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Generally, mammography is spoken about as the gold standard for detecting breast cancer. However, for women who were diagnosed younger and have dense breast tissue, mammography seems inadequate at best.

I'm not trying to diminish the value of mammography overall, but it did miss my cancer, and even women in their 40s have had this experience.

MRIs and ultrasounds pick up more than mammography. I wonder if anyone knows whether these diagnostic tests are encouraged for use with younger women as part of standard practice.

Is it the expense of the procedures that is prohibiting the widespread medical community from recommending these tests?

Women slip through the cracks every day because a mammogram missed breast cancer.

I'd appreciate any feedback as to why MRIs and ultrasounds are not being as widely promoted as mammograms.

This is a great question, Beth. I wonder... is there more radiation involved in MRIs and ultrasounds? That could be one reason they are not more widely promoted, since exposure to radiation can actually cause cancer instead of having the inteded effect of detecting it. Here is an interesting blog post about mammograms and radiation. Does anyone know if MRIs and ultrasounds expose people to higher levels of radiation than mammograms?

I have also always wondered how effective breast exams are. I am 28 years old and have never had a mammogram (nor MRI nor ultrasound) to check for breast cancer -- only self-exams and yearly exams by my gynecologist. I am not aware of any family history of breast cancer, but my mother was adopted so I have limited evidence to draw from on her side. Does anyone know of any studies that have been done around the effectiveness of breast exams vs. mammograms vs. MRIs/ultrasounds, and the relative risks of each of these?...

At this point when it comes to the detection of breast cance, much less is known about using ultrasound and MRI than about mammography.

According to the American Cancer Society, 2 to 4 screening mammograms of every 1,000 (less than one-half of one percent) lead to a diagnosis of breast cancer. 80% of biopsies will not be cancer.

Good medical practice errs on the side of the data, particularly when the risk of breast cancer in women under 40 -- even 50 -- is epidemiologically low. Of course, if you have a malignancy your risk is 100%.

And that introduces the concepts of specificity and sensitivity. Currently mammograms achieve what's considered the best balance of the two. Sensitivity =  your tool finds potential problems and misses few. But specificity means that what the tool identifies is truly of concern. Specificity means accuracy; it prevents unnecessary biopsies.

You might personally be willing to undergo a biopsy that turns out benign. Many women do. And you might be willing to do it more than once. But multiply that experience by the population and you have a real problem of unnecessary medical procedures.

With refinements and more experience, the specificity of MRI and ultrasound will likely improve and they will deliver -- overall -- a better ROI. But for the general population of women at average risk we're not there yet.

Eve,

Thanks for your insights regarding mammograms. I'm really hoping that the specificity of the other tools will improve. A mammogram had missed my tumor, so of course, it's easy for me to doubt their overall effectiveness with dense breast tissue. Even when I went to a special center for a mammogram (when I suspected something), they finally found the tumor, but it was almost invisible.

Devon, to answer your question, I don't think the MRI has radiation, but are done with magnets. I don't know the intricacies of how it all works, but my impression is that all these diagnostic tests don't put patients at risk.

Here is another article I just found about mammograms:

http://www.nytimes.com/2009/11/03/health/03second.html?_r=1&scp=3&sq=mammogram&st=cse

What do you all think of this?

Apart from X-Rays, MRI and ultrasound there's another darkhorse technique under going 3rd ph trials (I believe at Pittsburgh U) . Its a form of an electrical impedence spectroscopy.  

Here's another new study regarding mammograms and young women: http://www.reuters.com/article/idUSTRE6424VY20100504

One of the researches says, "Harms need to be considered, including radiation exposure because such exposure is more harmful in young women, the anxiety associated with false-positive findings on the initial examination, and costs associated with additional imaging"