18 September 2017

Breast MRIs are used in some newly diagnosed breast cancer patients, especially those with dense breast tissue. In addition, they are used as a supplement to mammography in women who are found to be at high risk. In order to distinguish between normal and cancerous tissue, an intravenous contrast dye is used. For MRI studies, the contrast material that is used is gadolinium-based.

Gadolinium is a heavy metal, and it has the potential to be retained in the brain and kidneys. Some recent studies in both the scientific and lay press have focused on the safety of gadolinium. While there have only been scattered reports of adverse events, an FDA advisory panel voted for warning labels and for more study.

The FDA advisory focuses primarily on a class of agents known as “linear”. The “macrocyclic” gadolinium contrast agents do not appear to have the same risk of depositing in the brain or kidneys. Both types of gadolinium contrast can be used for breast MRI studies. If you have concerns, ask the facility which form of gadolinium they use.

*Note – UCLA facilities (Westwood, Santa Monica and Santa Clarita), San Fernando Interventional Radiology (a RadNet facility) and Providence St. Joseph Hospital all use gadavist, a “macrocyclic” form of  gadolinium contrast, for their breast MRI studies. Because facility practice patterns may change over time, ask at the time of your exam if you have concerns.

8 May 2017

As a past-president of the American Society of Breast Surgeons I am probably more than a little biased. However, as always, the annual meeting held April 26-30th in Las Vegas was terrific. Topics including the full spectrum of breast disease, including benign and high risk lesions, genetic testing, breast cancer diagnosis and treatment including medical and radiation oncology updates, and metastatic disease.

The press briefing highlighted 3 abstracts which showed that:

  • Modern therapy for inflammatory breast cancer is associated with better outcomes than historically seen
  • Post-treatment lymphedema is related to a combination of treatments including surgery, radiation therapy, and chemotherapy – not just from surgery
  • Patients with DCIS have a 5 year risk of developing a cancer in the other breast of 2.8% and a 10 year risk of 5.6%, and patients should be discouraged from undergoing bilateral mastectomy for this condition. Developing a new cancer in the previously treated breast was twice as likely as developing a new cancer in the opposite breast, and the use of tamoxifen reduced the likelihood of any recurrence.

Dr. Nathalie Johnson moderated a pre-meeting course on Building a Breast Cancer Survivorship Program. I was invited to speak on Traditional Versus Virtual – Options for Patient Support and Education. Just as it can be challenging to choose between cake and ice cream (2 really good things), patients note advantages to both in person and online support and education. It doesn’t have to be one or the other – do what works for YOU! My slides are posted on SlideShare.

During the general sessions, a few topics stood out to me:

Dr. Shelley Hwang from Duke University spoke on DCIS subtyping and overtreatment. She noted that DCIS now comprises over 20% of all mammographically detected breast cancer. It is considered a “non-obligate precursor” of invasive cancer – the rate and likelihood of progression to invasive cancer are not clearly known. However, it is clear that some patients will never exhibit progression to invasive disease, and she discussed this in the context of thyroid and prostate cancer – two situations where we know that treatment in some patients will not provide the patient any benefit. The challenge is to sort out which patients will benefit from treatment and which ones will not. The COMET study is currently enrolling patients with low grade DCIS to in an attempt to help answer these questions.

Dr. Virginia Herrmann from Washington University in St. Louis spoke on non-genetic breast cancer risk factors. This is an important topic and I believe one that doesn’t get covered enough. She noted that hormone replacement therapy does increase risk – although the incremental risk is small and is seen only after about 5 years of use. However, longer term use does result in higher risk. Increased body mass index (BMI) is associated with risk – the risk of breast cancer is 30% higher in patients with a BMI greater than 31 kg/m2 compared to a BMI of 20 kg/m2. She noted that there is a linear relationship between alcohol intake and cancer risk, noting a 10% increase in risk for each 10 gm/day (for wine this is a little over 3 oz) increment in alcohol consumption. The risk is most associated with post-menopausal breast cancer, although in the study she quoted, only alcohol intake during age 50s was associated with an increased risk of postmenopausal breast cancer. She noted the association of ionizing radiation and breast cancer, and young women who received mantle (chest area) radiation for Hodgkin’s lymphoma have a markedly increased risk for developing breast cancer. She noted that breast cancer risk is increased in smokers, correlated with smoking intensity and duration. Finally, she noted the increased risk of breast cancer among soldiers stationed at Camp LeJune related to contaminated drinking water (tetrachloroethylene and trichloroethylene).

Dr. Tiffany Traina, a Memorial Sloan Kettering medical oncologist, gave a brief presentation about triple negative breast cancer: Searching For the Magic Bullet. There are several promising treatment strategies including targeting androgen receptors, the use of PARP-inhibitors in patients who have BRCA gene mutations, antibody-drug conjugates, immune modulating approaches, and targeted therapies based on tumor genomic profiles. Stay tuned – much more to come over the next few years related to this aggressive breast cancer subtype.

Dr. Lisa Newman, from the Henry Ford Health System in Detroit, spoke on Breast Cancer Outcomes: Disparities versus Biology. I have heard her speak on this topic multiple times over the years and always enjoy her excellent presentations. She noted that the incidence of breast cancer in black women is increasing, now close to that in white women. However, mortality rates for black women are higher than those for white women. There is an increased frequency of triple negative breast cancer in black women. She is involved in a research initiative evaluating the association between African ancestry and high risk breast cancer in white American women, African American women, and women in Ghana, including studying novel aspects of tumor biology and breast cancer stem cells – she is asking the question “are there differences in the oncogenic potential of mammary tissue that are associated with ancestry”? She concluded with what I felt was a powerful slide – 60% – 43% – 20%. Those were the survival rates for passengers on the Titanic who were in 1st – 2nd – 3rd class. She noted that healthcare outcomes are often dependent on access to care, and ended with a quote from Dr. Martin Luther King, Jr.: “Of all the forms of injustice, inequality in health care is the most shocking and inhumane”.

Dr. Stephen Edge, from the Roswell Park Cancer Institute, gave an update on the new American Joint Commission on Cancer staging system (AJCC 8th edition). Currently we stage breast cancer based on tumor size and lymph node status. However, it is recognized that that tumor biology plays an important role in prognosis and in some patients it may be more important that tumor size. The new staging system will incorporate tumor grade, Her2/neu status, ER/PR status, and Oncotype Dx status (if available) and should more accurately reflect prognosis. There are 422 lines in the new staging system – it will be impossible to memorize! Thankfully, he noted that the AJCC is working on a staging app.

The last day of the meeting held some great sessions, and the meeting room remained packed up until the very last minute. Dr. Ann Partridge from Dana Farber discussed special considerations in the young breast cancer patient. She noted that the disease is different, the patients are different, and the treatments should be different. Younger women have a higher likelihood to have more aggressive subtypes such as Her2/neu over-expressed and triple negative, and have lower survival rates than older women – even in those with the ER positive breast cancer. However, she cautioned not to over-treat patients based only on age. She noted that young age is not a contraindication for breast conservation, and that there is no clear improvement in mortality in patients who undergo more extensive surgery. She noted the need for improvements in treatment and support, including focused research and guidelines, which should lead to better outcomes.

Dr. Irene Wapnir from Stanford spoke on fertility preservation issues. She noted the various fertility options including medications and procedures. She also reviewed the POSITIVE trial, which will be assessing the risk of breast cancer relapse in patients who temporarily stop endocrine therapy to permit pregnancy, as well as to evaluate factors associated with successful pregnancy after interruption of endocrine therapy. She also stressed that fertility preservation should be discussed with any woman of childbearing age, whether or not she has had a prior pregnancy or a child – physicians won’t know what is important to their patients unless we ask!

Dr. Katherina Zabicki Calvillo from Dana Farber discussed breast cancer in pregnancy. She noted that 0.2-4.0% of breast cancers are diagnosed in pregnant patients – about 1 in 3000 pregnancies. She also noted that given the overall delay in childbearing (and the association of increasing age with breast cancer), the incidence of pregnancy-associated breast cancer will increase. Delays in diagnosis are related to hormonal changes which affect breast tissue making the exam more challenging, and that many patients and physicians assume that masses are related to pregnancy. She stressed that pregnancy termination is usually NOT required, but a multidisciplinary team approach is required. Many of these patients present in more advanced stages, but stage-for-stage, the prognosis is similar to non-pregnant patients with breast cancer. Chemotherapy can be given after the first trimester, but hormonal and Her2/neu targeted therapy should be avoided. She noted that mastectomy should be performed in the first and early 2nd trimester, and discussed the challenges of immediate reconstruction. Breast conservation could be considered in the late 2nd or 3rd trimester with post-lumpectomy radiation planned for after delivery.

Dr. Kevin Hughes from the Massachusetts General Hospital reviewed research studies that have found that in women over the age of 70 with early stage breast cancer, radiation therapy after lumpectomy may not be necessary.  The CALGB 9343 study showed that survival rates were the same whether women received radiation therapy or not. Radiation therapy did reduce the likelihood of cancer returning in the breast (local recurrence) from about 4% in the untreated patients to about 1% in the treated patients (after 5 years of follow up). However it is important to realize that the majority of women in that study were treated with endocrine therapy, which can help reduce the risk of local recurrence. As with many decisions regarding breast cancer treatment, a careful discussion of the risks and benefits of each option is necessary.

Dr. Tina Hieken from the Mayo Clinic gave a very interesting talk on the microbiome and the impact on breast cancer. We normally co-exist with many bacteria – we have ten times the more microbial cells compared to human cells. These microbes carry out metabolic reactions that can be essential to human health. The genetic material (genome) of our microorganisms is called the microbiome. She and her colleagues studied breast tissue from women with and without breast cancer and found that the background breast microbiome is different in women with breast cancer compared to those with benign conditions. She concluded by noting that the future may involve using a microbial pattern to predict breast cancer risk, exploiting the microbiome to enhance treatment response, and that there may also be implications for a cancer prevention vaccine. The Washington Post recently covered her research – definitely worth a read for more information.

Dr. Anthony Lucci from MD Anderson discussed the “Ongoing Saga of Circulating Tumor Cells”. We would all like to see the day when a blood test can tell us with certainty if cancer has developed or returned – but we’re not there yet. After reviewing several studies evaluating both circulating tumor cells (CTC) and circulating “cell free” DNA, he concluded that this information does provide prognostic information in both metastatic and non-metastatic patients, but is not in the current ASCO or NCCN guidelines for guiding treatment. Combining the CTC status with response to preoperative chemotherapy may identify a low risk subset of patients, but noted that additional studies are needed before we can reach the ultimate goal which is improving outcomes by monitoring and responding to CTC and cell free DNA levels.

Dr. Manjeet Chadha from Mount Sinai spoke on repeat lumpectomy after prior lumpectomy and breast radiation. Traditionally, mastectomy has been recommended if cancer returns after lumpectomy and radiation therapy. On average, there is about a 10% risk of “in breast” recurrence after lumpectomy and radiation, but this will vary based on tumor and treatment type. She reviewed several studies evaluating the different types of focused or partial breast radiation that may be used in selected patients who experience recurrence of their breast cancer. She also called for additional studies in this area.

One of the last talks was by Dr. Mehra Golshan from Dana Farber. He spoke about the decision whether or not to operate on patients with breast cancer who present with Stage IV (metastatic) disease. Traditionally, we have not recommended surgery for patients with metastatic breast cancer as these patients were not expected to have long survival, and it was not felt that removal of the main tumor would impact survival. Evaluating existing studies has also been challenging because while some have shown a benefit to removal of the main tumor, the patients who underwent surgery in those studies tended to be younger and healthier. He concluded by noting that surgery in patients with Stage IV breast cancer is not standard of care, but some studies do support this practice. It is recommended that these patients be evaluated in a multidisciplinary forum and that treatment choices be individualized.

 I returned from the meeting exhausted but energized. In addition to the scientific content, the meeting is an opportunity to connect with friends and colleagues across the country. I’m already looking forward to ASBrS 2018!

This post has not been endorsed by the American Society of Breast Surgeons.

23 August 2016

A study published in the Annals of Internal Medicine evaluated screening mammography taking into account breast density and breast cancer risk. For women age 50-74, the conclusion of the authors was that for women of average risk with low breast density (fatty or scattered fibroglandular), triennial (every 3 year) mammography screening averted the same number of breast cancer deaths as annual or biennial screening. Women screened every 3 years also had lower rates of biopsy procedures. For women at high risk with high breast density (heterogeneously or extremely dense), annual screening was better. High risk / high density patients accounted for approximately 1% of the study population.

The study was funded by the National Cancer Institute. The authors used simulation modeling which included national breast cancer incidence, breast density, and screening performance data. They did not include patients with genetic abnormalities such as BRCA 1/2 mutations. They also did not take into account the impact of MRI or tomosynthesis / 3D mammography.

Risk assessment involves a calculation (using various models) which takes into account a woman’s age, body mass index, menstrual and reproductive history, family history, prior biopsies, and other factors known to influence the risk of breast cancer development. In the current study, the authors used a risk calculator that takes into account breast density. Breast density is a factor associated with breast cancer, although studies vary regarding the impact of density on risk. Adding to the confusion, breast density rating is subjective – different radiologists may assign different density scores to the same patient. The model used in the current study also takes into account factors such as improved detection using digital mammography, improved treatment effectiveness, and the usual decrease in breast density that is seen with increasing age. It is unclear at this time which is the “best” risk assessment model to use – all have limitations, some significantly over-estimate risk, and none are a “crystal ball”.

So what should women do? The ideal screening test is one that is inexpensive, readily available and safe. It should also find cancers early enough to make a difference. Mammograms are an imperfect tool but they perform reasonably well in a wide variety of settings. The ideal screening program is to tailor the technology and screening frequency to the patient’s risk – one size never fits all. Women should be aware of their family history and risk factors, ask about their breast density, and then discuss these factors as well as their personal preferences regarding breast cancer screening with their physicians. True individualized and personalized risk-based screening is not yet a reality, but by making recommendations based on risk, we are taking steps in the right direction.

An Oklahoma mayor underwent a 3D mammogram (tomosynthesis) as part of a hospital promotion. She was diagnosed with ductal carcinoma in-situ (DCIS, also known as Stage 0 breast cancer) and she stated that the study “…saved my life.” She also recommended that women make sure to obtain a 3D mammogram. The story noted that tomosynthesis “virtually eliminates” the need for additional testing, and that early detection makes it less likely that the patient will need to undergo chemotherapy or radiation.

Here are a few errors in the story:

Statement: the mammogram saved my life
Fact: survival from breast cancer depends on many factors. The survival rate for patients with DCIS, regardless of treatment, is close to 97%. For invasive cancers, survival rates depend on stage as well as tumor biology. Small breast cancers “caught early” can still be lethal. It’s not the cancer in the breast that kills, it’s the cancer that gets to other areas of the body. Small tumors can and do spread.

Statement: early detection makes it less likely that a patient will need chemotherapy
Fact: the need for chemotherapy depends on tumor stage as well as tumor biology. As noted above, some very small, early stage breast cancers are very aggressive and have a high likelihood of spread, so chemotherapy is recommended. This is especially true for “triple negative” and “Her2/neu over-expressed” breast cancer subtypes.

Statement: early detection makes it less likely that a patient will need radiation therapy
Fact: radiation therapy is a standard recommendation for women with early stage breast cancer who undergo a lumpectomy. Since most women with early stage breast cancer are candidates for a lumpectomy, this statement simply doesn’t make any sense.

Statement: tomosynthesis “virtually eliminates” the need for additional imaging
Fact: while tomosynthesis can reduce the likelihood of needing additional views (“callback”) especially in women with dense breast tissue, diagnostic imaging with possible biopsy are still recommended when a concerning abnormality is seen.

While I certainly wish Ms. Noble well, stories like this always make me cringe, because they over-simplify a very complex situation. Here are some posts from Health News Review with some additional information:
Mayor: 3D Mammogram Saved My Life
3D Mammography and False Hope

27 June 2016

Choosing Wisely is an initiative of the American Board of Internal Medicine Foundation. Things Providers and Patients Should Question have been chosen by various medical societies based on review of the evidence-based literature. The American Society of Breast Surgeons (ASBrS) has published their contributions to the campaign (open access) in the Annals of Surgical Oncology.

The 5 ASBrS measures include:

1.) Don’t routinely order breast magnetic resonance imaging (MRI) in new breast cancer patients
2.) Don’t routinely excise all the lymph nodes underneath the arm in patients having partial breast removal (lumpectomy) for breast cancer when only one or two contain cancer
3.) Don’t routinely order specialized tumor gene testing in all new breast cancer patients
4.) Don’t routinely reoperate on patients if the cancer is close to the edge of the excised lumpectomy tissue
5.) Don’t routinely perform a double mastectomy in patients who have single breast with cancer.

Rational for the measures is included in the manuscript, and are posted on the Choosing Wisely website.

As with the other Choosing Wisely lists, these are meant to spark discussions between patients and their physicians regarding the appropriate use of medical tests and procedures. In many areas of medicine, tests and procedures may be performed without good supportive evidence. There may be many valid reasons for straying from an evidence based practice, which is part of the art of medicine. In fact, the Choosing Wisely website specifically states that “these recommendations should not be used to establish coverage decisions or exclusions.” In addition, the ASBrS statement notes that the selections made “are not meant to infer that a test or procedure endorsed in our list is a ‘never should occur’ event.”

Individualizing care as much as possible is extremely important. However, that does not mean performing every available test just because it’s available. Patients and physicians need to realize that there are downsides to unnecessary testing. Physicians also need to remain educated about current practice, and not continue to make outdated recommendations simply because they may have “always done it that way.” A goal of the Choosing Wisely campaign is to ensure that when decisions are made, available evidence is considered and that the process is a collaborative one between patients and their physicians.

26 April 2016

A growing number of states have enacted so-called “dense breast” legislation – requirements that radiology facilities inform patients if they have dense breast tissue, which may limit the sensitivity of mammography.

A study published in the Journal of the American Medical Association evaluated the dense breast legislation for 23 states who have these requirements. They evaluated the content, readability, and understandability of the dense breast notification. The authors found that the readability of these notices was at the high school level or above, and many notices had poor understandability. Also concerning was the fact that many notifications lacked concordance with the states’ average literacy.

Unless women (and their physicians) can make sense of the notifications, they are worthless. Research studies generally recommend that informed consents and study descriptions be presented to patients at a 6th-8th grade reading level, but these standards do not exist for other patient information.

It is important for patients to ask if there is anything about their medical test results or instructions that they do not understand.

17 January 2016

In October 2015, the American Cancer Society (ACS) updated their screening mammography guidelines, raising a lot of questions and concerns as annual mammograms were no longer recommended for all women starting at age 40. The United States Preventative Services Task Force (USPSTF) released new guidelines on screening mammography last week. The new USPSTF guidelines recommend an individualized risk-based approach for women age 40-49, and mammographic screening every other year for women age 50-74. The task force acknowledged that screening mammography reduces the likelihood of dying from breast cancer, but noted that the benefit was the greatest for women age 60-69, and the benefit was small for women age 40-49. For younger women, they noted that screening mammography is associated with higher false positives (false alarms).

The conflicting guidelines published by the USPSTF, ACS, and other organizations have caused much confusion. Many women simply want to know what they should do. The reality is, screening mammography is a one size fits all tool, and as any woman knows, that doesn’t really work. The sensitivity (“effectiveness”) of mammograms will vary depending on a patient’s age, menstrual status, use of hormone therapy, body mass index, breast density, and other factors. It is unrealistic to expect that one test can account for all of those variables, as well as personal risk factors for breast cancer, and personal preferences regarding screening risks and benefits.

To state it very simply:

  • Mammograms may lead to improved survival from breast cancer by detecting some cancers early
  • Some breast cancers are so aggressive that early detection does not lead to improved survival
  • Mammograms are imperfect

It is important to note that the USPSTF and ACS recommendations apply to average risk women. Unfortunately, risk assessment is not routinely performed, and many factors associated with an increased risk, such as heavy alcohol intake and breast density, are not taken into account in the existing models. In an ideal world, we would swab a cheek, obtain some DNA, and then determine whether or not a woman is predisposed to develop breast cancer [I’m thinking beyond BRCA and other genetic testing here]. If we can determine that a 30 year old woman, even without a family of breast cancer, is predisposed to develop the disease, we can make educated screening recommendations (perhaps ultrasound and/or MRI, as mammograms are not very helpful in very young women).  If we can determine that a woman is highly likely to die of a heart attack by age 60, and has no cancer predisposition, she might make the decision to forego screening mammography. Unfortunately we’re not quite there yet, but there are genetic risk tests under development.

I recently spoke with a researcher specializing in cancer risk. We discussed that at the end of the day, multiple organizations will continue to look at the evidence and draw different conclusions, so in his opinion, it wasn’t realistic that we should expect consensus. Physicians, researchers, and organizations are currently spending a lot of time and effort arguing with each other about whether mammography should start at age 40, if mammograms should be performed every versus every other year, and when screening should stop. However, our time and efforts might be better spent by working together to address issues such as disparities in access to screening mammography and lack of access to quality mammography and breast care for many women.

Recognizing the variability of each woman and her breasts, acknowledging the uncertainties regarding the risks and benefits of screening, and focusing on a shared decision making approach might help reduce some of the confusion. In medicine, as in many areas in life, there is often more than one right answer. The same applies to screening mammography. Time to move beyond the one size fits all approach.

Additional Reading:
New York Times: Panel Reasserts Mammogram Advice
JAMA: A Public Health Framework for Screening Mammography: Evidence-Based vs Politically Mandated Care 
New York Times: Insurer Rewards Push Women Towards Mammograms
Forbes: A Turning Point in the Breast Cancer Screening Debate?
NPR Shots: Federal Panel Finalizes Mammogram Advice That Stirred Controversy
OncLive Final USPSTF Guidelines
Cornell Mammogram Decision Aid for Women age 40-49

14 January 2016

Does cancer screening save lives? A study published in the British Medical Journal study noted that while many studies of cancer screenings report decreased cancer-specific mortality rates, the benchmark should be overall mortality rates, and this has not been consistently demonstrated. The 15 minute podcast is worth a listen. The lead author, Dr. Vinay Prasad, is not arguing against screening for cancers, but he notes that screening is for healthy people, who in general care about living longer and better, but disease-specific mortality does not capture that. He feels that before you tell a person that a screening test “saves lives”, you should be able to prove that the screening test and subsequent early detection results in an improvement in overall survival, not just disease-free survival.

It’s an interesting concept, and he goes on to note that the public (and physicians) have an inflated view of what screening can do for them. In addition, physicians sometimes get into a “check box” mentality – screening is just another thing to check off the list, or refer a patient for, when we really should be having discussions about the risks and benefits of screening and embracing the shared decision making process. He also noted that physicians need to be comfortable when patients make choices that are right for them, but might not be in line with the MD recommendation. He concluded by stating ” We encourage healthcare providers to be frank about the limitations of screening—the harms of screening are certain, but the benefits in overall mortality are not. Declining screening may be a reasonable and prudent choice for many people”. He also quoted Dr. Otis Brawley, chief scientific and medical officer of the American Cancer Society, who has stated: “We must be honest about what we know, what we don’t know, and what we simply believe”.

Personally, I feel that screening for certain cancers such as breast and colorectal cancer is of benefit even if there is improvement only in disease specific, and not overall, survival. But this is a decision that each person needs to make for themselves, ideally with input from their physician, taking into account the potential harms of screening (overdiagnosis / overtreatment with the subsequent impact on quality of life, as well as potential complications of the screening test itself) and the potential benefits.

Reuters coverage of BMJ Study
Medscape coverage of BMJ Study
Medscape – In Cancer Screening, Why Not Tell the Truth?

5 December 2015

Approximately 60% of women undergoing annual screening mammography over a 10 year period will be called back for additional views. Often these are in women with dense breast tissue, which can make it more challenging to read mammograms. Many of these callbacks are false alarms, also known as false positives – the abnormality may resolve with additional views, it may be found to be a benign lesion (such as a fluid filled cyst), or a biopsy may be performed and the pathology is found to be benign.

In a study published in the journal Cancer Epidemiology, Biomarkers, and Prevention, researchers found that false positive mammograms are associated with an increased likelihood of eventually developing breast cancer. Using data from the Breast Cancer Surveillance Consortium, they noted that women who had a false positive mammogram with additional imaging or biopsy recommendation had a higher likelihood of developing breast cancer compared to women with a normal mammogram. For every 1,000 women who had a true negative mammogram, 3.9 developed breast cancer over a 10 year period (average follow up 5.4 years). For those requiring additional imaging, 5.5 / 1000 developed breast cancer over 10 years, and in those who underwent a biopsy 7 / 1000 eventually developed breast cancer. It is important to note that the absolute risk of developing a breast cancer in the case of a false positive mammogram was very low – less than 1%.

The group of women with the highest rate of breast cancer development were those with dense breast tissue who underwent a biopsy. This is not surprising, as we know that breast density increases the risk of breast cancer, and the number of prior breast biopsies is factored into risk assessment models such as the Gail and Tyrer-Cusik models.

At this point, it is not recommended that women who have a false positive mammogram undergo any specific additional imaging such as MRI (unless recommended based on the mammogram). A false positive mammogram is one risk factor, but it needs to be evaluated in the context of other breast cancer risk factors, such as increasing age, family history, obesity, and alcohol intake.

Additional Information:
Dr. Margaret Polaneczky blog post
Breast Screening Decisions – screening mammogram decision tool for women age 40-49
ASCO Post Commentary
NPR False Alarm Mammograms

HNR False Positive Mammograms and Cancer Risk

 

 

9 November 2015

The American Society of Breast Surgeons Foundation has just launched a patient information website – Breast360.org. The site was developed by breast surgeons, and patient advocates have had input and oversight during the entire process. Please take a look, and feel free to provide feedback if you have a suggestion for additional content.