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August 2013 Ask the Expert: Breast Imaging and Screening Updates

Living Beyond Breast Cancer expert Debra Somers Copit, MD, answered your questions about the latest in breast imaging and screening in this companion to our August 2013 webinar

How are mammograms performed after a double mastectomy? I keep getting asked if I will have mammograms, and I can't picture it.

Is it beneficial to have a PET scan? I heard that the results can be sometimes wrong. 

My cancer was invisible on all films — mammogram, ultrasound and MRI. Is that common for all breast cancers? Is it more common for triple-negative breast cancer?

I am a 12-year breast cancer survivor and I get yearly mammograms, along with physical exams by my surgeon and medical oncologist. Under what circumstances would additional breast imaging be recommended?

Doesn't MRI imaging of the breast produce many false positives?

I had a double mastectomy in December 2011. What kind of imaging can I have to check that my chest is free of breast cancer?

Question: How are mammograms performed after a double mastectomy? I keep getting asked if I will have mammograms, and I can't picture it.

Dr. Somers Copit: It is extremely difficult to perform a mammogram after a mastectomy. The mammogram is performed in the same way that it was prior to a mastectomy, but how much the radiologist may see is dependent on the amount of tissue present. Ideally, almost no soft tissue remains after a mastectomy. Therefore, what is being imaged is often simply the residual skin and a small amount of fat underneath the skin.

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Question: Is it beneficial to have a PET scan? I heard that the results can be sometimes wrong. 

Dr. Somers Copit: A PET scan can be beneficial in certain situations and is typically most helpful for questions of metastatic disease. There is no "perfect" test and therefore, the results are not 100 percent accurate. 

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Question: My cancer was invisible on all films — mammogram, ultrasound and MRI. Is that common for all breast cancers? Is it more common for triple-negative breast cancer?

Dr. Somers Copit: It is uncommon for cancer to be "invisible" on all studies (mammogram, ultrasound, and MRI). It is not necessarily more common for triple-negative breast cancer as this type tends to be a more aggressive cancer. However, because certain tumors are not seen on any imaging studies, we stress the importance of physical examination combined with imaging to detect breast cancer. 

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Question: I am a 12-year breast cancer survivor and I get yearly mammograms, along with physical exams by my surgeon and medical oncologist. Under what circumstances would additional breast imaging be recommended?

Dr. Somers Copit: There are no additional tests necessary for breast cancer survivors unless you have dense breasts, in which case an ultrasound or MRI may be helpful. However, keep in mind that in a patient with dense breasts, there is no proven benefit to additional imaging, such as ultrasound and MRI, in terms of mortality.

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Question: Doesn't MRI imaging of the breast produce many false positives?

Dr. Somers Copit: MRI imaging does produce some false positives, some of which is dependent upon the time of the menstrual cycle during which the MRI is performed.  

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Question: I had a double mastectomy in December 2011. What kind of imaging can I have to check that my chest is free of breast cancer?

Dr. Somers Copit: After a mastectomy, it is not typical to continue imaging and there has never been a study that proves a survival benefit to performing follow-up mammography (which is limited after mastectomy).

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Denver, CO  ·  September 13, 2014

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