A diagnosis of Breast Cancer is given when tissues from the breast region undergo cancerous changes. This may be due to several factors such as genetics or environmental factors.

They most commonly present as breast lumps, or less commonly, as abnormal skin changes over the breast or abnormal nipple discharge.

The main imaging modality that is used for routine breast cancer screening is the mammogram.

Mammogram is a machine which uses low energy X-rays to look for early signs of breast cancer, such as small lumps or abnormal tissue changes such as microcalcifications.

Mammogram is usually recommended for breast cancer screening for women starting from the age of 40.

• 40-49 years old – yearly mammogram
• 50 years old and above – 2 yearly mammogram

It is also recommended for women to do breast self-examinations once a month from 30 years old and above to look for any abnormal lumps that can be felt.

Women at higher risk of breast cancer or with a strong family history may be required to start screening at an earlier age.

• Family History of Breast Cancer, especially in first-degree relative eg mother, sister or daughter
• Early onset of menstruation
• Late menopause
• Never given birth before
• Genetic mutations such as BRCA gene
• Hormonal therapy
• Obesity

However, it is important to note that the absence of any of these risk factors does not mean you have no risk of getting breast cancer!

Regular screening with mammogram and breast self-examinations are important in detecting the presence of early breast cancer as early disease may not have any symptoms at all.

Other imaging modalities for breast cancer screening can also include:

• MRI Breast or
• Ultrasound Breast.

While Mammogram remains the most reliable form of screening for breast cancer, it also has its own limitations which may then require these extra imaging modalities to come into play.

Ultrasound breast

Ultrasound uses sound waves to look at internal structures of the breast.

The benefits of ultrasound include being able to visualize lumps better in people with dense breast tissue and also providing information on the nature of the breast lump.

Ultrasound scan also does not use any radiation which makes it safe for people who are unable to take radiation eg pregnancy.

While ultrasound breast is a good modality for evaluating breast masses, it also has its limitations. Ultrasound cannot pick up small calcifications which can be seen with a mammogram.

As such, it is always important to use them in conjunction with mammogram, if clinically required.

MRI Breast

MRI uses a powerful magnetic field to visualize soft tissues and all other structures in the breast.

Hence, MRI can offer valuable information that cannot be obtained through other imaging modalities such as mammogram and ultrasound.

MRI breast is usually done as a screening tool for people who are at high risk of breast cancer (eg strong family history of breast cancer), determining the extent of cancer after a new diagnosis of breast cancer, or to evaluate lumps which cannot be accurately evaluated by mammogram or ultrasound.

The benefits of MRI breast are that it is a useful modality to evaluate women at high risk of breast cancer, and it can successfully image women with denser breasts or with breast implants.

While MRI is generally safe, the downsides are that it requires more resources and higher costs in conducting the scan compared to the other imaging modalities.

Firstly, it is important to know that having breast implants do not increase your risk of breast cancer.

Breast cancer screening can still be effectively carried out in women with breast implants, but special considerations do need to be taken.

Screening with mammogram can still be done for these women.

It is important for patients to inform the medical technologist conducting the scan about the presence of breast implants, so as to allow appropriate positioning to optimize visualization from the mammogram.

It may be possible that the implants may obscure the view of breast lumps depending on the location. Hence positioning of the breast is important, and additional views and images are also taken to minimize the chances of missing detection of a lesion.

While rare, there is also a slight risk of implant rupture due to compression during the mammogram.

Other imaging modalities such as MRI breast or ultrasound can also be conducted for women with breast implants.