1 in 7 women will be diagnosed with Breast Cancer over the course of their lifetime. Fortunately, with early detection and early treatment, 87% will also be survivors.
The size of a breast cancer and how far it has spread are the most important factors in predicting the prognosis (the outlook for chances of survival) of a woman with this disease. Finding a breast cancer as early as possible improves the likelihood that treatment will be successful. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests. Following the American Cancer Society’s guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.
All women over the age of 20 should be performing Breast Self Examination (BSE). Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.
Women in their 20s and 30s should have a Clinical Breast Examination (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. A baseline mammogram should be performed by age 35 unless otherwise indicated, then every 2-3 years after until age 40.
Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.
Women at increased risk should talk with their doctors about the benefits and limitations of starting mammograms when they are younger, having additional tests (such as breast ultrasound or MRI), or having more frequent exams.
Evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer a substantial benefit for women in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early. However, mammograms also have limitations. A mammogram will miss some cancers, and it sometimes leads to follow up of findings that are not cancer, including biopsies.
Women should be told about the benefits, limitations, and potential harms linked with regular screening. Mammograms can miss some cancers. However, mammograms, despite their limitations, remain a very effective and valuable tool for decreasing suffering and death from breast cancer.
Mammograms for older women should be based on the individual, her health, and other serious illnesses. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment, she should continue to be screened with mammography.
All women are at risk for breast cancer and the risk increases as women get older, especially after age 40. Some women have certain factors that increase their likelihood of breast cancer more than most women. The evidence available for women at increased risk is only sufficient to offer general guidance to help women and their doctors make more informed decisions about finding breast cancer early.
Women should discuss with their doctor what approaches are best for them.
The American Cancer Society believes the use of mammography, clinical breast examination, and finding and reporting breast changes early, according to the recommendations outlined above, offers women the best opportunity for reducing the breast cancer death rate through early detection. This combined approach is clearly better than any one examination. Without question, breast physical examination without mammography would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms. Although mammography is the most sensitive screening method, a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors.
The doctor reviewing the mammogram will look for several types of changes:
- Calcifications, or microcalcifications, are tiny mineral deposits within the breast tissue that appear as small white spots on the film. They may occur alone or in clusters. They are a sign of changes within the breast and can be either carefully watched by additional, periodic mammograms or examined by biopsy (removal of a small amount of breast tissue). They may be caused by benign breast conditions or, less often, by breast cancer.
- A mass, which may occur with or without calcifications, is another important change that can be seen on a mammogram. Masses can be many things, including cysts and fibroadenomas, but they may be cancer and usually should be biopsied if they are not fluid-filled cysts.
- A cyst is a collection of fluid in a small sac in the breast. It can feel like a lump, usually soft, in the breast. Either a breast ultrasound or removal of the fluid with a needle (aspiration) is used to confirm that a mass, or lump, is a cyst. It is very rare for a cyst to be cancerous. If a cyst has ultrasound features that are suggestive of cancer, fluid removed from the cyst will be examined to look for malignant cells.