What's the Latest on Breast Cancer Screening?

By Mary Wilde, M.D., Scripps Polster Breast Care Center

Breast cancer has certainly been brought into the spotlight over the past few years. Celebrity survivors such as Sheryl Crowe and Melissa Etheridge, along with nationwide walks, runs and other events, have all helped raise awareness of this disease. And thanks to research and advancements in prevention and treatment, the chances of beating breast cancer are greater than ever.

By now, most women know the importance of being screened for breast cancer—after all, the sooner it is detected, the greater the likelihood of a cure. What you may not know is what kind of screening is best for you, and how often you should be screened. At what age should you start having mammograms? Do you need one every year? What about ultrasound or other types of breast cancer screening?

To help clear up the confusion, here are basic guidelines for when and how you should be screened for this increasingly common but highly treatable disease.

*Breast Self-Exam
*Recommendation: Every month, starting at age 20

We recommend that most women examine their breasts once a month, ideally at the same time every month (for example, the week following your menstrual period). Breast self-exam can help you find tumors in their earliest stages, especially those that develop between mammograms or exams performed by your physician. Breast tissue is lumpy by nature, so by examining your own breasts regularly, you can become familiar with how they look and feel and may more easily recognize changes such as new lumps or dimples in the skin.

Your doctor or health provider can give you information on how to do a breast self-exam. However, if you do find something unusual, don’t panic. Many breast lumps are due to non-cancerous causes such as cysts. Just let your doctor know that you felt something unusual, and he or she will take it from there.

*Clinical Breast Exam
*Recommendation: Every year, starting at age 20

During a clinical breast examination, your physician, nurse practitioner, physician assistant or other qualified medical professional check your breasts for any abnormalities. Usually, the clinical breast exam is part of your annual “well woman” exam. If your health professional finds something of concern, he or she will recommend appropriate further evaluation.

*Mammography
*Recommendation: Every year, starting at age 40 (earlier for women with an increased risk of breast cancer)

Mammography is the most powerful screening tool we have for breast cancer. This technique uses X-rays to provide an image of the breast called a mammogram. The image can show early signs of breast cancer, such as tumors and unusual changes in breast tissue, when it is still highly treatable. And, in many cases, early detection with mammography enables women to have only the tumor removed (lumpectomy) rather than the entire breast (mastectomy).

There are two types of mammography currently in use: standard and digital. Standard mammography captures the images of the breast on film; digital stores them in a computer file. Both methods are highly effective in detecting cancer; however, because digital images can be magnified and manipulated on the computer, they may give a slightly more accurate representation of very dense breast tissue, and may be recommended for women who have dense breasts or are under age 50. Digital mammography is more expensive than standard mammography, and may not be as widely available.

Unfortunately, mammograms aren’t 100% perfect. Up to 20% of breast cancers simply cannot be detected through a mammogram. In some cases, additional diagnostic tools such as Magnetic Resonance Imaging (MRI) or ultrasound may be used.

MRI
Recommendation: If recommended by your physician

MRI uses magnetic fields to create an image of the breast. MRI is of most benefit in patients with a diagnosis of breast cancer to help determine how advanced it is. It may also be useful in combination with mammography to screen certain groups of women who have an increased risk of breast cancer due to genetic factors or a family history of the disease, or those with other risk factos.

Screening MRI is slightly more invasive than mammography because a contrast agent must be injected before the image is taken. Also, MRI is much more expensive than mammography.

Ultrasound
Recommendation: If recommended by your physician

Ultrasound, which creates images of breast tissue through the use of high-frequency sound waves, is often recommended following an abnormal mammogram or clinical breast exam. Because ultrasound may do a better job than mammography when it comes to distinguishing between tumors and dense breast tissue, it may be recommended for women with dense breasts or those with increased risk of breast cancer, as an adjunct to mammograms.

Remember, the recommendations made above are guidelines only. Ask your physician which screening techniques are best for you.

_Mary Wilde, M.D., is a breast specialist and medical director of the Scripps Polster Breast Care Center at Scripps Memorial Hospital La Jolla. Seminars on identifying and managing hereditary breast cancer are offered on the first and third Friday of every month from 10:30 a.m. to 12:30 p.m. Seminars are offered at no charge and open to everyone. Registration is required. For dates and information, call 1-800-SCRIPPS (1-800-727-4777).