The first mammogram was performed in 1913 by Albert Salomen. Breast ultrasound was reported in the 1950s. Modern screening mammograms were introduced in the 1960s. Breast MRI was first used in the early 1980s. Each of these imaging techniques, in addition to other screening modalities, has a different utility.
Modern mammography was introduced in the 1960s. As with most things, guidelines change as new evidence emerges to guide clinical decision making.
Screening Recommendations
- National Comprehensive Cancer Network (NCCN)
- Women ≥40 years old: annual screening mammogram
- Women with family history of breast cancer: begin annual screening mammogram 10 years prior to when youngest family member was diagnosed
- No age limit to stop screening mammograms, but consider comorbidities and whether any abnormal findings would be pursued further
- American Society of Breast Surgeons
- Women ≥40 years old: annual mammogram
- Women with hereditary susceptibility or prior chest radiation age 10-30: annual MRI starting at age 25; annual mammogram starting at age 30
- Women with strong family history or predicted lifetime risk >20%: annual mammogram starting at age 35
- U.S. Preventive Services Task Force (USPSTF)
- Women 40-74 years old: biennial screening mammogram
- Women ≥75 years old: insufficient evidence for formal recommendation
- American Cancer Society (ACS)
- Women 40-44 years old: shared decision with physician to start annual mammogram
- Women 45-54 years old: annual screening mammogram
- Women ≥55 years old: annual or biennial screening mammogram
- Continue screening while woman is in good health and expected to live at least 10 years
- American College of Obstetricians and Gynecologists (ACOG)
- Women ≥40 years old: screening mammogram every 1-2 years; shared decision with physician
Screening in High-Risk Populations
- High risk populations
- Patients with BRCA1/2 mutations
- Females with prior diagnosis of breast cancer, atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ
- Females with family history suggestive of familial breast and/or ovarian cancer
- Females with first-degree relative who has tested positive for breast cancer-associated genetic mutation
- Females who received mantle or chest wall irradiation between 10-30 years old
- Models to predict risk
- Gail Model
- Valid for women 35-85 years old
- Assesses breast cancer risk based on age, number of first-degree relatives with breast cancer, age of menarche, age of first live birth, number of precious biopsies, race or ethnicity
- Tyrer-Cuzick: includes family history of gynecologic history
- Overestimates risk of breast cancer
- Not as good a risk model as Gail model
- Gail Model
Stereotactic Biopsy
- “Stereotactic” = touching in space
- Sample nonpalpable or indistinct breast lesion through spatial localization using radiographic imaging