In April 2024, the U.S. Preventive Services Task Force updated its breast cancer screening guidelines. The new recommendations suggest that women with normal risk begin screening at age 40 and continue through age 74. The previous guidelines recommended that women start screening between the ages of 40 and 50.
“The radiology world and cancer world were happy to see these guidelines,” says Elizabeth Pietras, MD, Spectrum Healthcare Partners division director of breast imaging and the director of breast imaging at MaineHealth Maine Medical Center Portland. “We have been quoting data for years that starting screening at 40 can save additional lives without major harms.”
Just how many lives could it save?
It’s hard to say for sure, but consider that according to the American Cancer Society, about 316,950 new cases of invasive breast cancer will be detected in American women in 2025 alone. (Men can get breast cancer, too: about 2,800 men in the U.S. are expected to be diagnosed this year with invasive forms of the disease.) To broaden this context, the National Cancer Institute reports that in 2022, just over four million women were living with breast cancer in the United States. What if those women had not been diagnosed in time?
Christina Cinelli, MD, Spectrum Healthcare Partners radiologist and associate chief of the department of radiology at MaineHealth Maine Medical Center Biddeford and Sanford, also sees these new guidelines as a win. “We had been practicing at this level and beyond before the guidelines came out,” she says. “These new guidelines acknowledge breast cancer in younger women is something that we need to take care of.”
Patient Needs Can Go Beyond Guidelines
While these new breast cancer screening guidelines are an essential foundation, one size doesn’t necessarily fit all.
About 50% of women have dense breast tissue, which can make it harder for standard mammograms to detect cancer. “For patients with extremely dense tissue, we should assess risk factors to determine when additional screening, like ultrasound or MRI, may be appropriate,” explains Dr. Pietras.
Some individuals may need to start breast cancer screenings before age 40. Dr. Pietras and Dr. Cinelli suggest that those with higher risk factors, such as genetic predisposition, strong family history, or atypical results, consider discussing risk assessment with their provider as early as age 25.
Older age is also a factor beyond standard guidelines. “If you are a healthy woman in your late 70s or 80s, especially with risk factors, getting a mammogram is reasonable,” says Dr. Pietras. “We recommend screening as long as a patient is in good health.”
Innovation Supports Patient Care
Spectrum Healthcare Partners radiologists interpret 3D mammograms, also known as breast tomosynthesis, at more than a dozen hospital and outpatient sites. This imaging test creates a detailed, three-dimensional view of the breast, improving sensitivity for detecting abnormalities, including in denser tissue.
Spectrum also provides the highest level of breast imaging care. Ultrasound and mammogram-guided biopsies are typical, but there is also the capability to do MRI-guided biopsies for appropriate abnormalities. “The Scarborough campus is the only location in Maine offering MRI-guided biopsies,” says Dr. Cinelli. “We receive referrals from across the state and New Hampshire.”
When surgery is indicated, magnetic seed localization significantly reduces lumpectomy sizes by precisely targeting lesions. This process uses a magnetic, stainless steel bead the size of a grain of rice placed by the area of possible cancer. This helps the surgeon pinpoint suspicious tissue that would otherwise be hard to feel, and successfully remove it.
“There is always the challenge in any screening program to balance potential harms and benefits,” says Dr. Pietras. “We consider the impact of unnecessary imaging or biopsies, which can be hard on patients and costly to the healthcare system, but also weigh those risks against the potential to save a life.”
Radiologists Guide Patient Care
Ten years ago, most patients interacted with their primary care providers about their breast screening, but today, radiologists play a much more significant role in patient care.
“Women’s imaging is far more patient-facing than other radiology fields,” says Dr. Pietras. “In most cases, you won’t meet your radiologist, but in breast imaging, we are the ones who inform patients about biopsies, discuss results, and guide next steps.”
Radiologists collaborate with Spectrum radiation oncologists and pathologists, medical and surgical oncologists, and other specialists to ensure patients receive a personalized and effective care plan if cancer treatment is necessary.
Attracting Top Talent to Maine for Women’s Imaging
Delivering top-tier women’s imaging care often begins with residency training, and the MaineHealth Maine Medical Center (MHMMC) Diagnostic Radiology Residency Program plays a key role.
“Our residency program is the largest pipeline for attending radiologists for Spectrum and across Maine,” says Jennifer Talmadge, MD, Spectrum Healthcare Partners radiologist and director of the MHMMC Radiology Residency Program. “After training here, residents often realize that Maine is a great place to work and live, whether in Greater Portland or more rural areas.”
The MHMMC radiology residency is highly competitive. “We received over 800 applications for four positions last year,” adds Dr. Talmadge. “We’re fortunate to recruit exceptional residents year after year, which is a testament to our dedicated faculty.”
Dr. Pietras emphasizes the importance of new talent. “While we bring years of experience, it’s always refreshing to welcome passionate professionals who excel both with patients and with technology,” she adds. “This residency program helps attract top talent to Maine, which is critically important given the nationwide radiologist shortage.”
Advancing Women’s Health
Women at average risk should start screening at age 40. For those with different risk factors or any questions, Dr. Pietras and Dr. Cinelli recommend discussing personal history with their doctors. This information can help women make informed decisions about their health, possibly leading to early detection and a clear plan for the best possible care.
“Women’s imaging is more than diagnostics,” says Dr. Cinelli. “You feel connected to the local and global community in the fight against breast cancer—it’s a real sense of purpose.”
“Breast imaging saves lives and can improve cancer treatment choices,” adds Dr. Pietras. “I love working with my patients, and this job has given back to me as much as I’ve given.”
To learn more about our current radiology opportunities, visit the pages for our Northern Radiology and Southern Radiology divisions.
