Breast cancer screening
What is breast cancer screening? — Breast cancer screening is a way in which doctors check the breasts for early signs of cancer in women who have no symptoms of breast cancer. The main test used to screen for breast cancer is a special kind of X-ray called a mammogram.
The goal of breast cancer screening is to find cancer early, before it has a chance to grow, spread, or cause problems. Studies show that being screened for breast cancer lowers the chance that a woman will die of the disease.
Who should be screened for breast cancer? — Different experts have different recommendations for screening. Starting at the age of 40, it's important to talk to your doctor or nurse about the benefits and drawbacks of screening and decide, with your doctor or nurse's help, whether to get screening and when.
Women aged 40 to 74, and some older women who are healthy, might be offered screening with mammograms. Some women who are at high risk of breast cancer might need to begin screening at a younger age. This might include women who:
●Carry genes that increase their risk of breast cancer, such as the "BRCA" genes
●Have close relatives (such as a mother, sister, or daughter) who got breast cancer at a young age
What are the benefits of being screened for breast cancer? — The main benefit of screening is that it helps doctors find cancer early, when it might be easier to treat. This lowers the chances of dying of breast cancer.
What are the drawbacks to being screened for breast cancer? — The drawbacks include:
●False positives – Mammograms sometimes give "false positive" results. This means they suggest a woman might have cancer when she does not. This can lead to unneeded worry and to more tests – including a biopsy in some cases, which can be painful. False positive results are more likely to happen in women younger than 50 than they are in older women.
●Overdiagnosis – Sometimes, mammograms find cancer that would never have affected the woman's health. This is called "overdiagnosis." It can be a problem because treating these cancers does not have any benefit, and can cause harm. For example, a woman might get surgery or chemotherapy to treat a cancer that never would have caused problems if it hadn't been found. There is no way to know which cancers found by screening will lead to problems, and which won't.
●Radiation exposure – Like all X-rays, mammograms expose you to some radiation. But studies show that the number of lives saved by finding cancer early greatly outweighs the very small risks that come from radiation exposure.
What happens during a mammogram? — Before the mammogram, you will need to undress from the waist up and put on a hospital gown. Then your breasts will be X-rayed one at a time. Each breast is X-rayed twice. Each is X-rayed once from the top down and once from side-to-side so that the radiologist can get a good look at all the tissue. To make the breast tissue easier to see, a nurse or technician will flatten each breast between 2 panels. This can be uncomfortable, but it lasts only a few seconds. If possible, avoid scheduling your mammogram just before or during your period. Breasts are extra sensitive at that time. Also, do not use underarm deodorant or powder on the day of your appointment.
What happens after a mammogram? — If a radiologist (the doctor who will look at your X-ray) is able to look at your mammogram right away, you might get the results the same day. If not, you should get a phone call or letter with your results within 30 days. If you do not hear back about your results, call your doctor or nurse's office. Do not assume that your mammogram was normal if you hear nothing.
What if my mammogram is abnormal? — If your mammogram is abnormal, don't panic. Nine out of 10 women with an abnormal mammogram turn out NOT to have breast cancer. You will need more tests to find out what's really going on.
If your doctor thinks your abnormal result is probably NOT due to cancer, he or she might suggest that you wait and have another mammogram in 6 months. If your doctor thinks the abnormal result might be due to cancer, he or she will probably send you for more tests. Other tests could include a more detailed mammogram, called a diagnostic mammogram, or an ultrasound of the breast. Ultrasound tests might also be suggested for women whose mammogram shows very dense breasts. That's because dense breasts can make a mammogram harder to read.
If the other tests still show any suspicious findings, your doctor or nurse will probably order a biopsy. During a biopsy, a doctor takes samples of breast tissue and sends them to the lab to be checked for cancer. Biopsies are usually done by taking some tissue from the breast with a needle during a mammogram or ultrasound. But in some cases biopsies involve a small surgery.
What about breast exams? — Many experts no longer believe that breast exams by a doctor or nurse are helpful for women who have no breast complaints. Most lumps that are found when a doctor examines the breast turn out not to be cancer. Also, studies have not found that doing both a breast exam and mammogram is better than doing a mammogram alone.
Some women want to do exams on their own breasts. No study has shown that breast self-exams lower the risk of dying from breast cancer, and most experts do not encourage self-exams. Still, if you decide to do breast self-exams, make sure you know how to do them the right way.
Can I have a breast MRI instead of a mammogram? — Women are hearing a lot about breast MRIs in the news. But breast MRIs are not for everyone. Compared with mammograms, breast MRIs give more "false positives" and sometimes lead to unneeded biopsies. Still, breast MRIs are sometimes used to help find breast cancer in young women who have a high risk of breast cancer. Doctors do not recommend breast MRI to screen for breast cancer in women who do not have a high risk of breast cancer. In any case, MRIs don't replace mammograms. They are used with mammograms for the high-risk women who need them.
How often should I have a mammogram? — It is not clear what the best schedule for mammography is. Many experts suggest screening every year for most women. The schedule for screening might be different for women who have a very high risk of breast cancer.
Routine screening with mammograms should continue as long as the woman is healthy and expected to live for at least 10 more years.
How to perform a self breast exam
Start by standing in front of a mirror. Place both hands at your sides. Check your breasts for changes in skin color or texture, and check for dents. Note how your nipples look. Some women have inverted nipples, meaning that their nipples point inward instead of out. This is normal as long as the way they look does not change over time.
Lift your hands over your head and turn to the side. Then look at each whole breast in the mirror. If you need to, lift each breast so you can see the skin under the breast.
Lie down and put your left hand above your head (this flattens the breast and makes it easier to examine). Use your right hand to examine your left breast, starting in the upper breast near the arm pit and going up and down across the breast (like mowing a lawn). Begin to examine the breast by making small circles with your three middle fingers. Use your finger pads at the end of your fingers but not the tips, and move your fingers in circles as if you were tracing the edge of a dime. At each spot on the breast, make three circles: one very light, one a bit firmer into the breast, and one deep in the breast. Then switch hands and do the same thing on the other breast.
It is normal to feel your ribs in your chest. Abnormal lumps tend to feel firm, have irregular edges, and sometimes feel like they are "stuck" to your chest. If you don't know whether a lump is normal or abnormal, see your doctor or nurse.
Content adapted from UpToDate Patient Information.