consumption, being overweight or obese, physical activity, whether or not a child was carried to term, age(s) at time of childbirth, using oral contraceptives, hormone therapy after menopause and breastfeeding history.

Why is a different type of screening recommended for women with dense breasts?

For women with dense breasts, finding cancer is regularly compared to looking for an igloo in a snowstorm. A recent advancement in breast examination technology, called a 3D mammogram or breast tomosynthesis, provides a clearer, more accurate view of the dense breast tissue to allow doctors to pinpoint the size, shape and location of suspected abnormalities. While not replacing the traditional 2D mammogram, it has become the screening tool of choice for women with dense breast tissue.

How do you know if you have dense breasts?

That information is included in the results of your first screening mammogram that are provided to your doctor.

Does insurance cover all types of breast cancer screenings?

The annual 2D screening mammogram is still covered by insurance in Pennsylvania. In 2016, Pennsylvania state legislation mandated that insurance companies also cover the screenings for 3D mammograms. Since some self-insured or self-funded plans are not mandated, it is advised that you check with your insurance company about your particular coverage.

Are whole-breast ultrasound and breast MRIs covered by insurance?

Imaging tools, such as whole-breast ultrasound and MRI, may be used to further evaluate abnormal findings in dense breast tissue. These diagnostic tests are not always covered by insurance, or may require a large deductible. Strategies to consider might include timing these exams toward the end of the year, when the deductible may have already been met, or deferring funds for the test into a Flexible Spending Account.

Branton is the medical director of Susquehanna Health’s Kathryn Candor Lundy Breast Health Center at Divine Providence Hospital.