Breast Cancer Screening & Early Detection. It can be confusing.
Screening guidelines and media headlines about early detection can be unclear. Every woman should talk to her doctor about her own risk factors for developing breast cancer. Based on these factors, every woman, with her doctor, should determine at what age she should start screening, how frequently she should get screened and what screening tests will be most effective. Know what is normal for your body, and immediately report any changes in your breasts or body to your doctor.

abccThe mission of the Avon Breast Cancer Crusade includes empowering women by improving their access to quality medical care and medical experts to discuss breast health. The Avon Crusade also provides access to information that ensures women have the ability to make informed decisions with their doctors about their breast health care, early detection screening, breast cancer risk and risk-reduction strategies. A few recommendation summaries can be found here.

Knowing your body is most important.

Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. You should get to know your own body and breasts and if you find even a small change, call your doctor or health care provider.

Lumps and bumps are normal in every breast. You need to know ‘what is normal’ for you and be aware of changes.

Look out for these symptoms (relevant to both men and women’s breast health):box-symptoms

  • Development of a lump or swelling
  • Skin irritation or dimpling
  • Nipple pain or retraction (turning inward)
  • Inverted nipple
  • Redness or scaling of the nipple or breast skin
  • Discharge from the nipple (you may observe staining on your sheets or, for women, in your bra). For women, discharge other than breast milk. Clear fluid is more concerning than bloody, green or blackish fluid.
  • Dilation of the pores in only one area of skin on your breast that may have an orange peel appearance

At the onset of any of these changes, contact your health care professional as soon as possible for evaluation.

  • If you find even a small change, call your doctor or health care provider.
  • Remember, most of the time, these changes in your breast are not cancer.
  • Your doctor may arrange for you to visit her/him first for a clinical breast exam or have you go directly for diagnostic evaluation in a breast-imaging facility prior to seeing you

A great resource to learn more about breast health is Worldwide Breast Cancer’s Know Your Lemons project

Breast Self Exams (BSE)

  • BSE is an option for you to Check Yourself. Although studies have not shown routine BSE to be more effective than finding a breast lump by chance, it is important to know what is normal for your breast and report any changes right away to your doctor.
  • Breast self-exam is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE by their doctors and report any breast changes to their health professionals right away.
  • Doing BSE regularly, and at the same time each month, is one way for women to know how their breasts normally look and feel and to notice any changes.
  • Some women prefer doing regular BSE that involves a systematic step-by-step approach to examining the look and feel of one’s breasts at a regular interval (e.g. monthly after your period). Other women are more comfortable simply feeling their breasts in a less systematic approach, such as while showering, dressing, or doing an occasional thorough exam.
  • Sometimes, women are so concerned about “doing it right” that they become stressed over the technique. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away.

Resources for learning how to conduct your own Breast Self-Exam include: Breastcancer.org.

Women who choose to use a step-by-step approach to BSE should have their BSE technique reviewed during their physical exam by a health professional. It is okay for women to choose not to do BSE or not to do it on a regular schedule. However, by doing the exam regularly, you get to know how your breasts normally look and feel and you can more readily find any changes.

Learn About Your Screening Options

 

Option What is it? Who should have it?
Mammography Mammography remains the most common first step in screening for breast cancer in developed countries. It is normal for about 10% of women to be called back for extra testing after a screening mammogram. Most of the time, there is nothing of concern. Even when biopsy is recommended, only 20 to 30% of the time will cancer be found. A mammogram uses X-rays and causes relatively small radiation exposure to the breasts. There is greater risk from radiation the younger the woman is, especially before age 30. There is a benefit to mammography beginning at age 40 at the population level. Understanding the risks of extra testing for findings that are not cancer is important in choosing to have screening done.

Women known to have inherited a disease-causing BRCA mutation should start screening by age 25 with MRI (see below); screening mammography can wait until after age 30.

All women should talk to their doctors about the best screening regimen for them based on their health, history and individual risk factors.

Tomosynthesis Tomo is a “3D mammogram” that may be performed alone or in addition to a standard mammogram (which is 2D). It creates thin slices, or images of the breast, so that overlapping normal tissues are less likely to hide cancers. Importantly, tomosynthesis decreases the need for extra testing of overlapping normal tissues, scar tissue and some other benign (noncancerous findings). Tomo exposes a woman to approximately the same dose of radiation as a regular mammogram. If tomo is performed together with a regular mammogram, the woman would receive double the dose of X-rays as a regular mammogram. Tomosynthesis is used in some centers in place of the standard mammogram, but in many centers a regular mammogram is done first and tomo is done in addition.

Some centers also do a 2D and a 3D mammogram at the same time.

Ultrasound Uses high-frequency sound waves to evaluate abnormalities. No radiation exposure. Most often, ultrasound is used after a mammogram has been done. Ultrasound is often used to evaluate lumps and other breast symptoms and also for many abnormalities seen on a mammogram. Women with dense breasts, especially if there is also a family or personal history of breast cancer and MRI is not an option.

Women who are pregnant or lactating and need screening.

For women under 30 years of age with symptoms, ultrasound is often performed as the initial test.

Women at high risk for breast cancer who cannot have MRI.

Ultrasound is the preferred guidance method for breast needle biopsies when the abnormality can be seen on ultrasound.

MRI
(magnetic resonance imaging)
Uses magnets to energize water molecules in the body and a computer converts the vibrations into pictures. No radiation exposure. Requires intravenous injection of contrast agent. Can be used after a mammogram has been done. Prior to breast cancer surgery.

Those who have inherited a disease-causing mutation in the BRCA1 or BRCA2 gene.

Women who meet defined high-risk criteria due to family history of breast and/or ovarian cancer and/or other risk factors.

Prior breast cancer diagnosis (check with insurance).

Women who need evaluation of silicone breast implants for possible rupture.

Mammography is not perfect, but is currently the most widely tested screening technology and remains the standard of care. As new research findings, new tests, new technology and new treatments become available, it is important for women (and men) and their doctors to have regular, comprehensive discussions about the benefits, limitations and potential harms of screening tests, the risks of not being screened, and the importance of observing changes in one’s body. You may read about other technology or devices being used; however, until evidence-based research is conducted, women are not advised to use these devices for screening. Understand why early detection matters.

Early detection can improve the prognosis for survival in most cases.

In the United States, approximately 6% of all breast cancer cases are first diagnosed at Stage IV. Stage IV means the cancer has already spread from the breast to other organs in the body such as the bones or lungs. While there is currently no cure for Stage IV breast cancer, in many cases the cancer can be manageable with treatment for many years. In developing countries, approximately 40% of breast cancers are first diagnosed at Stage IV.

Recommendation Summaries from Leading Expert Groups

American Cancer Society Recommendations for Early Breast Cancer Detection in Women without Breast Symptoms:
Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so. The risks of screening as well as the potential benefits should be considered.Women age 45 to 54 should get mammograms every year. Women age 55 and older should switch to mammograms every 2 years, or have the choice to continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. Women at high risk for breast cancer should talk with their doctors about their history. They may need to be tested earlier, more frequently, and with additional tests.

U.S. Preventive Services Task Force (USPSTF) 2015 Recommendations:
In 2015, the U.S. Preventive Services Task Force (USPSTF) issued updated screening recommendations for women who do not have any symptoms of breast cancer and who are not at elevated risk of breast cancer. The USPSTF finds a mammogram is a good test, but not a perfect one. The USPSTF recommends screening mammography every two years for women ages 50 to 74. The decision to start regular screening mammography before the age of 50 should be an individual one and take patients’ wishes into account. Talk with your health care provider about what is appropriate for you to be doing.

Sources & Resources

  1. Society, A.C., Breast Cancer Facts & Figures 2013-2014. 2013.
  2. Hunt, B.R., S. Whitman, and M.S. Hurlbert, Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiol, 2014. 38(2): p. 118-23.
  3. Wild, B.W.S.a.C.P., World Cancer Report 2014 2014.
  4. Ross, A.C., et al., The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab, 2011. 96(1): p. 53-8.
  5. Silverstein, M.J., et al., Special report: Consensus conference III. Image-detected breast cancer: state-of-the-art diagnosis and treatment. J Am Coll Surg, 2009. 209(4): p. 504-20.

Disclaimer
This website was created for educational purposes only and should not be interpreted as medical advice. Be sure to partner with your medical provider to develop the best personal care plan for you. Adapted from the American Cancer Society, 2013-2014 Breast Cancer Facts & Figures.