A Guide to Supplemental Breast Cancer Screening Methods

Rona Ahdout3 min readThis piece is part of a series of stories on the breakthroughs reshaping breast cancer screening and prevention to personalize care, detect cancer earlier, and save lives. Read the rest of the stories here. A mammogram is the main recommended breast cancer screening method because it’s been proven time and again to save lives. Today’s technology uses a low-dose X-ray machine to compile 2D and 3D images of the breasts. This helps detect masses, flecks of calcium, and other abnormalities in breast tissue that may signal early cancer.Additional screening methods are recommended for those who are at 20 percent or greater lifetime risk for breast cancer (as calculated by a risk-assessment tool), and in select cases, those with dense breast tissue. Breast density isn’t something you can feel during a breast exam; it can only be determined by a mammogram. Since September 2024, the FDA has required mammogram facilities to inform women about their breast density, which is divided into four categories ranging from not dense (almost entirely fatty tissue) to extremely dense (mostly glandular and fibrous tissue).While state laws increasingly require insurance companies to cover supplemental screenings in high-risk women, coverage still varies. Those who don’t meet the 20-percent-or-greater risk benchmark but still have above-average risk, for instance due to dense breasts, are in even more of a gray zone. But emerging laws are also expanding coverage for this group.We enlisted breast imaging radiologists Kimberly Feigin, MD, and Anjali Malik, MD, to break down the most common supplemental screening methods and who they’re best for.MRI You’ll receive an injection of a contrast fluid called gadolinium and then slide into a narrow machine that uses magnets and radio waves to create 3D pictures of your breasts. Cancers tend to have ample blood flow, so they quickly suck up the contrast, which makes them stand out in the images.Who it’s for: Because it has the highest cancer detection rate, MRI is considered the best imaging technique for women deemed high-risk. The typical path involves annual MRIs and mammograms, often staggered every six months, starting at age 30. However, there are two groups of high-risk women who may be recommended to start MRIs before they begin mammograms: young women who’ve had chest radiation and those with a known genetic mutation.Young women who’ve had chest radiation (to treat a prior cancer in the chest area, like lymphoma) should generally get annual MRIs beginning eight to 10 years after that radiation. And those with a known genetic mutation are typically recommended to get annual MRIs starting between 25 and 30. Guidelines suggest women in both camps add in annual mammograms starting between age 30 and 40, depending on when they began the MRIs.UltrasoundGel is applied to your skin, and a technician glides a handheld probe across each breast, using sound waves to create images of the structures within and detect abnormalities. Alternatively, a tech may use an automated breast ultrasound (ABUS), where a motorized scanner sweeps across each breast and snaps images that build a 3D visual.Who it’s for: It’s generally used as an adjunct to mammograms to get a closer read of tissue in women with dense breasts (and is often done on the same day as a mammogram). It’s not as sensitive as MRI, though, so women with dense breasts who are also designated high-risk due to other factors are generally better served by MRI.Contrast-Enhanced Mammography This is a newer technique that’s still in the early stages of implementation. As with an MRI, you’ll receive an injection, but in this case, the dye is an iodine contrast. Then you’ll get a standard mammogram. The dye spills out from the blood vessels that surround cancers, which makes them show up more visibly in the image.Who it’s for: It’s recommended as an alternative to MRI for high-risk women (and sometimes those with very dense breasts) who can’t get an MRI due to limited access, metal screws or plates in their bodies, an allergy to gadolinium, claustrophobia, mobility issues, or another contraindication. In these cases, it may replace a standard mammogram.Photographs: Rona AhdoutManicure: Yukie Miyakawa using DiorVisual Director: Fabienne Le RouxArt Director: Christine Giordano