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Dr. Catherine Evans on 'Keeping Abreast of Breast Imaging Guidelines'


In 2020, more than 325,000 women will be diagnosed with breast cancer and an estimated 42,170 will die from the disease.

Catherine Evans“One-in-six breast cancers are found in women ages 40 to 49, conversely the incidence in women younger than 30 is very low,” said Catherine Evans, MD, of Boulder Radiologist during a free online health lecture. “There is a steady increase in detection in women ages 40 to 75.”

She adds, “The good news is that early detection saves lives.”

Latest Mammogram Screening Guidelines

For women who are at average risk

Dr. Evans stated that 75 percent of women with breast cancer are of average risk, meaning they have no family history or other high-risk factors. The recommendation from the American College of Radiology and Society of Breast Imaging is for women of average risk to have yearly mammograms starting at age 40.

Dr. Evans emphasizes, “The most lives are saved when women are screened every year, starting at age 40. Not doing so, increases your chances of dying from breast cancer.”

Dr. Evans explained it is reasonable to continue screening if you:

  • Are in good health
  • Expect to live at least for 5 to 10 years
  • Are willing to seek treatment if a cancer if detected

For women who are at high risk

You may be considered at high risk if you have a:

  • lifetime risk of more than 20 percent,
  • known genetic mutation or have a first degree relative with BRCA1 or BRCA2,
  • hereditary cancer syndrome and/or,
  • history of chest radiation therapy before age 30.

Guidelines for high risk are different. The recommendation is:

  • Begin annual screenings by age 30, but not before age 25, and 10 years earlier than the diagnosis age of a first-degree relative
  • Start supplement annual mammograms with contrast enhanced MRIs – alternating each exam every six months (i.e. you wouldn’t have both at the same time).

Alternative Screening Guidelines (For Women of Average Risk)

The American Cancer Society guidelines recommend that women start regular mammograms no later than age 45 and that those who want to start at age 40 should have insured-access to mammograms. And, the U.S. Preventative Services Task Force (USPSTF) does not call for women ages 40 to 49 to be routinely screened and recommends every-other-year screenings for women 50 to 74.

However, Dr. Evans maintains, “These guidelines would miss approximately 6,500 to 10,000 additional cases each year.” The federal government has barred Medicare and private insurance companies from basing mammography coverage on USPSTF guidelines.

Risk Assessment for Earlier Screenings

According to Dr. Evans, all women should have a risk assessment by age 30 to see whether they are at increased risk for breast cancer – particularly black and Jewish women – indicating they should begin annual mammogram screenings by age 30.

She said the Tyrer-Cuzick Risk Assessment, a very accurate risk assessment model, estimates the likelihood of a woman developing breast cancer in 10 years and over the course of her lifetime based on the following risk factors:

  • Age
  • Body mass index
  • Age at menstruation
  • Obstetric history
  • Age at menopause
  • History of benign breast conditions that increase breast cancer risk (ADH, ALH, LCIS)
  • History of ovarian cancer
  • Use of hormone replacement therapy
  • Family history (breast and ovarian cancer, Ashkenazi inheritance, genetic testing)

In the future, Tyrer-Cuzick scores will appear on mammogram reports. “These scores calculate a person’s likelihood of carrying BRCA1 and BRCA2 mutations and estimates the likelihood for developing breast cancer,” said Dr. Evans.

Dr. Evans then stated, “We know that there’s an increased risk of breast cancer for those with dense breasts and it’s harder to spot cancer within a dense breast.” She added, “If you have dense breasts, you’re not alone. About 50 percent of women have dense breasts.” She feels it’s important for every woman to know her breast density, noting that 38 states including Colorado are required to send a letter following your mammogram indicating your density.

BCH Offers the Lastest Mammogram Technology

All of BCH’s locations offer the latest advances for mammogram screenings:

  • Digital mammography: Creates incredibly accurate and vivid images of breast tissue. Compared to traditional film-based mammography, digital mammography uses less radiation and allows our radiologists to manipulate high-resolution digital images so abnormalities can more easily be seen.
  • 3D mammography (tomosynthesis):This is a newer type of imaging technology that creates a highly detailed, 3D composite picture of the breast, allowing radiologists to view several layers of breast tissue from various angles. This type of mammogram makes it easier to detect small cancer tumors in moderately dense or very dense breast tissue. It’s also beneficial for patients with an increased risk for or personal history of breast cancer.

To schedule a screening mammogram, call 303-415-5170.

Click here to view the PowerPoint slides from the “Keeping Abreast of Breast Imaging” presentation provided by Boulder Radiologists’ Catherine Evans, MD.