Breast Cancer Screening

There is a difference between breast cancer screening and diagnosis.

Doctors use screening tests to detect diseases such as breast cancer in otherwise healthy people who do not have any signs or symptoms of the disease.  The regular mammogram you get is a perfect example of a screening test.  If you discover a lump, or a screening mammogram reveals a problem, doctors use a variety of tests and procedures to determine the exact nature of the problem – in other words, to diagnose it.

The first goal of diagnostic tests is to determine if a lesion is malignant or benign, but diagnosing breast cancer is a complex process that involves analyzing a number of factors that influence treatment and prognosis.

 
Breast Examination
Every woman should be familiar with her own breasts and aware of any changes that might occur in them.  Learn the proper technique to examine your own breasts and practice it on a regular basis.  Many women do find their own lumps or notice changes that they can report to their doctors, but breast self-examination by itself does not lower the death rate from breast cancer.   Make sure that your doctor includes breast examinations in your checkups and that you follow the appropriate mammography screening guidelines for your age and risk level.

 
Breast Cancer Symptoms
In general, the symptoms of breast cancer are the same as those for non-cancerous breast conditions.  They include a lump you can feel or see, especially new lumps; nipple tenderness or discharge, especially if it occurs suddenly, is bloody, or is in only one breast; a nipple that becomes inverted; a change in the size or shape of the breast; persistent sores, dimples or scaliness; or warm, red or swollen breasts.  If you develop any of these signs or symptoms, you should contact your doctor immediately.

 
Mammography
Mammography is the best tool available to screen women for breast cancer and to detect cancers early when they occur.  Today's mammograms are highly sensitive, accurate and safe.  Is mammography perfect?  No. 

As with virtually every medical test, false positives occasionally happen.  A false positive is a result that appears to reveal a tumor that isn't there.  A false negative is a result that does not detect a tumor that is present.  Experts disagree about the age a woman should be when she begins regular mammogram screening and how often she should be screened.

For many years, the American Cancer Society and other leading groups have recommended that women begin annual mammograms at age 40.  In 2009, the U.S. Preventive Services Task Force issued a report recommending that women get mammograms every two years between the ages of 50 and 74.  The report was based on statistical evidence that routine screening before age 50 and after age 74 does not improve overall survival from breast cancer.  The report also recommends that women between the ages of 40 and 49 decide with their doctors when to begin screening.

Comprehending why top experts disagree on such an important topic is difficult, but every woman must understand herself and her individual risks of breast cancer, communicate with her doctor and be comfortable with her choices.  The most important thing is getting regular mammography screening based on age, risks and personal preferences.

 
Other Breast Cancer Imaging
While mammography remains the primary method for breast cancer screening and detection, doctors sometimes use other imaging techniques to help evaluate women at higher risk for breast cancer: 

• Diagnostic mammography is similar to screening mammography except that it involves taking more pictures (views) of the breast.  It is often used if something suspicious is found on the screening mammogram or if a woman has symptoms such as a lump or nipple discharge.
• Magnetic resonance imaging (MRI) has become a very important diagnostic tool for many diseases, but its use in breast cancer is mostly in addition to mammography for women who are at high risk for the disease.  MRI is often better at detecting very small masses, especially in women with very dense breast tissue.  However, it does not detect breast calcifications, which can indicate cancer, and it has a higher rate of false positives.
• An ultrasound (also called a sonogram) is sometimes used to evaluate a suspicious finding on a mammogram or physical examination.
• Thermography works by detecting areas of increased heat within the body – which can be an indication of malignancy.   While doctors continue to be interested in finding optimal uses for this technology, it has not become standard procedure in screening for or diagnosing breast cancer.
• BSGI (breast-specific gamma imaging) and PEM (positron emission mammography) are new techniques that are currently used only to evaluate breast lesions in special circumstances.  They are not appropriate for screening.