Screening for Breast Cancer

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All women should know the look and feel of their bodies, including their breasts. If, for instance, you have always had an inverted nipple your adult life, it should not be a source of worry. Acute onset, however, is something to bring to your health provider's attention. Knowing the look and feel of your breasts is important in avoiding unnecessary procedures, too. All women should have their doctor do a clinical exam of their breasts on a regular basis.

The best way to screen for breast cancer is through a mammogram. Mammograms can help find tumors in women who don’t show any symptoms of cancer. But some doctors disagree about screening rules.

The decision about when to start screening mammograms, and how often to have them, should be made individually by each woman after discussing the issue with her doctor.”

Some studies and doctors assert that mammograms can lead to overdiagnosis and false positives, which lead women to make difficult choices and engage in expensive and life-altering treatments that could have been avoided or delayed. “Overdiagnosing” means diagnosing cancer that didn’t require immediate treatment without any change to a woman’s prognosis, or diagnosing a cancer that never would have required treatment or affected a woman’s health. False positives are suspicious findings that turn out to be normal; they are technically “good news” but can have significant psychological, physical, and economic tolls.

The current status on breast cancer screening recommendations are as follows:

  • American Medical Association: mammograms at age 40
  • American College of Obstetricians and Gynecologists: mammograms at age 40
  • American College of Radiology: mammograms at age 40
  • National Cancer Institute: mammograms at age 40
  • American Cancer Society: mammograms at age 45.
  • American College of Obstetricians and Gynecologists: mammograms at age 40.

The guidelines also say that if a woman doesn’t start having annual mammograms at age 40, regular screening should start at age 50.

However, in all cases, the decision about when to start screening mammograms, and how often to have them, should be made individually by each woman after discussing the issue with her doctor.

There are special screening rules for people who are at a high risk for breast cancer or who have found a lump or other suspicious area in their breasts. Mammograms can help diagnose the issue, but a doctor may also suggest other tests, like a sonogram or an MRI. Having dense breast tissue makes it harder for mammograms to spot the cancer. Dense tissue and tumors both appear light on mammograms, unlike fatty tissue. Women with dense breast tissue> may be told to have 3-D tomosynthesis or molecular breast imaging, rather than normal mammograms.

3-tomosynthesis takes multiple X-ray pictures of each breast from many angles and does not compress the breast as much as traditional mammograms. Molecular breast imaging uses a radioactive tracer, injected through a vein, to reveal cancer inside the breast. Breast cancer cells absorb the radioactive substance more than normal cells, so they “light up,” making them easier to spot. A special scanner is used to locate high concentrations of the substance and thereby identify the location of cancer. Unfortunately, molecular breast imaging and 3-D tomosynthesis may not be covered by all health insurance providers. The cost may make them inaccessible to some groups of women, and they are not available in all care facilities.

Written by: Dr. Deborah Axelrod, NYU Langone. Last Updated: September 3, 2017 by Melissa Sakow.


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