Best with Dense Breasts - MRI/Ultrasound/Mammo with tomo

Every year I had mammogram followed by MRI six months later because I am in a high risk group. Family history of breast cancer and ver dense breasts. This has been standard protocol for over 20 years. My mammograms always came back normal. BUT in 2002 my MRI found Lobular carcinoma in situ and atypical ductal hyperplasia. Stage 0 breast cancer. I had lumpectomies and was put on tamoxifen for 5 years and Raloxifene for 7 years. Then discontinued the meds. Last year my mammogram was normal BUT again, the MRI found DCIS, ductal carcinoma in situ. MRI is a valuable and legitimate screening tool. Absolutely get a second opinion if your doctor is advising you against having one. Insurance will cover it.

I was not told about the false positive, but have scheduled an MRI because of my dense breast tissue.

MRI definitely has a higher false positive rate, I think its something like 20% false positives vs mammo of 10% false positives if I recall correctly. However MRI definitely finds a lot that mammos miss, but MRI is most important for high breast density. At your age, most likely you have fatty / low density, but be sure to ask if its not on your report. If you do have high breast density, then a MRI is more likely to find things that mammo wont. Breast density is also why mammos are only about 50% accurate in young women (30s, 40s) but very accurate in women age 60 and up. Ductal typically shows up on mammo if breast density is not high. Lobular however rarely shows on mammo, but will show on MRI. Ultrasound is another option - but its best done with mammo or MRI rather than alone from what I understand

I went faithfully every year for my mammograms. On one of my annual visits the doctor thought there was a lump. The most recent mammogram didn’t show anything other than dense breast tissue. So another mammogram was done, then an MRI, and then an ultrasound. The mammogram showed one mass. The MRI showed a different mass. The ultrasound showed yet another different mass. no one test showed all three masses. So on my way toward getting a mastectomy, I saw the breast oncologist. He did the basic breast exam in office and said to me that as long as he was looking at the three scans while he was palpating my breast he thought that maybe he might be feeling something, but without having the scans in front of him, he would’ve given me a totally clear report. The masses were removed and biopsied. They were all the same cancer. They were three areas either they split off or developed in three areas, but it was the same cancer. Amazed that none of the scans and physical examination of my breast course, I don’t know how many years, totally missed the masses. But there was obviously something about the structure of those masses that was so soft. They appeared to be normal breast tissue. It was ER positive breast cancer, and 19 lymph nodes were removed. Four of the lymph nodes were malignant and one of them was totally obliterated. The radiation oncologist said to me that it was a good thing. I had my surgery when I did because the cancer that I had was particularly vicious. He said in a very short period of time it had probably spread through four lymph nodes totally obliterating one of them. there’s so much about breast cancer that just isn’t fair and none of the testing is absolutely perfect. Hopefully that will change. Going forward as technologies develop. Every year I have an MRI and ultrasound and physical exam by the breast cancer staff. It’s the best I can do! I am over five years out at this point with no recurrent so far.

MRI is critical.

@karlsjenine
My breast cancer was not detected on annual mammogram. Instead I found through self-exam 6 months after mammogram, it had already spread to lymph nodes. At time my insurance would not authorize MRI until had breast cancer diagnosis. Had biopsy to confirm, then insurance paid for for MRI.

It has been 5 years since original diagnosis. I currently alternate every 6 months between mammogram and MRI. I asked oncologist if needed mammograms if did MRIs, and he said yes, different imaging find different things.

Any imaging could show false positive, I would rather have a false positive and investigate, then miss something. Since my lumpectomy, chemo and radiation. My MRIs have never shown a false positive.

To address your comment about increase chance of cancer due to additional imaging test. Studies show the benefits of mammography outweigh the small risks from radiation exposure. Below is a link to a Princeton Radiology article, it states the risk is 20-25 cancers per 100,000 women. That is less than 1%.
https://www.princetonradiology.com/do-yearly-mammograms-increase-the-risk-of-getting-breast-cancer/
Have you decided to go ahead and ask for MRI?

I was too young at 38 for a mammo so the cancer was first found on ultrasound after I and my midwives had all felt the lumps.

I have dense breasts and had TNBC Stage 3 B - I went through UCLA and my standard of care post treatment is yearly mammogram with ultrasound, and yearly MRI so one or the other every 6 months.

No one told me about chance of false positives, but given the speed of the first disease (Stage 2 to Stage 3B in 6 weeks) we all want to catch anthing that comes up.

We are far apart in age, but I hope you can get the MRI option as well as the mammmo, especially given your history!
Hugs