Supplemental screenings for women at high risk for breast cancer

Woman in a doctors office having a breast ultrasound preformed.

An annual mammogram for women starting at age 40 is the gold standard for detecting breast cancer in its early, most treatable stages. But for women with higher-than-average risk due to a personal or family history of breast cancer, dense breasts or other risk factors, additional screening with breast MRI or ultrasound can provide essential information that mammography may miss.

Thanks to a recent change in Pennsylvania law, women with a high breast cancer risk can access supplementary screening annually at no cost to them. Insurers based in Pennsylvania must cover the full cost of the additional test, including copays and deductibles. The law defines supplementary screening as medically necessary breast imaging using MRI or, if MRI is not available, ultrasound if recommended by the treating physician to screen for breast cancer when no breast abnormality is seen on mammogram or suspected.

"No-cost access to supplemental screenings will remove barriers to early detection of breast cancer, which we know can save lives," says Lana Henry, MD, radiologist at Main Line Health.

Risk factors for breast cancer

"Your risk of breast cancer is increased if you or a first-degree relative have a history of breast cancer, if you have a genetic predisposition to the disease or if you have dense breasts," explains Dr. Henry. "At Main Line Health, we assess risk and advise every patient having a mammogram."

Dense breast tissue contains less fatty tissue and more glandular and fibrous tissue, which appears white on a mammogram, making it more difficult to find breast cancer. Women with dense breasts also have a higher risk of developing breast cancer than women with fatty breasts. "Nearly half of all women age 40 or older have dense breasts," says Dr. Henry. "Only a mammogram can determine breast density. You can’t tell by yourself."

What to expect from a breast MRI and breast ultrasound

Breast MRI and breast ultrasound use different technologies than mammograms, so the screening appointments are different, too.

Breast MRI

Mammography uses X-rays, whereas a breast MRI uses magnetic fields to create an image. It involves lying face down on a padded table with depressions for your breasts. An injection of contrast dye in your arm helps create a dynamic picture.

"We mainly recommend breast MRI for screening our high-risk patients. It is very sensitive, allowing us to investigate areas of concern seen on mammograms and determine whether biopsies are needed," Dr. Henry says. "The contrast dye allows us to spot differences in blood flow: Cancers tend to draw blood and expel it quickly, whereas blood flow through benign tumors is steadier."

Breast ultrasound

Ultrasound uses sound waves. A radiology technician applies gel and then moves a probe over your breasts to collect digital snapshots. The procedure takes about 30 minutes.

"Ultrasound can help determine whether a lump is solid, which may indicate cancer, or a fluid-filled cyst, which is likely benign," says Dr. Henry. "But it finds more false positives than MRI and does not evaluate blood flow."

Next steps:

Meet Lana Henry, MD
Learn more about radiology at Main Line Health
Patient-focused care for breast cancer patients