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Screening for Breast Cancer

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The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

When to get screened for breast cancer can be confusing because there are several organizations that recommend different screening schedules. Below are 2009 recommendations from the United States Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG).

Screening Tests

Breast Self-exam

When doing a breast self-exam (BSE), you feel for anything new or different. You will be able to feel a particularly lumpy portion of the breast. Sometimes cysts appear and disappear. Masses that come and go are generally not cancerous. Other than new lumps, look for nipple discharge (either clear or bloody), dimpling of the skin, thickening of the skin, redness of the skin, pain, new lumps, or a fullness feeling in the armpit.

There is a lack of evidence that breast self-exams can reduce your risk of death from breast cancer. The USPSTF does not recommend this self-screening, and the ACS views the exam as optional for women aged 20 and older. ACOG suggests that it is considered in high-risk women.

If you are unsure as to whether you should do a breast self-exam, talk to your doctor. To learn how to do the exam, click here.

Clinical Breast Exam

During your routine physical exam, your doctor may do a clinical breast exam (CBE). Your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes. Both the ACS and ACOG recommend that women 20 to 39 years old have the exam every three years, and every year for women aged 40 and older.

USPSTF has no recommendations for this exam.

Mammogram

A mammogram is a special x-ray of the breast that may be able to find tumors that are too small for you or your doctor to feel. Your doctor may suggest that you have a mammogram, especially if you have risk factors for breast cancer.

Guidelines for getting a mammogram vary depending on the organization:

  • USPSTF
    • 40 to 49 years old—the decision to have a mammogram every two years is an individual one. You should make your decision after you understand the risk and benefits that apply to you. Talk to your doctor.
    • 50 to 74 years old—every two years
  • ACS and ACOG
    • 40 years and older—every year

The USPSTF, the ACS, and the ACOG do not give specific guidelines as to when women should stop having mammograms. But, the American College of Radiology and the Society of Breast Imaging recommend that mammograms should end when an older woman's health is poor and treatment would not be beneficial.

The accuracy of a mammogram to detect cancer will depend on several factors. It may be affected by the size of the tumor, your age, breast density, and the skill of the radiologist. Although mammograms are the most sensitive test currently used to evaluate the breast, they will miss 10%-15% of breast cancers. Mammograms have a false-positive result almost 1/3 of the time. A false-positive result occurs when a test suggests an illness that actually does not exist.

Magnetic Resonance Imaging (MRI)

MRI scan is a procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. MRI scans are used to evaluate breast masses that have been found by BSE or CBE and to recognize the difference between cancer and scar tissue. This type of imaging test is also used in women with a diagnosis of breast cancer to search for other lesions that may not be seen on mammography. An MRI scan can be used as a screening tool for certain women who are at high risk for breast cancer.

The use of breast MRI scan has increased lately. But, this test is not for all women. You and your doctor can discuss whether an MRI scan is the right test for you.

Ultrasound

During an ultrasound, sound waves are bounced off tissues, and the echoes are converted into a picture (sonogram). An ultrasound may be used in cancer screening if you:

  • Are at high risk for breast cancer and cannot have an MRI scan
  • Have dense breast tissue

This test can also be used to evaluate lumps that have been identified by a BSE, CBE, or mammography.

Talk to Your Doctor

Talk to your doctor about the right screening schedule for you. For example, if you are at high risk for breast cancer, you will need to start having mammograms at an earlier age.

Revision Information

  • American Cancer Society guidelines for the early detection of cancer. American Cancer Society website. Available at: http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Updated June 23, 2011. Accessed August 12, 2011.

  • Breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov. Accessed January 27, 2006.

  • Breast cancer screening: research and guidelines. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated November 2009. Accessed January 19, 2010.

  • Calvagna M. Breast self-exam (BSE). EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated May 2008. Accessed January 19, 2010.

  • Detailed guide: breast cancer. American Cancer Society website. Available at: http://www.cancer.org. Accessed January 27, 2006.

  • 10/23/2009 DynaMed Systematic Literature Surveillance: http://www.dynamicmedical.com/what.php. Nothacker M, Duda V, et al. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review. BMC Cancer. 2009;9:335.

  • 1/19/2010 DynaMed's Systematic Literature Surveillance: http://www.ebscohost.com/dynamed/what.php. Lee C, Dershaw D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol. 2010;7(1):18.

  • 8/7/2011 DynaMed's Systematic Literature Surveillance: http://www.ebscohost.com/dynamed. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013 Jun 4;6.

  • 8/12/2011 DynaMed's Systematic Literature Surveillance: http://www.ebscohost.com/dynamed. The American College of Obstetricians and Gynecologists. Practice bulletin: breast cancer screening. Obstetrics & Gynecology. 2011;122.