From the Guidelines
Based on your mammogram findings and the potential for a genetic predisposition to breast cancer, I strongly recommend following through with the radiologist's suggestion for a repeat mammogram and ultrasound in 6 months, as well as keeping your scheduled appointment with the genetic counselor to discuss potential genetic testing, such as BRCA1 or BRCA2 testing, as recommended by the NCCN guidelines 1. The report identifies multiple focal asymmetries in both breasts (18mm and 15mm in the right breast, 9mm in the left breast) and some lymph nodes on ultrasound. These findings require follow-up but don't necessarily indicate cancer. Focal asymmetries are areas of tissue that appear denser than surrounding breast tissue and often need monitoring over time to determine if they change. According to the NCCN guidelines 1, the sensitivity of breast MRI screening is significantly higher compared to mammography, especially in high-risk populations, with a sensitivity of 79% and specificity of 86%. Additionally, the American College of Radiology recommends supplemental screening with contrast-enhanced breast MRI for women with genetics-based increased risk 1. While waiting for your follow-up appointments, be aware of any changes in your breasts such as new lumps, skin changes, or nipple discharge, and report these to your doctor immediately. It's also important to note that the optimal surveillance approach in women at high risk for familial breast cancer remains uncertain, and future prospective trials are needed to evaluate different surveillance strategies 1. However, based on the current evidence, annual MRI starting at 25 years of age combined with alternating digital mammography/MRI starting at 30 years of age may be the most effective strategy when radiation risks, life expectancy, and false-positive rates are considered 1.
From the Research
Mammogram Findings and Recommendations
- The mammogram findings indicate the presence of focal asymmetries in both breasts, with sizes ranging from 9 mm to 18 mm, and a few lymph nodes were identified on ultrasound, although it is indeterminate if these correlate with the mammogram findings 2.
- The impression suggests a repeat mammogram and ultrasound in 6 months, and the patient is scheduled for genetic counseling, implying a potential increased risk of breast cancer 3.
Breast Cancer Screening and Surveillance
- Studies have shown that screening mammography can detect breast cancer at an early stage, and the addition of ultrasonography to the screening regimen may reduce false-negative rates, although it may also increase false-positive findings and unnecessary biopsies 2.
- For women with dense breasts, the combination of mammography and ultrasonography has been shown to detect more breast cancer cases than mammography alone, although the number of false-positive results and biopsy rates may be higher 2.
- Follow-up guidelines for mammogram and clinical breast examination after a benign breast biopsy are lacking, but increased surveillance is indicated due to the increased need for subsequent biopsy or risk of cancer development 4.
Imaging Recommendations for Palpable Breast Masses
- The American College of Radiology Appropriateness Criteria recommend ultrasound as the initial imaging for women under 30 years of age with palpable breast masses, while diagnostic mammography and tomosynthesis are recommended for women 40 years of age or older 5.
- The choice of imaging modality depends on the patient's age, clinical scenario, and initial imaging findings, with further imaging or biopsy recommended if the findings are suspicious or highly suggestive of malignancy 5.