The first mammogram was performed in 1913 by the German surgeon Albert Salomen. Salomen found that the films he took gave a good picture of the margins and extent of tumors and that he could differentiate tumor types based on the pictures he obtained.
Breast Self-Examinations
- No reduction in breast cancer specific or all-cause mortality from regular breast self-exams in average risk populations
- Demonstrated no value in large randomized control trials
- May encourage patients to bring changes to physician attention
Clinician Examinations
- Unclear value
- Increases breast cancer detection over mammograms alone
- Several limitations
- Effectiveness varies by technique
- Time spent on exam
- Expense of clinician availability
- High false-positive rate → requires expensive workup and patient stress
Mammograms
- 2 views: mediolateral oblique and craniocaudal
- Radiologist doesn’t have to be present
- BI-RADS classification
Digital Mammograms
- Replaced film mammograms
- Mammogram limitations
- Radiation is carcinogenic → overutilization of mammograms can cause cancer
- Overdiagnosis
- False-positive rate
Tomosynthesis
- Aka 3D digital mammogram
- Multiple images at different angles
- Can be more costly
Whole Breast Ultrasound
- Can be a useful adjunct to mammography despite several limitations
- Time to perform exam
- Exam varies widely from one ultrasonographer to another
- High false-positive rate
- Sometimes considered in very dense mammograms and high risk patients in which screening mammogram is insufficient or not able to be performed
- Commonly used to guide biopsy
Breast MRI
- Annual MRI for patients received radiation to chest between 10-30 years old, Li-Fraumeni syndrome, Cowden syndrome