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How to Detect Breast Cancer

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    NEWSLETTERS

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    We previously told you about the risk factors for breast cancer. Now here's an overview from Healthy Women on how to detect it.

    While you can't alter some of your personal risk factors for developing breast cancer, such as age or family history, you can adopt specific lifestyle choices, such as maintaining your ideal body weight and exercising, to reduce your risk of the disease.

    Early detection of breast cancer, however, provides the best opportunity for successful treatment and reduces your chances of dying from breast cancer.

    There are three main ways to detect abnormalities in your breasts that may be cancerous: breast self-examination, mammograms and regular breast exams by your health care professional. Other imaging studies such as ultrasound and MRI (magnetic resonance imaging) can also help find cancer in the breast.

    The American Cancer Society recommends an annual mammogram for all women 40 and older. The United States Preventive Services Task Force (USPSTF), an independent government-appointed panel, modified its recommendations in 2009 to say that women ages 50 to 74 should have a mammogram every other year. The USPSTF does not recommend mammograms for women outside of that range, unless they are at high risk for breast cancer, because false positive screening results could require unnecessary follow-up screenings or treatment.

    If you are at high risk for developing breast cancer, the ACS suggests you start getting an MRI and mammogram annually at age 30, unless your health care provider suggests a different age. MRI scans are more sensitive than mammograms at detecting an abnormality in women with dense breasts. The two tests together give health care professionals a better chance of finding breast cancer in its early stages, when it is the most treatable.

    HealthyWomen recommends that you ask your health care professional about breast cancer screening recommendations with your personal health history in mind.

    Breast Self-Exam

    Breast self-exam (BSE) is an option for women age 20 and older. Although BSE isn't specifically recommended for breast cancer screening, many women choose to examine their own breasts regularly, which is a good idea. Research has shown that BSE plays a small role in breast cancer detection compared with finding a breast lump by chance. Overall, the main goal of a BSE is to help a woman become familiar with the look and feel of her breasts so she can report any changes to her health care provider right away. Some women feel very comfortable taking a step-by-step approach to doing a monthly BSE. Other women prefer to examine their breasts in a less systematic way, while they are showering or getting dressed, with an occasional more thorough exam. As long as a woman monitors the look and feel of her breasts regularly, either technique is acceptable.

    Women who examine their own breasts should keep in mind that breast changes can occur with pregnancy, aging, menopause, during menstrual cycles or when they are taking birth control pills or other hormones.

    Ask your health care professional to show you how to perform a BSE correctly or check the American Cancer Society website (www.cancer.org) for detailed instructions. The procedure for doing BSE is different from previous guidelines. There is now evidence that the right amount of pressure, the pattern of coverage of the breast and the position (lying down is best) increase a woman's ability to feel abnormalities. You may also want to ask for a brochure to help when you get home. It may take several months for you to become familiar with the routine and to learn what to expect to feel. But with practice, BSE can increase your chances of noticing anything abnormal about your breasts.

    If you find a suspicious lump or notice something else abnormal, make an appointment with your health care professional. He or she will perform an exam and will likely have you undergo a mammogram. The majority of breast changes found by women who regularly perform BSEs are not cancerous.

    Mammograms and Clinical Breast Exams

    A mammogram is a specialized X-ray of your breasts from various angles. Although it doesn't usually hurt, a mammogram can be uncomfortable or embarrassing. A health care professional moves and flattens (breast compression) your breasts on the X-ray machine so it is in the best position for taking X-ray images. The entire procedure typically takes less than 15 minutes.

    The value of mammography is that it can identify potentially cancerous breast abnormalities at an early stage before they can be felt. While mammograms can detect a breast lump up to two years before it can be felt during a physical examination, they can miss up to 20 percent of breast cancers.

    A clinical breast exam (CBE) is a manual examination of the breasts by a health care professional to check for any suspicious masses. CBE is a complement to mammograms and an opportunity for you and your health care professional to discuss changes in your breasts, early detection testing and factors in your history that might make you more likely to have breast cancer.

    According to the American Cancer Society, all women age 40 and older should have an annual screening mammogram and continue to do so as long as they are in good health. Women in their 20s and 30s should have a clinical breast exam conducted by a health care professional at least once every three years; after age 40, women should have a clinical breast exam every year.

    Ultrasound and MRI

    If something abnormal is detected in a mammogram, the next step is usually to take additional X-ray views or an ultrasound.

    Ultrasound is also used to create visual images of breast tissue. Ultrasonography, or ultrasound, uses high-frequency sound waves. The images it creates can be viewed on a monitor and allows your health care professional to see if a breast lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Ultrasound may be used with a mammogram, and the images produced are printed and/or stored as video.

    Magnetic resonance imaging (MRI) uses magnetic fields to show differences between normal and abnormal tissue. For most women at high risk for breast cancer, screening with both mammograms and MRI should start at age 30 (or an age determined by the woman's health care professional) and continue for as long as a woman is in good health.

    For an MRI scan, you lie in a specially designed structure that houses the magnetic field. Contrast material is injected into your veins, and the MRI image shows the dye coursing through the blood vessels in your breasts.

    This test is used to detect cancer, determine the extent of disease, monitor response to therapy and screen women at high risk for breast cancer.

    Biopsy

    Even after an ultrasound or mammogram, if your health care professional still believes the area is suspicious, he or she may recommend a core-needle biopsy, taking a sample of breast tissue by needle and sending it to a pathologist to determine if it's cancer. Biopsies can usually be done in your doctor's office under local anesthesia. Fine needle aspiration is frequently performed. However, the rate of false negatives is very high and most often additional studies, like checking for estrogen or progesterone receptors based on an aspiration, are hard to perform.

    If Breast Cancer is Found

    If breast cancer is found, more tests will be done to find out the size and extent of the cancer in the breast and to determine whether the cancer has spread from the breast to other parts of the body. This is called staging. To plan treatment, your health care professional needs to know the stage of the disease. Learn more at HealthyWomen.org.