Additional information about BI-RADS is available on the ACR Web site at http://www.acr.org or by calling the ACR at 1–800–ACR–LINE (1–800–227–5463).
Over the past 30 years, improvements in mammography have made it possible to detect a larger number of tissue abnormalities, including DCIS. DCIS is a condition in which abnormal cells are confined to the milk ducts of the breast. The cells have not invaded the surrounding breast tissue. DCIS usually does not cause a lump, so it cannot be detected during a clinical breast exam or BSE. However, mammography is able to detect 80 percent of DCIS cases. Some of these cases will eventually develop into invasive breast cancer.
It is not possible to predict which cases of DCIS will progress to invasive cancer. Therefore, DCIS usually is removed surgically. In the past, DCIS was often treated with a mastectomy , but breast-conserving therapy (breast-sparing surgery plus radiation therapy) is now standard practice for many women with DCIS. Tamoxifen may also be used. Women who have been diagnosed with DCIS should talk with their doctor to make an informed decision about treatment.
The cost of screening mammograms varies by state and by facility, and can depend on insurance coverage. However, most states have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms. Women are encouraged to contact their mammogram facility or their health insurance company for information about cost and coverage.
All women age 40 and older with Medicare can get a screening mammogram each year. Medicare will also pay for one baseline mammogram for a woman between the ages of 35 and 39. There is no deductible requirement for this benefit, but Medicare beneficiaries have to pay 20 percent of the Medicare-approved amount. Information about Medicare coverage is available at http://www.medicare.gov on the Internet, or through the Medicare Hotline at 1–800–MEDICARE (1–800–633–4227). For the hearing impaired, the telephone number is 1–877–486–2048.
Some state and local health programs and employers provide mammograms free or at low cost. For example, the Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program. This program provides screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States and in several U.S. territories. Contact information for local programs is available on the CDC’s Web site at http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp or by calling the CDC at 1–800–CDC–INFO (1–800–232–4636).
Information about low-cost or free mammography screening programs is also available through NCI’s Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237). Women can also check with their local hospital, health department, women’s center, or other community groups to find out how to access low-cost or free mammograms.
Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices.
The Mammography Quality Standards Act (MQSA) is a Federal law designed to ensure that mammograms are safe and reliable. Through the MQSA, all mammography facilities in the United States must meet stringent quality standards, be accredited by the Food and Drug Administration (FDA), and be inspected annually. The FDA ensures that mammography facilities across the country meet MQSA standards. These standards apply to the following people at the mammography facility:
Women can ask their doctors or staff at the mammography facility about FDA certification before making an appointment. All mammography facilities are required to display their FDA certificate. Women should look for the MQSA certificate at the mammography facility and check its expiration date. MQSA regulations also require mammography facilities to give patients an easy-to-read report on the results of their mammogram.
Information about local FDA-certified mammography facilities is available through the CIS at 1–800–4–CANCER (1–800–422–6237). Also, a list of these facilities is on the FDA’s Web site at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMQSA/mqsa.cfm on the Internet.
Women with breast implants should continue to have mammograms. (A woman who had an implant following breast cancer surgery should ask her doctor whether a mammogram of the reconstructed breast is necessary.) It is important to inform the mammography facility about breast implants when scheduling a mammogram. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. If the technician performing the procedure is aware a woman has breast implants, steps can be taken to make sure that as much breast tissue as possible can be seen on the mammogram.
Both digital and conventional mammography use x-rays to produce an image of the breast; however, conventional mammography stores the image directly on film, whereas digital mammography takes an electronic image of the breast and stores it directly in a computer. This allows the recorded information to be enhanced, magnified, or manipulated for further evaluation. The difference between conventional mammography and digital mammography is like the difference between a traditional film camera and a digital camera. Aside from the difference in how the image is recorded and stored, there is no other difference between the two.
Because digital mammography allows a radiologist to electronically adjust, store, and retrieve digital images, digital mammography may offer the following advantages over conventional mammography:
In January 2000, the FDA approved the use of digital mammography in the United States. In September 2005, preliminary results from a large clinical trial that compared digital mammography to film mammography were published ( 1 ). These findings showed no difference between digital and film mammograms in detecting breast cancer in the general population of women in the trial. However, the researchers concluded that women with dense breasts who are premenopausal or perimenopausal (women who had their last menstrual period within 12 months of their mammograms) or who are younger than age 50 may benefit from having a digital rather than a film mammogram.
Some health care providers recommend that women who have a very high risk of breast cancer, such as those with BRCA1 or BRCA2 gene alterations, have digital mammograms instead of conventional mammograms; however, studies showing that digital mammograms are superior to conventional mammograms for these women are lacking.
Digital mammography can be done only in facilities that are certified to practice conventional mammography and have received FDA approval to offer digital mammography. The procedure for having a mammogram with a digital system is the same as with conventional mammography.
NCI is supporting the development of several new technologies to detect breast tumors. This research ranges from methods being developed in research labs to those that have reached clinical trials. Efforts to improve conventional mammography include digital mammography (see Question 15 ), magnetic resonance imaging (MRI), and positron emission tomography (PET scanning).
In addition to imaging technologies, NCI-supported scientists are exploring methods to detect markers (genetic traits) of breast cancer in blood, urine , or nipple aspirates (fluid from the breast) that may serve as early warning signals for breast cancer. The NCI fact sheet Improving Methods for Breast Cancer Detection and Diagnosis provides more information about technologies that are under development for breast cancer screening and diagnosis. This fact sheet is available at http://www.cancer.gov/cancertopics/factsheet/Detection/breast-cancer on the Internet.
NCI conducts and supports ongoing breast cancer research that ranges from basic science through the full spectrum of clinical care.
On NCI's Web site ( http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms ), the text below links to searches of clinical trials for female breast cancer prevention, screening, and treatment. The trials are included in the clinical trials database that can be searched at http://www.cancer.gov/clinicaltrials/search on the Internet.Current NCI-supported clinical trials for female breast cancer prevention
Current NCI-supported clinical trials for female breast cancer screening
Current NCI-supported clinical trials for female breast cancer treatment
Additional information about clinical trials is available from NCI's Cancer Information Service (1-800-4-CANCER) or on the main clinical trials page of NCI's Web site at http://www.cancer.gov/clinicaltrials on the Internet.
Related NCI materials and Web pages:
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