Which Post-Cancer Screen is Best?

You've won the war against cancer's invasion. Now you're ready to fight back before it comes back. Check out these 5 screening methods to protect yourself from the return of cancer.


Mammogram

The most common diagnostic tool for breast cancer, this x-ray machine compresses each breast and makes an image of it.

Time: Each view takes less than three seconds, but setup and review of the film stretch most appointments to 30 minutes.

Frequency: The American Society of Clinical Oncology recommends scheduling your first post-treatment mammogram no earlier than six months after radiation ends. After that, annual mammograms are typically scheduled.

Pros: "Mammograms save lives," says Julie Gralow, MD, associate professor of medical oncology at Seattle Cancer Care Alliance. Oncologists and even health insurers say these machines detect tumors too tiny to be felt by touch, and theoretically can catch cancer at its earliest and most treatable stage. Mammography also can pick up calcifications that an MRI might miss.

Cons: Tumors are harder to detect in women with denser breasts, including those who are under age 50, premenopausal, or taking hormone replacement therapy. "But mammography remains the best tool we have," says Constance D. Lehman, MD, PhD, radiology professor and breast imaging director at the Seattle Cancer Care Alliance. "So keep on getting them!"

Approximate Cost: $150-$200

Insurance: Most insurers pay for breast cancer survivors' mammograms.

Success Rate: Numerous screening studies show mammography catches 80 to 85 percent of cancers in the general population. In screening trials, the false-positive rate of the initial round of mammography was 3 to 6 percent (that is, a specificity of 94 percent to 97 percent). The risk of false positives is that a patient might undergo unneeded anxiety, testing, and possibly treatment.

Availability: Wide

Digital Mammogram

This process is similar to standard mammography, but the image is processed digitally, much like that of a digital camera.

Time: Each view takes less than three seconds, but setup and review of the film stretch most appointments to 30 minutes.

Frequency: The American Society of Clinical Oncology recommends scheduling your first post-treatment mammogram no earlier than six months after radiation ends. After that, annual mammograms are typically scheduled.

Pros: In women with dense breasts, digital mammograms detect cancer better than film. Digital mammography may be better at spotting cancers in asymptomatic women who are under age 50, are premenopausal, or have dense breast tissue. Digital mammography allows a radiologist to manipulate the images.

Cons: Mammography does not spot all cancers.

Approximate Cost: $150-$200. Digital mammograms may cost more than regular mammograms depending on the facility.

Insurance: Most insurers will pay the same for digital as for a regular mammogram.

Success Rate: The results were the same for postmenopausal women for traditional and digital mammography, but digital is 15 percent better at detecting cancer in women under age 50, according to a joint trial of the National Cancer Institute and American College of Radiology Imaging Network involving 49,528 patients and 33 medical centers. Results were reported in the October 2005 New England Journal of Medicine.

Ultrasound

Ultrasound uses sound waves emitted through a wand that's moved across the surface of the breasts.

Time: Five to 30 minutes per breast.

Frequency: As needed.

Pros: Ultrasound works best as a backup tool to find or characterize lumps felt by women or doctors. Physicians also may use it if breast tissue is dense and the original tumor did not show up on mammography. "Ultrasound is a very important diagnostic tool to determine if a lump is a cyst or solid, but it's not a strong screening tool," Lehman says. Ultrasound also helps guide biopsy needles to tumors.

Cons: Ultrasound cannot differentiate between tumors and scar tissue in women who've had partial mastectomies or lumpectomies.

Approximate Cost: $375

Insurance: Health providers usually cover ultrasound when it's used diagnostically but may not when used as a stand-alone screening tool.

Success Rate: Ultrasound finds as few as half of tumors. But in a 2003 study when used with mammography and clinical exam, ultrasound found eight malignancies and correctly downgraded 332 malignancies to noncancerous cysts or fibrous tissue, according to the Archives of Internal Medicine.

Availability: Wide

CAD (Computer-Aided Detection)

Computer-aided detection is an add-on to mammography. The radiologist uses computer software as a second set of eyes to point out areas that are possibly abnormal. Plain film must be digitized before CAD can be used.

Time: Time spent at the doctor's office won't be affected because this process is done after the patient leaves.

Frequency: CAD is recommended for every routine mammogram, says Carol H. Lee, MD. professor of diagnostic radiology at Yale University School of Medicine.

Pros: CAD picks up cancers radiologists might miss. "For a radiologist who reads only breast exams, CAD may not provide significant additional benefit, but for a nonspecialist radiologist who reads other types of x-ray films as well, it may be helpful," says Gralow, an American Society of Clinical Oncology spokesperson.

Cons: Radiologists who specialize in breast imaging often find cancers as well as CAD does. Also, a small number of women are called back for another look at suspicious areas that turn out to be cancer-free.

Approximate Cost: $15

Insurance: Varies

Success Rate: Between 7 and 20 percent more cancers might be detected with the use of CAD.

Availability: Wide

MRI (Magnetic Resonance Imaging)

A patient lies flat and is moved through a machine hat uses magnetic fields and radio waves to create an image. Before the breast, chest, and axillary lymph odes in the armpit are examined, a contrast agent is given intravenously. Cancerous and irregular tissue is more likely to pick up the dye, which makes it "light up."

Time: 45-60 minutes

Frequency: The use of MRI as a follow-up in patients with breast cancer has not been uniformly agreed upon. "We think it's reasonable for a breast cancer survivor to have a breast MRI if she hasn't had one before," Lehman says. "We might find the cancer in another quadrant or the other breast."

Pros: Women deemed to have more than a 25 percent lifetime risk of breast cancer should have an MRI annually. These include women who have a known genetic mutation (such as BRCA-1 or 2, P-53, or Li-Fraumeni Syndrome, the last affecting tumor-suppressor genes); who've not been tested but have a mother, sister, or aunt with a known mutation; whose biopsies show lobular carcinoma in situ (a condition that increases the risk of breast cancer); and who received chest radiation between the ages of 10 and 30 for prior cancers. MRI also can be useful in women who have breast implants.

Cons: MRIs lead to 10 to 15 percent false positives, which can result in unwarranted anxiety, biopsies, further testing, and possibly surgery. Breast MRI requires a special breast coil and expertise in reading the results.

Approximate Cost: About $1,500

Insurance: Reimbursement varies, but Aetna, Blue Cross/Blue Shield, and others will cover it as a screening tool in very high-risk women .

Success Rate: Screening data on MRIs has only been gathered in high-risk women, but in them, 85 percent or more of cancers are spotted.

Availability: Major cities

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