Emerging Areas in Early Detection

Many tools for the early detection of breast cancer are under study. These include magnetic resonance imaging (MRI), ultrasound, breast tomosynthesis (3D mammography), molecular breast imaging (MBI), positron emission tomography (PET) and thermography. At this time, it is not clear if these tools will play a role in breast cancer screening in all women or certain groups of women at higher risk.  

If you are interested in joining a clinical trial studying one of these screening methods, talk to your health care provider. BreastCancerTrials.org in collaboration with Susan G. Komen for the Cure® offers a custom matching service that can help you find a clinical trial. Learn more about this program or search BreastCancerTrials.org for clinical trials on breast cancer screening.

Learn more about clinical trials.   

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) uses magnetic fields to create an image of the breast. MRI is used mostly in breast cancer diagnosis and staging.  

MRI and breast cancer screening for women at higher risk of breast cancer

There is growing evidence that MRI in combination with mammography, compared to mammography alone, can increase detection of breast cancer in [56-59]:

• Women with a BRCA1 or BRCA2 gene mutation  
• Women with a strong family history of breast cancer

The American Cancer Society and National Comprehensive Cancer Network recommend yearly screening with mammography plus MRI for these women, starting at earlier ages than women at average risk would begin screening with mammography [18,60].  

Some findings also suggest that for women diagnosed with cancer in one breast, MRI with mammography can find breast cancer in the opposite breast better than mammography alone [62-63]. MRI with mammography is also under study for screening in women with dense breast tissue [61,64]. Learn more about breast density.  

Susan G. Komen for the Cure® recommends that women at higher risk of breast cancer ask their health care provider which screenings tests are right for them. Learn more about MRI as a screening tool for women at higher risk.  

MRI and breast cancer screening for women at average risk of breast cancer

Whether screening MRI offers benefit to women at average risk of breast cancer is under study and, at this time, is not recommended for these women. Screening MRI has some drawbacks.

• MRI is more invasive than mammography because a contrast agent is given through an IV before the procedure.
• Like mammography, MRI has false positive results, which need follow-up, but may turn out to be benign (not cancer).
• Some centers cannot do an MRI of the breast or do not have radiologists specially-trained to read images of the breast.
• Not all centers can do an MRI-guided biopsy to follow-up on an abnormal finding that can only be seen on MRI (and not other imaging like mammography).
• MRI is expensive and not always covered by insurance.

Learn more about MRI as a screening tool for women at higher risk.

Learn more about MRI and the diagnosis of breast cancer.  

Ultrasound

Ultrasound uses sound waves to make images of the breast. It is often used as a follow-up test after an abnormal finding on a mammogram, MRI or clinical breast exam.  

Studies show ultrasound alone is not a good breast cancer screening tool and has many false positive and false negative results [29,61,65]. Because image-making with ultrasound is not yet automated, the quality of the image can vary greatly depending on the skill and experience of the person doing the ultrasound. Automated ultrasound may help improve image quality and is under active study [66]. However, at this time, it is not widely available or routinely used.  

Ultrasound is better than mammography at distinguishing dense breast tissue from tumors. Studies have shown ultrasound combined with mammography can find more breast cancers than mammography alone in women with dense breasts [61]. However, ultrasound plus mammography leads to more false positive results.  

For women at higher risk of breast cancer, screening ultrasound does not appear to add benefit to screening with MRI and mammography [61,67]. However, ultrasound may be a useful addition to screening mammography among women at higher risk of breast cancer for whom MRI is not yet recommended [61]. Ultrasound is less expensive and less invasive than MRI. More research on the benefits of ultrasound in combination with mammography and MRI is needed before recommendations can be made on its use for screening women at average or higher risk of breast cancer.

Screening tools under active study and not widely available

Breast tomosynthesis (3D digital mammography)

Advances in digital mammography machines and software can create a three dimensional (3D) X-ray image of the breast (called breast tomosynthesis). The machine takes multiple two dimensional (2D) X-ray images. Computer software combines the 2D images into a 3D image.

A few studies have suggested screening with standard mammography plus breast tomosynthesis may find more breast cancers than standard mammography alone [68-69]. However, it is unclear whether this difference improves prognosis or survival. A concern about breast tomosynthesis as a screening tool is that it gives a somewhat higher dose of radiation than mammography [70]. In addition, it requires a special imaging machine and radiologists must have special training to read the images, so it is not widely available in the United States.

It is not yet clear whether breast tomosynthesis will become a standard breast cancer screening tool. At this time, it is still under study. 

Nuclear medicine imaging of the breast (molecular breast imaging)

Nuclear medicine breast imaging (you may also hear the term molecular breast imaging) uses short-term radioactive agents that are given through an IV and absorbed into tissues, including the breast. Breast cancer cells appear to absorb more of the agents than healthy cells and these cancer cells can be imaged with a special camera. Nuclear medicine breast imaging is being studied in combination with mammography screening for women with dense breasts [71].  

Two types of nuclear medicine imaging techniques are:

• Breast-specific gamma imaging (BSGI). The radioactive agents used in BSGI emit gamma rays that are tracked by a special camera.
   
• Positron emission mammography (PEM). The radioactive agents used in PEM are sugars. PEM uses positron emission tomography (PET), a test that shows how much sugar is consumed by cells, along with a special camera to image cells. Cancer cells tend to consume more sugar than normal cells and this can help identify tumors. PET does not have the special camera needed for PEM, so PEM cannot be done on a regular PET scan machine. PET alone cannot provide a detailed enough image to find early stage breast cancers [72].

Although still under study, BSGI and PEM are used in clinical practice, but are not widely available.  

Nuclear medicine breast imaging gives a higher dose of radiation than mammography [73]. Ways to lower the amount of radiation exposure are under study.

Thermography

Thermography uses infrared light to measure temperature differences on the surface of the breast. Although breast cancer can cause abnormal heat patterns, many benign conditions also cause abnormal heat patterns. Thermography cannot distinguish between benign and cancerous patterns [74]. And, because thermography measures heat at the surface of the breast, it is not good at finding cancers deeper within the breast tissue.  

Neither the U.S. Food and Drug Administration (FDA) nor the American College of Radiology views thermography as a valuable breast screening or imaging tool [75-76]. In 2011, the FDA issued an alert warning the public about misleading claims by thermography practitioners and manufacturers on the screening benefits of the tool [76]. To read the full alert, visit the FDA website.   

Updated 02/19/13

Screening Options for Women at Higher Risk of Breast Cancer

Questions for Your Provider