A Breast Radiologist Breaks Down Breast Cancer Screening Guidelines: With Sara Nunnery, MD, MSCI; and Dana Bonaminio, MD

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Dana Bonaminio, MD, a breast radiologist and the director of breast imaging at Ascension Saint Thomas in Nashville, who is also a breast cancer survivor and community advocate.

The experts discussed breast cancer screening amid recent conflicting guidelines, beginning with an overview of the breast radiologist's role across screening, diagnosis, and image-guided procedures. Dr Bonaminio shared her own diagnosis at age 44, which was detected on supplemental MRI and underscored her advocacy for breast cancer screening in women with dense breasts.

The conversation then addressed breast density, which Dr Bonaminio explained affects approximately 50% of women, constitutes an independent risk factor, and can mask cancers through overlying tissue. She noted that women exceeding a 20% lifetime risk should undergo a supplemental MRI. She also reassured that breast implants do not preclude effective mammography. Dr Bonaminio also clarified the distinction between screening mammograms and diagnostic imaging, which is warranted for any symptoms, such as a lump, pain, or nipple discharge.

Turning to emerging technology, Dr Bonaminio detailed contrast-enhanced mammography, which she is bringing to Nashville, describing its ability to subtract normal tissue and highlight enhancing cancers, particularly in extremely dense breasts. She anticipated it becoming standard of care and serving as a staging tool.

The experts then contrasted screening guidelines, with Dr Bonaminio advocating for annual mammography starting at age 40 and cautioning against biennial or delayed approaches. She also reviewed artificial intelligence–based risk assessment tools, including Clairity Breast, as well as more traditional models.

Finally, Dr Bonaminio highlighted her advocacy work, which includes founding a Nashville chapter of Pink Ribbon Good, which provides free rides, meals, and peer support to patients with breast cancer.