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Breast cancer screening

The American Cancer Society (ACS) recommends these measures for the early detection of breast cancer:

Mammogram. Women ages 45 to 54 should have a mammogram every year, and starting at age 55, they can switch to every other year, according to the ACS. For women at high risk for breast cancer, it may be best to start even sooner. Your doctor can help you determine your risk level.

Mammograms are specialized x-rays of the breast that can reveal tumors before they can be felt. Many studies have shown that early detection saves lives and increases treatment options, according to the ACS. Today, most mammograms are digital. The images are saved as computer files instead of being on film. This allows a doctor to look at the x-ray image from different views or magnify sections for a closer look. Digital x-rays also allow doctors to view with greater accuracy potential areas of concern in women who have dense breasts.

Ongoing research is exploring how newer technologies can help make mammograms even more effective. For example:

  • Breast tomosynthesis, or 3D mammography, may allow clearer views of breast tissue. In this type of x-ray, numerous images are taken as the machine moves over the breast. Then a computer puts the images together to create a 3D picture. Breast tomosynthesis may find more cancers and also reduce callbacks for more tests, some studies suggest. But it also may involve more radiation than traditional mammograms, and some insurers may not cover it.
  • Computer-aided detection and diagnosis uses a program that scans the x-ray for patterns that could be cancer. These areas are highlighted so the doctor can pay extra attention to them.

Breast awareness. While the ACS no longer recommends breast exams, it is still important for women to be aware of how their breasts normally look and feel and to report any new changes to a healthcare professional right away. In most cases, breast changes aren't a sign of cancer. Still, tell your doctor if you develop any of the following:

  • Changes in the appearance of either breast, such as a lump, swelling, redness or scaliness.
  • Changes in either nipple, including pain, a nipple that has turned inward or a discharge that isn't breast milk.

Magnetic resonance imaging (MRI). In addition to a mammogram, women at high risk for breast cancer should have an MRI every year. Women with moderately high risk for breast cancer should discuss this screening test with their doctor.

An MRI uses magnetic fields to image breast tissue. This test can reveal some cancers that a mammogram would miss, but it is also more likely to reveal unusual tissue growth that isn't cancer. In women at average risk for breast cancer, this is more likely to lead to follow-up procedures for growths that aren't cancer, which carries its own risks. That's why screening with MRI is not recommended for all women.

Breast ultrasound. If something unusual shows up on a mammogram, a breast ultrasound test may show if the mass is solid or filled with fluid. A solid mass could be cancer. Breast ultrasound may also be helpful in addition to mammograms for women who have dense breasts and an increased risk of breast cancer, according to the ACS.

Ultrasound can also be helpful if a woman's breasts are very dense, which can make it difficult to get a clear mammogram picture. Some doctors also use ultrasound to see if the edges of a tumor are smooth or ragged. Cancerous tumors more commonly have ragged edges.

Determining your risk

According to the ACS, a woman is at high risk for breast cancer if she has:

  • A known BRCA1 or BRCA2 gene mutation.
  • A first-degree relative (mother, father, brother, sister or child) with a BRCA1 or BRCA2 gene mutation.
  • A history of chest radiation therapy between ages 10 and 30.
  • Li-Fraumeni syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome or a first-degree relative with one of these syndromes.
  • A 20 to 25 percent or greater lifetime risk of breast cancer because of other factors (usually family history).

A woman is at moderately high risk for breast cancer if she has a 15 to 20 percent lifetime risk of breast cancer, a personal history of breast cancer or a precancerous breast condition, or breast tissue that appears dense on mammograms.

Your doctor can help you determine your breast cancer risk.

reviewed 4/17/2019

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