Dr. Sandra Rao, director of breast imaging at Rhode Island Medical Imaging, spoke recently with Providence Business News about her role and breast imaging trends to help raise awareness with National Breast Cancer Awareness Month being observed in October.
PBN: Why did you want to step into the role of director of breast imaging at RIMI?
RAO: Having grown up in Rhode Island, I am honored to return to the Ocean State as the director of breast imaging at Rhode Island Medical Imaging, where I have the opportunity to make a meaningful impact on women’s health in our community.
My experiences in academic medicine at Northwestern University have provided me with a strong foundation in advanced imaging technologies and clinical innovation, which I now bring to serve patients here at home.
PBN: What are some of the newer technologies you have noticed used in breast imaging?
RAO: Advancements in breast imaging technology have greatly improved the early detection of breast cancer, especially among women without a family history of the disease.
Since its FDA [Food and Drug Administration] approval in 2011, 3D mammography – also known as digital breast tomosynthesis – has become a widely adopted standard for breast screening, providing more detailed and accurate views of breast tissue than traditional 2D mammograms. New imaging options, such as contrast-enhanced mammography and breast MRI, further enhance a radiologist’s ability to detect subtle changes that might indicate cancer.
Looking ahead, artificial intelligence is one of the most promising developments in the field. AI-powered mammography can assist in analyzing images, identifying potential abnormalities, reducing false positives and improving overall accuracy.
Another emerging tool, molecular breast imaging, uses a small amount of radioactive tracer to highlight cancer cells that may not yet be visible on standard mammograms, offering even greater potential for early detection. Together, these innovations are transforming breast cancer screening and helping more women receive diagnoses at earlier, more treatable stages.
PBN: What trends have you noticed in breast cancer diagnosis and mortality rates?
RAO: Breast cancer remains the most common cancer among women worldwide, with an estimated 2.3 million new cases and about 670,000 deaths reported in 2022. Globally, the number of breast cancer diagnoses has been rising by roughly 1%–5% each year in many countries, and if current trends continue, projections suggest there could be as many as 3.2 million new cases and 1.1 million deaths annually by 2050.
In the United States, breast cancer incidence has slowly increased, particularly among women under 50, yet mortality has dropped by about 40% since 1989, reflecting major progress in care. However, disparities persist – non-Hispanic Black women, for example, continue to experience higher death rates compared to their white counterparts. These trends highlight both the progress made in early detection and treatment and the ongoing need to address inequities in access to care. Continued efforts in prevention, screening and equitable treatment access are essential to reduce the impact of breast cancer worldwide.
PBN: What advice do you have for women looking to improve their breast health?
RAO: Staying proactive about breast health is essential for early detection and prevention of breast cancer. Being “breast aware” – knowing how your breasts normally look and feel – helps you notice changes such as lumps, skin dimpling, nipple changes, or unusual discharge. Formal monthly self-exams are not universally recommended, as they have not been shown to reduce mortality and may cause unnecessary anxiety.
Maintaining a healthy lifestyle can also reduce risk: regular physical activity, a balanced plant-forward diet, limiting alcohol, achieving a healthy body weight, avoiding smoking, and careful use of hormone therapy all contribute to breast health. Additional protective measures include understanding personal risk factors, which can guide individualized screening and preventive strategies, and promptly consulting a health care provider if any changes are noticed.
PBN: Have there been any recent changes to breast screening guidelines?
RAO: The American College of Radiology recommends that women at average risk of breast cancer begin annual mammography screenings at age 40, with screening continuing beyond age 74 if overall health allows. All women should also receive a formal breast cancer risk assessment by age 25 to identify any high-risk factors early.
For women at higher-than-average risk – such as those with a strong family history, known genetic mutations (like BRCA1/2), prior chest radiation, or a personal history of breast cancer –more intensive screening is advised. This may include annual MRI with contrast in addition to mammography, starting as early as age 25-30 depending on individual risk.
Supplemental imaging, such as ultrasound or contrast-enhanced mammography, may be considered if MRI is not possible. Importantly, screening decisions should be individualized, taking into account personal risk factors, health status and preferences. The ACR emphasizes shared decision-making, ensuring women understand both the benefits and potential limitations of different screening strategies.
Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.
