In the battle against cancer, most women know about mammograms and Pap tests.
Now two newer cancer-detection tests that you may not have heard of are gaining attention.
Ultrasounds for women with dense breasts
One of the first questions you’ll probably ask is “Do I have dense breasts?” It’s not easy to know, and you can’t tell by looking or feeling; imaging is the only way to find out.
Breasts are composed of both connective tissue, which is dense, and fatty tissue, which is much less so. Connective tissue appears white on a mammogram, but so does cancer, so tumors can be difficult to spot. Mammograms determine density in breasts, which are classified from almost entirely fatty at the low end to extremely dense at the high end. The vast majority of women—80 percent—fall into the two middle categories, according the American College of Radiology.
Having dense breasts raises the risk of developing breast cancer by up to sixfold (though not the chance of dying from the disease, according to recent research, but ultrasounds and MRIs can spot it more effectively than mammograms.
Four states (New York, Connecticut, Texas and Virginia) require that women getting their mammogram results also be told if they have dense breasts. Illinois has no such “must inform” law, but is one of only two requiring insurance companies to provide free coverage (no co-pays or deductibles) for an ultrasound screening if a mammogram reveals a woman has dense breasts, according to Are you Dense Advocacy.
“If density information is not shared with women, they are uninformed participants in their own health care and therefore unable to advocate for themselves,” says JoAnn Pushkin, executive director of the organization.
For women who would take action if they found out they have dense breasts—get annual mammograms, do self-exams, have in-office exams—”it would be important to know,” says Dr. Peter Jokich, a radiologist and director of the Breast Imaging Center at Rush University Medical Center in Chicago.
So is getting an ultrasound the right move for most women? According to Jokich and other experts:
The Pros
- Better at finding breast cancers than mammograms alone for women with dense breasts
- Widely available
- Is painless and does not expose you to radiation
- Less invasive and expensive than MRIs
The Cons
- Has high false-positive rates, which can result in added testing and unnecessary biopsies
- Can be more expensive than mammograms
- Not enough evidence to recommend routine screenings, according to the American College of Radiology and the Society of Breast Imaging
- Many medical centers don’t offer screening ultrasounds for women with dense breasts
In most cases, the minuses outweigh the pluses, Jokich says, so routine ultrasounds are not recommended. But that doesn’t mean women are stuck without options: “Mammography remains the gold standard for finding early breast cancer,” he says.
CA-125 blood test
You may have gotten an email or been told by a friend to “demand this life-saving test!” which detects elevated levels of CA-125, a protein associated with ovarian cancer.
So should you? Many doctors say for most women, the answer is no. “There is no controversy among experts in the field. We all agree it should not be offered in the general population,” says Dr. Lauren Streicher, an assistant professor of Obstetrics and Gynecology at Northwestern University’s Feinberg School of Medicine in Chicago and author of “The Essential Guide to Hysterectomy,” adding that “major medical organizations such as The American College of Obstetricians and Gynecologists don’t recommend it.”
The U.S. Preventative Services Task Force also recently recommended against screening for ovarian cancer for asymptomatic women, noting that it can lead to “important harms, including major surgical interventions in women who do not have cancer.”
Most women don’t need it, Streicher says, because the test:
- Has a high rate of false-positives and can miss up to 50 percent of stage 1 cases
- Can show conditions other than cancer, such as endometriosis or fibroids
- Doesn’t decrease the number of women who die of the disease annually
- Could lead to unnecessary testing and surgeries
Those who might benefit from CA-125 testing, according to Streicher, are women who:
- Are at high risk, which includes having a family history of the disease
- Have tested positive for BRCA1 or BRCA2 mutations, which increase the risk of breast and ovarian cancers
- Display symptoms, such as persistent abdominal bloating, pelvic or abdominal pain or a significant increase in urinary frequency
- Had an ultrasound that showed a mass on an ovary
