From the Guidelines
If a patient refuses a mammogram, the most appropriate alternative breast cancer screening test is breast ultrasound, particularly for women with dense breasts, as it uses sound waves to create images of breast tissue and can detect cancers that may be missed by mammography. According to the American College of Physicians guidance statement 1, breast ultrasound is a viable alternative to mammography, especially for women with dense breasts, as it can reduce recall rates and increase cancer detection. However, it may produce false positives and miss some cancers.
Alternative Screening Options
Other alternative breast cancer screening options include:
- Breast MRI: provides detailed images using magnetic fields and is highly sensitive, making it excellent for high-risk patients, but it's expensive and may lead to unnecessary biopsies 1.
- Molecular breast imaging: uses a radioactive tracer to identify cancer cells and works well for dense breasts, but involves radiation exposure and limited availability.
- Clinical breast exams: performed by healthcare providers can detect palpable abnormalities but miss smaller lesions.
Considerations for Alternative Screening
When considering alternative screening options, it's essential to discuss the patient's risk factors, breast density, and reasons for refusing mammography with a healthcare provider to determine the most appropriate option. Mammography remains the gold standard for breast cancer screening with proven mortality reduction benefits 1. The American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography suggest that women at increased risk of breast cancer may benefit from additional screening strategies beyond those offered to women at average risk 1.
Key Points to Consider
- Breast ultrasound is a viable alternative to mammography, especially for women with dense breasts.
- Breast MRI and molecular breast imaging are also options, but have limitations and potential harms.
- Clinical breast exams can detect palpable abnormalities but may miss smaller lesions.
- Mammography remains the gold standard for breast cancer screening with proven mortality reduction benefits.
From the Research
Alternative Breast Cancer Screening Tests
If a patient refuses a mammogram, there are alternative breast cancer screening tests that can be used. These include:
- Magnetic Resonance Imaging (MRI) 2, 3, 4
- Ultrasound 2, 3, 5
- Digital breast tomosynthesis 3
- Contrast-enhanced mammography 3
Recommendations for Alternative Screening Tests
The use of alternative screening tests depends on the patient's risk level and breast density. For example:
- High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or ultrasound if MRI is not available 3
- Women with dense breast tissue may benefit from screening breast sonography as an adjunct to screening mammography 5
- The addition of MRI to mammography in high-risk groups has the greatest potential to detect additional mammographically occult cancers 2
Effectiveness of Alternative Screening Tests
Studies have shown that:
- Adding MRI to mammography provides a highly sensitive screening strategy, especially for young women at high risk of breast cancer 4
- Ultrasound can detect small breast cancers that are not detected on mammography or clinical breast examination, especially in women with dense breast tissue 5
- Digital breast tomosynthesis and contrast-enhanced mammography have also shown potential to further increase diagnostic performances, but more evidence is needed to support their use 3