An essential part of breast cancer awareness and breast cancer prevention is breast cancer screening. Screening takes many forms, from the self-breast check to the breast MRI, but all play their part. These screening examinations provide an opportunity to catch signs and symptoms of breast cancer, as well as lumps, early so that treatment options can be less extreme. Here is some information on the basics of different tests, when and how they are taken, and the decision-making process behind them.
When should I start breast cancer screening?
While any person with breasts should start a regular breast self-exam as their breasts start to develop, clinical screening does not need to begin so early. Different organizations vary in their breast cancer screening recommendations, especially as it comes to when exactly you should begin your breast cancer screening. Your particular risk and family history can play a part in your timeline.
When should I get screened for breast cancer?
The general timeline recommends:
- Ages 25-39: Self breast exam monthly; annual clinical breast exam; mammogram for high-risk patients (annually, starting 10 years before youngest family member diagnosed with breast cancer)
- Ages 40-54: At age 40, patients with normal risk start annual screening mammogram.
- Ages 55+: It is recommended that screening continues for as long as the patient is still living a healthy life and is expected to do so for at least ten more years. According to the U.S. Department of Health and Human Services, women between 40-74 with screened mammograms have a decreased chance of dying from breast cancer.
As with any medical concerns or tests, ask your doctor the best time to start your breast cancer screening and how often you should go.
What are the screening tests for breast cancer?
There are a handful of different kinds of breast cancer screening tests, each with its own purpose and use, as well as benefits and risks.
What are Clinical Breast Exams?
A clinical breast exam is an exam performed in a doctor’s office by a doctor or other health professional. They will use their hands to feel and check for any physical abnormalities, signs, or symptoms of breast cancer in the breast and surrounding areas. These include lumps, irritated or puckered skin, and swelling.
The doctor will also ask for any relevant information such pregnancy history or the date of the patient’s last period. These can affect a patient’s risk of developing breast cancer and the current state of their breast. It is always best to be familiar with your own breasts look and feel so you can note any changes to your doctor straight away.
Most often, when a woman finds a lump or other sign or symptom, it tends to be during dressing, bathing, or other regular activities. However, doing these regular physical and visual checks, especially self-checks, keeps you familiar with your breasts’ regular state, so you are more likely to notice a change.
What is a mammogram?
A mammogram is the most common method of breast cancer screening in women ages 25 and above. It is a low dose x-ray exam that provides internal images of the breast. Mammography is an integral part of early detection because it can find small changes within the breast before these changes can be felt or seen by the patient or their doctor. Ductal Carcinoma in Situ (DCIS) can also be found early in mammograms. DCIS is a collection of abnormal and/or pre-cancerous cells in the milk ducts of the breasts. The sooner breast cancer is found and treated, the better, as it is usually much easier to treat in early stages.
As with any medical test, there are some risks. Because it is an x-ray, there is radiation involved. However, it is such a low dose, and such a brief exposure, that no radiation is left in the body after the examination. These risks also include the chance of a false-positive in the test results. A false positive can be caused by particularly dense breast tissue, scar tissue, or other factors. However, most doctors will not give a positive diagnosis purely based on just the mammogram due to the risk of false positives. They will recommend another form of test to compare results. There is also a 10-15% risk of a false-negative test result from a mammogram.
Another form of this test is digital mammography, also known as 3D mammography or tomosynthesis, which is particularly helpful for women with dense breast tissue or other factors that might cause a false positive on a typical mammogram. This screening exam can improve the chances of finding small cancers while reducing the need for additional testing to confirm false positives. 3D mammography does give a clearer picture of the breast tissue.
Other Breast Cancer Screening Tests
A few other types of breast cancer screening tests are used less commonly, though each has its purpose. These screening tests are generally used for women or patients with many risk factors, such as a family history of breast cancer or a genetic predisposition for breast cancer, or potential positives in previous mammograms.
- Breast MRI Screening–MRI, or Magnetic Resonance Imaging, uses radio waves and magnets to collect detailed images of the body. This is often used for high-risk patients and those with a genetic mutation that increases their risk of breast cancer. This may actually start prior to mammogram on these high-risk patients.
- Breast Ultrasound–An ultrasound of the breast can be used when a woman cannot undergo an MRI or x-ray screening (for example, if they are pregnant). Ultrasounds are particularly useful on dense breast tissue, containing more glands or ducts than fat. The ultrasound can differentiate the dense tissue and breast cancers better than traditional mammography. If there is no contraindication, however, a patient also needs a mammogram.
- Thermography– Thermography uses a heat-sensing camera to observe and record the temperature of the breast’s skin. Because some tumors cause temperature changes, the thermogram may detect the presence of these tumors. However, there have not yet been any randomized clinical trials of this test to determine its validity. This may be additional information for your physician but does not replace annual mammograms.
What is the most accurate test for breast cancer?
Each test used to screen for breast cancer, from the breast self-exam to the breast ultrasound, has benefits and risks. Mammography is the easiest screening test to access and has been found to to find DCIS and other breast cancer tumors reliably, and is best for average-risk women. However, 5-15% of mammograms need a follow-up by another test for clarification. Ultrasounds can add diagnostic information on a painting and can help give a clearer picture than a mammogram, especially for women with dense breasts. MRIs are also helpful diagnostic tools for women with dense breasts and can sometimes find cancers that were even missed by the ultrasound. MRI cannot be used by those who have metal implants or are allergic to the contrast.
Each of these types of cancer screening exams works uniquely to collect different results. Ask your doctor for their recommendation based on your personal risk factors and concerns.
Does screening for breast cancer really work?
No one breast cancer screening exam is going to find 100% of breast cancer. However, between regular screening and breast self-checks, the chance to find breast cancer while it is still in the early stages increases dramatically. The sooner breast cancer can be detected, the easier it is to treat, and therefore the easier treatment will be on the cancer patients.
Remember, you can speak to your doctor or health care provider about your risk factors and determine your best method and pacing for screening. Dr. Gorman and her team at the Texas Breast Center are always happy to speak with you about breast cancer and any next steps in treatment plans.
Valerie Gorman, MD, FACS, is a breast cancer surgeon. She is board certified by the American Board of Surgery and serves as Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie.
- Certificate, Physician Leadership Program, Southern Methodist University, Dallas, Texas (2010)
- M.D., University of Texas Southwestern Medical School at Dallas, Texas (June 1999)
- B.S., Biola University, LaMirada, California, (1994) Magna Cum Laude
- Residency in General Surgery, University of Texas Southwestern Medical Center at Dallas, Texas (June 2004)