Breast Cancer Screening
Breast cancer is easier to treat when it’s found as early as possible. Early detection can mean that less aggressive treatment is needed and there’s a lower risk of dying from breast cancer.
Getting regular screening tests, such as mammograms, is the best way to detect breast cancer early. Screening tests look for breast cancer in people who haven’t developed any obvious signs or symptoms of the disease.
However, screening tests aren’t ever used to diagnose breast cancer on their own. If a screening test shows something abnormal, your doctor will recommend that you have more tests (typically a diagnostic mammogram and ultrasound). A breast biopsy is the only test that can tell for sure if breast cancer is present.
What screening do you need?
Talk with your doctor about developing a plan for which screening tests you should get, how often, and starting at what age. To create the plan, you and your doctor can take into account your individual risk factors, such as your breast density (which you can find out by getting a mammogram) and your age.
By doing a breast cancer risk assessment, your doctor can help you find out if you’re at average, intermediate, or high risk for breast cancer. The American College of Radiology recommends that all women be evaluated by a doctor to find out if they’re at higher-than-average risk for breast cancer no later than age 25.
Medical organizations have screening recommendations for women at different risk levels, for people who are transgender or non-binary, and for cisgender men who are at high risk for breast cancer.
Which tests are used to screen for breast cancer?
Screening is done using imaging tests (such as mammograms, ultrasounds, and breast MRIs) and physical exams. Your doctor may recommend that you routinely get more than one type of test as part of your screening plan. Combining tests increases the chances of early detection, since each test can sometimes find cancers that the others would miss.
Screening with mammograms
A mammogram is an X-ray picture of the breast tissue. Mammograms are the most widely used imaging method for screening for breast cancer.
Most mammogram facilities offer 3D mammograms, also called digital breast tomosynthesis, which are more effective for finding breast cancers than 2D mammograms.
Medical organizations publish guidelines on using mammograms for screening, including who should get mammograms and when. Many experts and several medical organizations recommend that women at average risk starting getting annual screening mammograms at age 40. For people at high risk, the recommendations are more individualized, but in general experts say they should start annual screening mammograms around age 30.
Screening with mammograms isn’t typically recommended during pregnancy. However, a mammogram may be done in someone who is pregnant if they have symptoms of breast cancer.
Screening mammograms can be done in people who have breast implants. Extra pictures are taken to help make more of the breast tissue viewable.
Screening mammograms are also recommended for some people who’ve had breast cancer in the past, especially if they have some remaining breast tissue (you may have remaining breast tissue, for example, if you had a single mastectomy, a nipple-sparing mastectomy, or a lumpectomy).
Screening with breast MRI
Breast MRI (magnetic resonance imaging) is an imaging test that uses magnets and radio waves to produce detailed cross-sectional images of the breast tissue. It’s used in addition to mammograms to screen for breast cancer in people who have specific risk factors. For example, if you’re at high risk for breast cancer (you have a lifetime risk of 20% or more) or you have extremely dense breast tissue, your doctor may recommend that you get a breast MRI and a mammogram every year. They may also recommend that you periodically get an ultrasound. Breast MRI can find some breast cancers that wouldn’t be found on a mammogram, particularly in people with dense breast tissue.
Screening with breast ultrasound
Ultrasound is an imaging test that sends high-frequency sound waves through your breast to create a digital image of the breast tissue. Ultrasound is sometimes used in addition to mammograms to screen for breast cancer in people who have dense breast tissue. Your doctor may be more likely to recommend an ultrasound for screening if you also have other factors that put you at higher than average risk for breast cancer (besides having dense breast tissue). Like breast MRIs, ultrasounds can sometimes find breast cancers in people with dense breasts that mammograms miss.
Screening with breast physical breast exams
A breast physical exam is when a healthcare provider examines your breasts to look for any abnormal changes. They carefully feel your breasts and underarm area for any lumps or other changes, using the tips of their fingers. Sometimes they can find lumps or other changes that you wouldn’t have found on your own, and that should be further checked using a mammogram or other imaging test.
The recommendations about breast physical exams vary a lot among medical organizations. Some recommend that women at average risk for breast cancer should get them every one-to- three years starting at age 20-25, and every year starting at age 40. Women at high risk should talk with their doctors about whether they should get breast physical exams more frequently or starting at an earlier age.
If you’ve had early-stage or locally advanced breast cancer, it’s generally recommended that you get physical exams of the breast (or chest area) on a regular basis after active treatment ends (two to four times a year for the first three years after active treatment ends; one to two times a year for the next two years; once a year after that). These exams are used to monitor for a possible breast cancer recurrence.
Screening with breast self-exams
A breast self-exam is checking yourself for lumps and other symptoms of breast cancer by feeling and looking at your breasts. Breast self-exams are a good way to become familiar with how your breasts normally feel and look. This makes it easier to notice any changes.
Most medical organizations no longer recommend formal, step-by-step breast self-exams. But many do recommend “breast self-awareness” (or learning what’s normal for your breasts).
Also, breast self-exams can be a helpful tool for early detection for some people. (It’s not uncommon for people to find a lump on their own at home that leads to a diagnosis of breast cancer). However, breast self-exams should always be used along with other screening tests, not instead of them.