Breast cancer screening has evolved far beyond the traditional mammogram. In this episode of Health Matters, Dr. Janice Sung, radiologist and associate division chief of breast imaging at NewYork-Presbyterian and Columbia, explains the growing range of screening options available today and how doctors tailor screening recommendations based on an individual's risk factors. Dr. Sung discusses the benefits and limitations of mammograms, the impact of breast density on screening, and when additional imaging tests such as ultrasound, MRI, abbreviated MRI, and contrast-enhanced mammography may be appropriate. She also explains how family history and genetic mutations like BRCA can affect screening recommendations. The conversation explores how emerging technologies, including artificial intelligence, are helping improve cancer detection and reduce false alarms, while highlighting the importance of early detection in improving outcomes.
Breast cancer remains one of the most common cancers affecting women, but advances in screening are helping detect cancers earlier and improve outcomes. In this episode of Health Matters, host Courtney Allison speaks with Dr. Janice Sung, radiologist and associate division chief of breast imaging at NewYork-Presbyterian and Columbia, about today's breast cancer screening options and how women can better understand their personal screening needs.
Dr. Sung explains why annual mammograms remain the foundation of breast cancer screening and reviews current recommendations for when screening should begin. She also discusses how family history, genetic mutations, and breast density can influence both risk and screening strategies.
The conversation explores supplemental screening options, including breast ultrasound, MRI, abbreviated MRI, and contrast-enhanced mammography. Dr. Sung explains how these technologies work, why some tests are more sensitive than others, and how newer vascular-based imaging techniques are helping identify cancers earlier.
Finally, she discusses the role of artificial intelligence in breast imaging, the move toward more personalized screening approaches, and why staying up to date with recommended screenings remains one of the most effective ways to reduce breast cancer mortality.
Chapters
00:00 – Why Breast Cancer Screening Matters
How screening helps detect cancer earlier, improves outcomes, and saves lives
02:15 – Mammograms, Breast Density, and Screening Guidelines
When to start screening, what mammograms can and cannot detect, and how dense breast tissue affects imaging
06:00 – Ultrasound, MRI, and New Screening Technologies
How supplemental screening works and when tests like MRI, abbreviated MRI, and contrast-enhanced mammography may be recommended
09:15 – Genetics, AI, and the Future of Screening
Understanding inherited risk, how artificial intelligence supports breast imaging, and the shift toward personalized screening
Key Topics Covered
· Breast cancer screening
· Mammograms
· Dense breasts
· Breast density
· Breast ultrasound
· Breast MRI
· Abbreviated MRI
· Contrast-enhanced mammography
· Breast cancer prevention
· Early cancer detection
· Breast cancer risk factors
· Family history and breast cancer
· BRCA mutations
· PTEN mutations
· Genetic testing
· Artificial intelligence in healthcare
· AI in breast imaging
· Personalized medicine
· Women's health
· Cancer screening guidelines
· Breast imaging
· Breast cancer awareness
· Screening recommendations
· Preventive care
Key Takeaway
Breast cancer screening saves lives, and today's screening options are more personalized than ever. While annual mammograms remain the foundation of screening for most women beginning at age 40, factors such as breast density, family history, and genetic risk may make additional imaging tests appropriate. Talking with your healthcare provider about your individual risk can help ensure you're getting the screening that's right for you.
Doctor Bio
Dr. Janice Sung is a board-certified radiologist specializing in breast imaging. She is an attending radiologist at NewYork-Presbyterian Hospital and professor of radiology at Columbia University Vagelos College of Physicians and Surgeons. Dr. Sung is experienced in all types of breast imaging and breast cancer diagnosis, including mammography, ultrasound, and MRI, as well as image-guided interventional procedures such as stereotactic breast biopsy, ultrasound-guided biopsy, MR-guided biopsy, and radioactive seed placement and wire localizations.
Dr. Sung's research focuses on imaging for early breast cancer detection in women who are at intermediate and high risk for developing breast cancer. She has co-authored multiple scientific articles defining groups of women who will benefit from screening that is more intensive than routine, annual mammography. She is frequently invited to lecture on this and other topics in breast imaging. She also trains and supervises residents and fellows in interpreting breast-images and in interventional breast procedures. In recognition of her accomplishments, she has been named a Fellow of the Society of Breast Imaging.
Dr. Sung received her medical degree from the State University of New York, Buffalo, and completed a residency in diagnostic radiology at the University of Pennsylvania. She then completed a one-year fellowship in breast and body imaging at Memorial Sloan Kettering Cancer Center.
Dr. Sung: When you have certain genetic mutations, such as the BRCA or the PTEN mutations, that puts you at an elevated risk for various cancers. So, when you have one of those mutations, you're recommended to begin screening at a far earlier age, and often with a test like the MRI.
Courtney: Welcome to Health Matters, your dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.
This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at V for vigilance. About one in eight women in the US will develop breast cancer in her lifetime, but the good news is that we have more personalized methods and sophisticated tools to help screen for breast cancer than ever before. We spoke with Dr. Janice Sung, radiologist and associate division chief of breast imaging at NewYork-Presbyterian in Columbia. She shares what to know about these screening methods, from mammograms to ultrasounds to MRIs and more, and how to tell which one might be best for you.
Dr. Janice Sung, thank you so much for joining us today on Health Matters.
Dr. Sung: Hi, Courtney. I'm so excited to be here.
Courtney: So, I'm excited to talk with you today about the different breast cancer screening options available. Before we dive in, why is it so important to get screened for breast cancer?
Dr. Sung: We know that since screening and mammography programs have been established, breast cancer mortality has really decreased. And so while we've made a ton of progress, it's really important to keep moving forward in order to help the most number of women.
Courtney: And I imagine screening helps us catch cancer early.
Dr. Sung: Right.
Courtney: And there's more to do when we catch it early.
Dr. Sung: Right. So in terms of breast cancer, women do better in general when their cancers are detected smaller. You want to identify the cancers and be able to treat them, and especially with less aggressive treatment while they're smaller and confined to the breast. And so instead of waiting for a cancer to become large enough to feel it or before you get other symptoms or signs of breast cancer, you really want to be able to detect it on a screening study.
Courtney: So I think many women, when they think of breast cancer screening, they think about the mammogram. Could you just explain what is a mammogram and why is it the foundation of screening?
Dr. Sung: Mammography is what we've used for breast cancer screening for decades, and what a mammogram is, is that we compress the breast in two different directions in order to best visualize all the tissue, and then we basically take an X-ray of the breast. And what we're looking for on that mammogram are signs that there may be a breast cancer in the tissue. Often, the cancers appear as white patches of tissue, or sometimes as what we call calcifications. But those are some of the things we look for when we're reading a screening mammogram.
Courtney: So for someone of average risk, when should they start screening for breast cancer?
Dr. Sung: So, the current guidelines are that women begin annual screening mammography beginning at the age of 40 and continue as long as they're in good health. There's really no endpoint for when you should stop undergoing screening mammography.
Courtney: And what are some cases where you might wanna start earlier than 40?
Dr. Sung: So some women are at a higher risk for developing breast cancer. If you had a mother or a sister detected with breast cancer before the age of 50, you wanna start 10 years before they were diagnosed. So for example, if your mom had breast cancer when she was 45, instead of waiting until you're 40, you would start breast cancer screening at the age of 30.
Courtney: Mammograms are incredibly important, but they're not a perfect test. Is that right? Could you describe some of the limitations?
Dr. Sung: I think one of the main limitations of mammography is the fact that it's somewhat limited in women who have dense breast tissue, and about 50% of women who undergo screening mammography do have mammographic dense breasts. But one of the problems with having dense breasts is the fact that your dense tissue on a mammogram appears white. We're looking for cancers that are also white on a mammogram, and so when you have something white hiding within a lot of white tissue, it can be much more difficult, if not impossible, to detect.
Courtney: Could you share more about what it means to have dense breasts?
Dr. Sung: Your breast is composed of both fat and what we call underlying glandular tissue, normal breast tissue, and that normal breast tissue is what appears white on the mammogram. And just like all of our bodies are different, our breasts are different. So some people have very dense breasts. They have a lot of that breast tissue within their breast, versus other people might have the same size breasts, but they have more fat and less tissue.
Courtney: So does having dense breasts put you at higher risk? And if it does, is it because it's harder to spot on a mammogram, or is there something in the nature of dense breasts that puts you at higher risk?
Dr. Sung: It's a combination of both. It really stems from a study a long time ago that were comparing people with very, very dense breasts, that's the top 10% of the population, compared to the women at the lowest 10%. So it was kind of comparing the two extremes of the spectrum, and in those women, it was a significantly higher risk for breast cancer. If you compare having dense breasts compared to the average risk, average woman with breast density, then that risk is far lower at about 1.2, which is equivalent to maybe having a history of a mother with breast cancer at an older age. So, for most people, having dense breasts is a slightly increased risk, but it's not considered a significant increased risk. The greater problem, and the one that really impacts the most number of women, is not so much the risk of the dense tissue itself, but the fact that it makes the screening test that we use slightly more limited.
Courtney: So I imagine dense breasts and other risk factors might make someone want to explore further screening for breast cancer beyond mammogram.
Dr. Sung: Correct. We call that supplemental screening when you do another test in addition to mammography. And all breast cancer screening, again, should begin with a mammogram. But for women with dense breasts, for over a decade now, many women have undergone what we call screening breast ultrasound. Ultrasound is an alternative technique, and instead of taking an X-ray of the breast, we use a probe and use sound waves to try to detect areas in the breast that look different from the normal breast tissue. And for most women, that has typically been the alternative or the option that we use for supplemental breast cancer screening.
Courtney: And I know MRIs are also an option in some cases.
Dr. Sung: Right. So MRI is the best test that we have for detecting breast cancer. The guidelines say if you're at greater than 20% lifetime risk of breast cancer, then insurance will cover, typically, you to have that additional MRI in addition to a mammogram.
Courtney: Would you describe an MRI, and why is MRI so effective in picking up more cancer?
Dr. Sung: So with mammography and even ultrasound, we're waiting until we find changes in the breast, so we're waiting for the mass to grow large enough that we can identify it as being different than the regular breast tissue. With MRI, that's called vascular-based screening. With an MRI, we inject a contrast agent into your vein, and then we allow that to go to the breast, and we look for areas of increased uptake. And that's because we know that for cancers to grow, they need a blood supply. And so on the MRI, we're not waiting for the cancer to grow large enough so that we can see a change in the anatomy. We're looking for the increased blood flow so that we can detect that cancer earlier.
Courtney: That's so interesting. And now, is an abbreviated MRI also an option for some people?
Dr. Sung: So MRI has really been reserved for those women who are at the highest risk of breast cancer, but that's really a small proportion of women compared to all women who could benefit from a vascular-based imaging test. And so in order to allow more women to have access to vascular-based screening, we've begun to offer what we call an abbreviated MRI. It's very similar to regular MRI, except for it's a shorter exam. We've reduced the number of images we take to the ones that we know are the most critical to finding the breast cancer.
Courtney: Are there any other tests that also look at blood flow to detect cancer?
Dr. Sung: So the newest test that we've been using is something called contrast-enhanced mammography. We inject a contrast agent. It's a different agent than the one we use for MRI, but very similar in concept. We inject an agent into your vein, and then we wait a couple minutes, and then right afterwards, we do a regular mammogram. When we do that mammogram, we're taking two pictures of each breast at the same time. One is the regular mammogram that we're all familiar with, and then right after that, it takes another picture that shows us the areas of increased blood flow, very similar to what we see on MRI.
Courtney: And I imagine there are certain genes that can put people more at risk. We hear about the BRCA gene and others. Could you share what are some genetic issues people should be aware of in terms of breast cancer risk?
Dr. Sung: There are several genes that can increase your risk of developing breast cancer. When you have certain genetic mutations, that puts you at an elevated risk for various cancers, and there are several of them, such as the BRCA or the PTEN mutation is another one associated with having an increased risk of developing breast cancer. So when you have one of those mutations, you're recommended to begin screening at a far earlier age and often with a test like the MRI.
Courtney: Has AI enhanced or helped advance breast cancer screenings today?
Dr. Sung: When you have a screening mammogram, about 10% of women are asked to come back for additional views for further evaluation. The reassuring fact is that in the majority of cases, everything will be fine once we do a couple of extra views, once we do maybe even an ultrasound. One of the benefits of AI is that it helps reduce the number of women who are asked to come back for additional views. So if you have something you're like, "Oh, you know, is this something?" and AI says it's completely normal, that's very reassuring, and you may not be required to come back for additional views. The other benefit of AI is that it is able to pick up cancers that you might ordinarily not detect. So the AI flags certain areas and says, "Oh, pay a little bit more attention to this." It's not always right. Often, they flag something, and you look at it, and you say, "Oh, that's really nothing to worry about." But it does help highlight some areas that you might otherwise miss.
Courtney: So it's like another set of eyes for data and diagnostics.
Dr. Sung: It's like another set of eyes. At NewYork-Presbyterian, we do use AI computer-aided detection systems, and as better programs are available, we're continuously upgrading our systems so that we have the latest and greatest.
Courtney: Could you share some numbers around the amount of cancer these different types of screening methods can catch for people?
Dr. Sung: With a regular mammogram, you're finding five, maybe six cancers per thousand women, which doesn't sound like a lot, but that is enough for us to be able to reduce the number of women who die from breast cancer by about 30%. It is effective. When you do a screening breast ultrasound, you can find two, maybe three, up to four additional cancers that were completely missed on a regular mammogram, largely because they were hidden by that dense breast tissue. So, screening breast ultrasound is a benefit, but one of the problems with screening breast ultrasound is that there are a lot of what we call false positives. Many women will have to come back for a six-month follow-up for two years, or they might be asked to or recommended to undergo a biopsy that turns out to be not cancer. We call that a false positive biopsy. To put this in perspective with the vascular-based imaging test that we have, with MRI, when you do a vascular-based study, you can find, instead of four extra cancers per thousand, you can find about 16 extra cancers per thousand women, which is a huge leap. So the way I like to think about it is mammography is good, screening breast ultrasound is a little bit better, but now that we talk about vascular-based imaging, you're in a whole new ball game in terms of finding those cancers earlier on.
Courtney: With all these screening options, I imagine it's common to maybe procrastinate or put things off. You know, as we're talking, I'm thinking, "Okay, I need to get up to date with something." Do you have a message for people who maybe are anxious about screening, whether it's because of the exam itself or maybe you're afraid of finding something?
Dr. Sung: I think it's normal to feel scared. I think, you know, we've all known somebody who's a sister, a friend, a mother who's been diagnosed with breast cancer, and so it can be very, very scary to undergo a test when you're trying to find whether you have it. But at the same time, I think we need to remember that breast cancer screening works. This is how we reduce the number of women who ultimately die from breast cancer. Mammography is uncomfortable. I don't think anybody enjoys having a mammogram, but it's pretty fast. We try to compress the breast, take the picture, and get through the study as quickly as possible. And because it's so effective, whatever discomfort or fear that you have of getting the test, it's worth it, because this could ultimately save your life.
Courtney: It seems like screening is becoming more personalized. Are we moving away from one-size-fits-all approach and towards matching screening to each person's individual risk?
Dr. Sung: Absolutely. I think until recently, it's really been a one-size-fits-all approach. Every woman beginning at the age of 40 should undergo annual screening mammography. But we also know that breast cancer remains the second leading cause of cancer deaths in the United States. So there is somewhat of a discrepancy. Some women are gonna need more intensive screening. In some women, they may not need a screening mammogram every year. Some women are gonna be recommended to go more intensive screening, and some women are undergoing less intensive screening.
Courtney: So would you encourage patients to talk with their doctors about all these different options and what's right for them?
Dr. Sung: Absolutely. I think every test comes with its pros and its cons, and part of it is what your risk factor is, how old you are, what your other health conditions are. But for many women who have the dense breasts, who do have other risk factors for breast cancer, who don't have access to getting a vascular-based imaging test of an MRI, the contrast mammogram or the abbreviated breast MRI are excellent alternatives.
Courtney: What's the most important thing you hope listeners remember about breast cancer screening and their breast health?
Dr. Sung: The most important thing is that breast cancer screening works. I really strongly believe that it is in every woman's best interest, especially when they reach the age of 40, that they begin annual screening mammography. I think it's also important to remember that although one in eight women are diagnosed with breast cancer, most women do very, very well. So the idea of having a breast cancer or going for a test that might find the breast cancer may be scary, but even if you're diagnosed with a breast cancer, and especially if you catch it early on, you most likely will do very, very well. So many women have had a history of breast cancer and are living completely fulfilling lives.
Courtney: Dr. Sung, thank you so much for such a wonderful conversation on the options available for women. You've encouraged me to make sure I'm on top of my screening. I really appreciate this conversation.
Dr. Sung: It was so great to be here. I'm so happy we've had this opportunity. We are always available here if anybody has any questions.
Courtney: Our many thanks to Dr. Janice Sung.
I'm Courtney Allison.
Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Sung's work with patients, check out the show notes.
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