Right Woman, Right Test, Right Time

07 Oct 2021

Right Woman

There are many factors that increase your risk for developing breast cancer, such as age, obesity, having a past history or family history of breast cancer, and having certain inherited genetic mutations.  A radiological risk factor is mammographic breast density.

The whiter a woman’s breasts appear on mammogram the higher her breast density.  Breast density cannot be determined by the way the breast feels or looks.  It can only be determined by the radiological (mammographic) appearance.  Breast density information may be available on the mammogram report.  This may be a subjective category based on the radiologist’s assessment, or an objective measure based on specialised software.

Mammographic breast density is emerging as one of the strongest independent risk factors for breast cancer.  Women who are in the highest category of breast density for age are at 4-6 times increased risk of breast cancer compared with women in the lowest category.  Women with dense breasts are not only at increased risk of developing breast cancer, but are also more likely to mask breast cancer, which may result in delayed detection on mammogram.

Using a breast cancer risk calculator, a woman’s risk for developing breast cancer can be calculated.  Some risk calculators allow for input of mammographic breast density as a risk factor, which provides a more accurate result.

Right Test

There are several different methods to image the breast to detect breast cancer.  These include 2D and 3D mammography, ultrasound, contrast enhanced mammography and breast MRI.  Each of these modalities have different advantages and limitations.  For example, contrast enhanced mammography and breast MRI have been shown to have higher detection rates than conventional mammography or breast ultrasound, however are generally more expensive, less readily available, and require an intravenous injection of contrast.

3D mammography has been shown to have a higher detection rate than 2D mammography.  The addition of breast ultrasound further increases this detection rate.

Right Time

Early detection is the key to a better outcome for breast cancer.  BreastScreen Australia recommends women aged between 50 and 74 to have screening mammograms every two years.  However, based on a woman’s individual risk for developing breast cancer, it may be appropriate for her to commence screening at an earlier age, and have a period of annual screening.

Based on a woman’s age, risk profile and breast density, a personalised breast imaging screening recommendation could be formulated, which not only makes recommendations on timing but also breast imaging modalities.  This service is available at Imaging Associates Mitcham through a GP referral.

Dr Daniel Lee

Clinical Director at Imaging Associates Mitcham