Understanding Breast Cancer and Imaging: When to Consider an MRI, Mammogram, or Ultrasound

Breast cancer is a major health problem worldwide, affecting millions of women each year. Early detection and accurate diagnosis are essential for effective treatment and improving survival rates.

“Breast cancer is the most common cancer in women worldwide, with more than 2 million new cases diagnosed in 2020,” said Valenina Hoyos, MD, an oncologist at Baylor Medicine. “It starts in the cells of the breast and can spread to other parts of the body if not caught early. Common symptoms include a lump in the breast, changes in breast shape, dimpling of the skin, and nipple discharge. Regular screening is essential for early detection and better outcomes.”

The importance of screening

Breast cancer screening is essential because it helps detect the disease before symptoms appear. Early detection through screening can lead to less aggressive treatments and better outcomes.

“Screening is a powerful tool in the fight against breast cancer. Early detection not only saves lives, but also provides more personalized and less invasive treatment options. For example, early-stage cancers may require only a lumpectomy (removal of the tumor) rather than a mastectomy (removal of the entire breast),” said Pabel Miah, MD, a breast cancer surgeon at Baylor Medicine.

For more information or to schedule an appointment at the Lester and Sue Smith Breast Center, call (832) 957-6500.

Imaging modalities: mammograms, MRI and ultrasounds

Imaging plays a vital role in the detection and management of breast cancer. Mammograms, MRIs, and ultrasounds are often used for breast cancer screening and diagnosis.

Mammograms

Mammography is the most commonly used imaging modality for breast cancer screening. It uses low-dose X-rays to create detailed images of breast tissue.

Mammograms are effective for early detection, widely available, and relatively inexpensive, but they cannot detect all cancers, especially in women with dense breast tissue. This is where an MRI may be necessary.

Magnetic resonance imaging (MRI)

“Breast MRI uses powerful magnets and radio waves to create detailed images of the breast,” says Kellen Carril, a radiologist with Baylor Medicine’s Breast Center and Dan L Duncan Comprehensive Cancer Center. “It’s more sensitive than mammography and can detect cancers that mammography might miss.”

MRI is usually recommended for women at high risk for breast cancer, such as those with a BRCA1 or BRCA2 gene mutation or a strong family history of breast or ovarian cancer. It can also be used to assess the extent of cancer after diagnosis and to monitor response to treatment.

“MRI can provide a more detailed view, especially for high-risk patients, but it’s not necessary for everyone,” Hoyos said. “It’s about finding the right balance based on individual risk.”

Ultrasound

Breast ultrasound uses sound waves to create images of the inside of the breast. It is often used as a complementary tool to mammograms and MRIs.

“Ultrasound is recommended for women with dense breast tissue, for whom mammography may be less effective,” Carril said. “It is also used to further examine abnormalities detected during a mammogram or physical exam.”

Which imaging option is best?

Choosing the right imaging method depends on a variety of factors, including age, breast density, personal and family history, and overall breast cancer risk. “Regular mammograms are the cornerstone of breast cancer screening for most women,” Miah said. “However, those with higher risk factors should discuss the possibility of additional imaging with their healthcare provider.”

• Women at average risk:Annual mammograms from age 40.
• Women at high risk:Annual mammograms and MRIs starting at age 30 or as recommended by your healthcare professional.
• Women with dense breasts:Complement mammograms with an ultrasound or MRI.

“Regular exams and knowing your personal risk factors are essential steps to early detection and effective treatment,” Miah said. “By staying proactive with your exams, you can ensure the best possible outcomes and take control of your breast health.”

By Tiffany Harston, Communications Officer, Michael E. DeBakey Department of Surgery