Dense Breasts and Microcalcifications....mammograms now or wait?

So I recently went for my yearly MRI (it was totally normal). I am borderline high risk....somewhere between 15-20% lifetime risk. My doctor and I discussed yearly mammograms. I am 34 and have already had 6 mammograms for diagnostic purposes (all benign). I do worry about radiation exposure from mammograms especially since starting them at a younger age. My doctor said with this concern and my age and risk profile it would be reasonable to just do a yearly MRI and wait until I am 40 to do yearly mammograms. I have extremely dense breasts so basically they are a sea of white on a mammogram anyway. BUT she did say the only real thing the might be able to see on my mammogram would be microcalsifications. BUT I don't want radiation exposure if the chance of seeing a cancer as microcalsifications is really small. Does that make sense? It is my understanding that most cancers do not show up as calsifications....is that true? Does waiting until I am 40 for mammograms seam reasonable? I'd love to hear opinions. Thank you!!

ok, here's the deal. At least my story, anyway. I'm 37, but I went in for a diagnostic mammo for what was supposed to be "just" a flipped implant. Long story short, the implant itself wasn't flipped. But, lying low, were microcalcifixations. So, there you have it. Opposite to you, I DO have a family history. However, had I waited until I was 40, it would have been too late.

My theory is, better safe than sorry.

MelissaDallas,

How does someone figure out their personal percentage

I hope MelissaDavis won't mind me butting in here. But I went for years wondering why I was getting very different numbers for my lifetime breast cancer risk - I had numbers ranging from 10% to almost 90%. (Obviously I'm in a different situation than you are.)

There are several breast cancer risk calculators. You may get different numbers from different calculators, but you ALSO NEED TO KNOW HOW WELL THEY KNOW THE NUMBERS THEY GIVE YOU.

I just found a powerpoint slides on a 2016 lecture on breast cancer calculators. https://www.sbi-online.org/Portals/0/Breast%20Imag... especially pg. 23-24. Pg. 52 has info on which risk calculator they recommend for different conditions.

No matter what number you get from the calculator, do look at what is called the C-statistic. In clinical studies, the C-statistic gives the probability a randomly selected patient who experienced an event (e.g. a disease or condition) had a higher risk score than a patient who had not experienced the event. < Otherwise, you are looking at the statistics of the ENTIRE population of women, not YOUR risk. These can be VERY DIFFERENT NUMBERS.- comment mine.>

• A value below 0.5 indicates a very poor model.
• A value of 0.5 means that the model is no better than predicting an outcome than random chance.
• Values over 0.7 indicate a good model.
• Values over 0.8 indicate a strong model.
• A value of 1 means that the model perfectly predicts those group members who will experience a certain outcome and those who will not. http://ibis.ikonopedia.com/

The very BEST model in terms of C-statistic is the BODICEA model, which was 0.77. The Tyrer-Cusik was 0.74. This is indeed better than the modified Gail model which was about 0.59-0.66 or so even when they added factors such as breast density. https://academic.oup.com/jnci/article/98/23/1673/2521932

(I couldn't find an internet calculator for BODICEA. Note that even the IBIS/Tyrer-Cusik model says its FOR RESEARCH PURPOSES ONLY. http://ibis.ikonopedia.com/) That's probably at least partly because none of the calculators have a great C-statistic value.

See my post above (our posts may have crossed.) If they give you some other radically different number, then that's based on 'expert opinion', not statistical data. Here's a link for the modified Gail calculator. https://www.cancer.gov/bcrisktool/

Note almost all the calculators say that you should NOT depend on them for patient clinical decisions. That's because for most of them they don't have great C-statistic numbers. But its the best we have that's based on population data.

(Your doctor may give you an 'expert opinion'. If its a radically different number than the calculators, then you may want to ask him how (s)he got that number.)

Thank you to all of you for your replies! Ah, these decisions can be so hard sometimes.

all_done84....I met with a genetic counselor as well as high risk doctors at a cancer institution. They took my personal information and gave me a risk. Of course that number is just a estimate. A true risk can be very hard to determine. I would suggest seeing a certified genetic counselor at a very credible institution. I had met with a different counselor first and was given a 38.9% lifetime risk. I of course lost my mind for a few months until I met with a different counselor and doctors who broke it down for me and pointed out where the first coulselor was way off. So, my suggestion is to do your homework before meeting with someone.

Two considerations. I have a 7cm lobular tumor that a regular mammogram did not see this past May. It was seen, however, with the 3-d imaging mammogram I did in October - clear as a bell.

Read Dr Sam Epstein's comments about mammograms and breast cancer. His belief (as well as many others) is that the first line of defense is self-examination.

Too bad thermography isn't as helpful as it could be. It could be an exam to do with frequency (have a baseline and look for changes).

The least invasive exam is the ultrasound. Those you could do every 3 months if you felt is necessary.