Breast cancer is a leading cause of cancer death among women—second only to lung cancer. Approximately 1 in 8 women will develop breast cancer in her lifetime. Breast cancer rates have been increasing slightly in recent years, and experts estimate that in 2024, more than 300,000 women and approximately 2,800 men in the U.S. will be diagnosed with invasive breast cancer. The good news is that diagnosing breast cancer early dramatically improves a patient’s chances of survival, and technological advancements have increased our ability to detect breast cancers at their earliest stages. In this article, we’ll examine the evolution of breast imaging technology and how modern screening techniques are helping to save lives.
Diagnosing breast cancer as early as possible is critical. When caught at the earliest stages, breast cancer can be treated more successfully and with less invasive procedures than when diagnosed later. When breast cancer is detected early—before it spreads outside the breast—99% of patients survive at least five years after diagnosis. When the cancer has spread outside the breast to nearby structures, the five-year survival rate is 86%. However, when it has spread to distant parts of the body, such as the lungs, liver, or bones, that rate drops to just 31%. Because of this, discovering developing cancer as early as possible gives women the best chance of beating it.
For decades, mammography has been the cornerstone of breast cancer screening. Traditionally, mammograms were two-dimensional images of the breast, typically captured from two different angles. Around the turn of the 21st century, digital technologies began to replace the use of X-ray film, increasing the quality and contrast of these images. While 2-D mammography has been highly effective in helping to reduce breast cancer mortality, the information it can provide is limited—especially in women with dense breast tissue. This is because, like cancerous tumors, dense fibroglandular tissue appears white on X-ray images. As a result, tumors can be very difficult to see in 2-D X-ray pictures of dense breasts.
In 2011, the FDA approved a new kind of mammogram that gives doctors a clearer view. 3-D mammography, also known as digital breast tomosynthesis, was a significant advancement in breast imaging. Unlike 2-D mammography, breast tomosynthesis uses multiple images of the breast from a variety of angles to create a layered, three-dimensional view that radiologists can examine in minute detail. This has improved mammography effectiveness, particularly for women with dense breasts. Studies have found that the addition of tomosynthesis to mammography increases the detection of invasive cancers while reducing the number of false positive results. That means better cancer detection with fewer callbacks for additional imaging.
Magnetic resonance imaging (MRI) has long been used to supplement mammography for women who are at high risk for breast cancer. High-risk MRI screening is recommended for women with a strong family history of breast cancer, genetic mutations (such as BRCA1 or BRCA2), or other factors that create a lifetime breast cancer risk of more than 20%. MRI is capable of producing highly detailed images of the breast that can allow doctors to visualize cancers that can be missed in mammography.
MRI is an excellent tool for imaging dense breast tissue and breast implants, both of which can be difficult to evaluate with mammography alone. While MRI can pick up cancers that aren’t visible on a mammogram, it can also flag other abnormalities that are not cancer and miss some cancers that mammography could show. For these reasons, MRI is used as a supplement to mammography, not a replacement for it.
A newer technique known as abbreviated—or fast—breast MRI has made the enhanced detection capabilities of MRI available to more women. This abbreviated MRI procedure is recommended for women with dense breast tissue who do not meet the criteria for high-risk MRI. The abbreviated MRI technique takes fewer images and less time than high-risk MRI breast imaging, and it is available at a lower cost. Studies show that abbreviated breast MRI results in significantly higher rates of invasive breast cancer detection than 3-D mammography in women with dense breasts.
Unlike mammography, MRI does not use ionizing radiation to create images. However, breast MRI uses gadolinium contrast to enhance image quality. Because this type of contrast can create complications in some patients with decreased kidney function, it’s important to let your provider know if you have a history of kidney problems before undergoing an MRI with contrast. You can learn more about gadolinium contrast in our ebook, What You Should Know About MRI Contrast Agents.
Iowa Radiology offers a full spectrum of imaging services, including cutting-edge 3-D mammography and abbreviated breast MRI. We pride ourselves on delivering exceptional patient care. Learn more about our women’s imaging services, or browse our blog for a wealth of information on a variety of health topics
American Cancer Society. Breast MRI. Cancer.org. Revised January 14, 2022. Accessed August 12, 2024. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-mri-scans.html.
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Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women with Dense Breasts Undergoing Screening. JAMA. 2020;323(8):746–756. http://dx.doi.org/10.1001/jama.2020.0572
National Breast Cancer Foundation. Breast Cancer Facts & Stats. Nationalbreastcancer.org. Reviewed June 15, 2023. Updated August 1, 2024. Accessed August 12, 2024. https://www.nationalbreastcancer.org/breast-cancer-facts/.
Radiological Society of North America. Breast MRI. Radiologyinfo.org. Reviewed April 15, 2022. Accessed August 12, 2024. https://www.radiologyinfo.org/en/info/breastmr.
Skaane P, Bandos AI, Gullien R, et al. Comparison of Digital Mammography Alone and Digital Mammography Plus Tomosynthesis in a Population-based Screening Program Radiology 2013;267(1):47–56. http://dx.doi.org/10.1148/radiol.12121373.