Breast Cancer Awareness Month – Preventative Care

Linda Sanders, MDAfter skin cancer, breast cancer is the most commonly diagnosed cancer among women and is the second leading cause of death from cancer among women. The American Cancer Society estimates that there will be 268,000 new cases of invasive breast cancer diagnosed in women in the US this year.

Regular breast screenings can help to discover breast cancer at its earliest and most treatable stages. While most women are aware of the importance of breast cancer screening and getting their yearly mammogram, many may not know of the additional available screening options. Linda M. Sanders, MD, Chief of Breast Intervention and Medical Director of the Barnabas Health Breast Center at the Ambulatory Care Center of Saint Barnabas, an RWJBarnabas Health facility, explains the importance of regular breast screenings as well as other screening options available for women with dense breasts.

Standard Screening: Mammograms
A mammogram is a low-dose x-ray used to screen for and detect breast cancer. Finding small breast cancers early improves a woman’s chance for successful treatment.

“Mammography is especially useful for detecting breast cancers that cannot be felt during clinical breast examinations and a mammogram may detect breast cancer years before it can be physically detected,” said Dr. Sanders.

According to Dr. Sanders, “A screening mammogram is used to detect any breast changes in women who have no signs or symptoms or breast cancer. During a screening mammogram, two x-rays are taken of each breast, from two different angles.”

A diagnostic mammogram is performed if abnormalities are found on a screening mammogram or if there are notable breast concerns, such as a lump, pain, nipple discharge or a change in breast shape or size. A diagnostic mammogram generally requires special x-ray views compared to a screening mammogram.

“Although mammograms are important for screening, they can sometimes miss tumors in women with dense breast tissue,” said Dr. Sanders.

Breast density is determined by the radiologist who reads your mammogram and will be included in your imaging report. In fact, since the NJ Breast Density Law was signed in 2014, reports must include information about breast density. One of the main purposes of this law was to make sure women understand that dense breasts at mammography reduces the sensitivity of the exam to detect breast cancer. This legislation also requires insurers to cover supplemental evaluations, in women with dense breast tissue on their baseline studies, as well as if there are any imaging abnormalities which require further evaluation.

Understanding the Different Types of Breast Tissue
“Breast are composed of different kinds of tissue that look different on a mammogram,” said Dr. Sanders. “Fatty tissue is dark or black on a mammogram and fibroglandular tissue is white. Mammograms of fatty breasts are easier to interpret. Developing cancers are easier to spot since they appear as white lesions against a black background. If the mammogram has abundant fibroglandular tissue, then the breast tissue appears mostly white, and that can obscure a developing lesion in that breast, making additional screening methods necessary.”

Breast density is graded on a continuum of very fatty to very dense.

“In every mammogram whether screening or diagnostic, the density of the breast is placed on the continuum into one of four groups: fatty, scattered fibroglandular, heterogeneously dense, and extremely dense,” Dr. Sanders explained. “Because breast density is normally distributed, 50% of women fall into the dense part of the spectrum.”

Advanced Imaging Methods
“Digital breast tomosynthesis, also commonly known as 3D mammography, is an advanced breast imaging technique that uses x-rays and computer software to create slices of the breast which reduce superimposition of tissues” said Dr. Sanders. “Unlike a screening mammogram, which takes two x-rays of each breast, breast tomosynthesis takes a sequence of x-rays of each breast in each position from different angles.”

These images enable doctors to see inside the breast more clearly than with a standard 2-view mammogram and may help to identify a cancer that could be missed with just a standard mammogram.

Another supplementary method of screening for women with dense breasts is breast ultrasound, also known as breast sonography.

“Breast sonography or ultrasound uses sound waves to produce images of the tissues inside the breast, including the area closest to the chest wall and axillary tissue,” said Dr. Sanders. “Ultrasounds are supplementary to screening mammography and may depict a cancer not identified by mammogram.”

In the diagnostic setting, ultrasound is particularly useful for palpable concerns since it best differentiates cystic from solid lesions. It is the first line study in patients too young for mammography (under age 30).

“Breast magnetic resonance imaging or breast MRI is a third imaging modality,” added Dr. Sanders. “It is acknowledged to be the most sensitive modality for diagnosing breast cancer, but requires an injection of contrast, and is expensive, which is why it is not universally utilized in all patients. Its sensitivity is based on the increased blood flow of tumors, and it is not hindered by breast density.”

As a cross sectional imaging tool, breast MRI produces detailed images of the structures within the breast. The American Cancer Society recommends annual breast MRI in patients with a lifetime risk of 20% or higher.

Screening Frequency
“There are a different medical societies with different screening recommendations, so the public has gotten mixed messages regarding what age to start screening and at what frequency,” said Dr. Sanders. “The American College of Radiology and Society of Breast Imaging recommend annual mammography screening beginning at age 40 and that’s the recommendation our Breast Center advises.”

Some patients at very high risk may be advised by their physicians to begin screening by age 35.

“Patients should understand their breast density, personal breast history, as well as family history of breast cancer,” explained Dr. Sanders. “These data points are important to calculate each patient’s specific risk of breast cancer and suggest any supplemental imaging that might be necessary.”

Comprehensive Breast Care
Using cutting edge diagnostic technologies, the RWJBarnabas Health team of breast specialists delivers care that is continually focused on overall health and wellness.

The Breast Center at Barnabas Health Ambulatory Care Center in Livingston, NJ, provides comprehensive breast care and wellness services essential for good health. The Center offers a full range of preventative, diagnostic and treatment services – all delivered by a caring, highly-trained staff that understands your concerns and is always available to answer your questions.

“At the Breast Center, patients can be assured that they’re receiving a high level of individualized care from a multi-disciplinary, highly qualified team, experience in treating breast-related issues,” said Dr. Sanders.

The Breast Center at Barnabas Health Ambulatory Care Center is accredited as a Breast Imaging Center of Excellence by the American College of Radiology, and the full breast program (including Radiology, Surgery, Medical Oncology, Radiation Oncology, and Pathology) is accredited by the National Accreditation Program for Breast Centers (NAPBC), which requires a rigorous evaluation process and performance review.

“Our NAPBC accreditation reflects the high standard of care we provide for patients with diseases of the breast and our commitment to offering patients every advantage when it comes to breast care,” Dr. Sanders added.

To schedule a mammogram or for more information, visit