What You Should Know

May 2023 | Submitted by Jose Calderon-Reyes, PharmD Candidate 2023 

In the United States in 2019, more than 264,000 new cases of female breast cancer were diagnosed, and approximately 42,000 women died from the disease. During the same year in Alabama, about 127 out of every 100,000 women were diagnosed with breast cancer.¹

What Screenings Are Used for Breast Cancer and Why Are They Important?

Mammograms are X‑ray images of the breast used to help detect breast cancer. Screening mammograms typically include two or more X‑ray images of each breast and are designed to find tumors that cannot be felt during a physical exam.²

Diagnostic mammograms involve additional X‑ray images taken from different angles. These are used when a lump, abnormal screening result, or other signs or symptoms of breast cancer are present.²

While mammograms do not prevent breast cancer, they can help detect the disease earlier, when treatment is often more effective.

How Often Should You Get Screened?³

Screening recommendations vary based on age and individual risk factors:

  • Women ages 40–49: Screening decisions should be made individually based on personal risk.

  • Women ages 50–75: Screening mammography is recommended every two years.

  • Women ages 75 and older: No specific screening recommendation is provided.

Women should talk with their health care provider to determine the screening schedule that is right for them.

What Do the Results Mean?

Mammography results are reported using a standardized system called the Breast Imaging Reporting and Data System (BI‑RADS), which includes seven categories.²

Category 0
Assessment: Incomplete
Follow‑up: Additional imaging is needed before a final category can be assigned.

Category 1
Assessment: Negative
Follow‑up: Continue regular screening mammograms.

Category 2
Assessment: Benign findings
Follow‑up: Continue regular screening mammograms.

Category 3
Assessment: Probably benign
Follow‑up: A follow‑up mammogram is recommended in six months.

Category 4
Assessment: Suspicious abnormality
Follow‑up: A biopsy may be recommended.

Category 5
Assessment: Highly suggestive of malignancy (cancer)
Follow‑up: A biopsy is required.

Category 6
Assessment: Known biopsy‑proven malignancy (cancer)
Follow‑up: Cancer has already been confirmed before treatment begins.

In addition to BI‑RADS categories, mammography reports also include breast density. Dense breast tissue is a risk factor for breast cancer and can make mammograms more difficult to interpret. Higher breast density may reduce the accuracy of mammogram readings.

Where Can You Get High‑Quality Mammograms?²

Mammograms are available at many locations, including breast clinics, hospital radiology departments, mobile mammography vans, private radiology offices, and some physician offices.

Before scheduling an appointment, ask whether the facility is FDA‑certified. Facilities should display a current Mammography Quality Standards Act (MQSA) certificate. Be sure to check the expiration date.

Information about FDA‑certified mammography facilities is available through the National Cancer Institute’s Cancer Information Service at 1‑800‑4‑CANCER. You may also access a searchable list of certified facilities by visiting the U.S. Food and Drug Administration website.

BI-RADS Breast Density Categories

Breast density is classified into four categories (A–D) based on the American College of Radiology (ACR) BI‑RADS system. This system measures the proportion of dense fibroglandular tissue to fatty tissue on a mammogram. Categories C and D are considered “dense,” which can make tumors harder to detect and is a risk factor for breast cancer.

  • Category A (Almost entirely fatty): The breast is mostly fatty tissue, making abnormalities easier to detect.
  • Category B (Scattered areas of fibroglandular density): There are some scattered areas of dense fibrous and glandular tissue.
  • Category C (Heterogeneously dense): Much of the breast tissue is dense, which may hide small masses on a mammogram.
  • Category D (Extremely dense): Most of the breast tissue is dense, making cancer the most difficult to detect.

References

  1. CDC: United States Cancer Statistics: Data Visualization . U.S. Department of Health & Human Services. Atlanta (GA): Centers for Disease Control and Prevention. Updated November 2022 [cited April 4, 2023].
  2. National Cancer Institute: Breast Cancer: Mammograms . U.S. Department of Health & Human Services. Bethesda (MD): National Institutes of Health. Updated February 21, 2023 [cited April 4, 2023].
  3. Recommendation: Breast Cancer: Screening . Rockville (MD): U.S. Preventive Services Task Force; 2016 [cited April 4, 2023].