Cancer screenings are an important part of staying healthy and can help prevent illness or diagnose diseases at their earliest stages. Many women wonder when they should start screening for breast cancer.
Mammography is an imaging procedure that uses low-energy x-rays to examine the breasts. It’s one of the best tools to screen for or detect breast cancer and other abnormalities.
Because mammography produces such high-quality images of the breast, it can show cancer that may be too small for you or your doctor to feel.
The Society of Breast Imaging and the American College of Radiology (ACR) support annual mammography exams starting at age 40, as this saves the most lives. It is up to you and your doctor to decide on routine exams or diagnostic evaluation.
Most medical organizations recommend more vigilant breast cancer screening guidelines for women at high risk of getting breast cancer. These guidelines may apply to women who have such risk factors as:
- A known BRCA1 or BRCA2 gene mutation.
- An untested family member of someone with a BRCA1 or BRCA2 mutation.
- A history of chest radiation before age 30.
- Certain syndromes, such as Li-Fraumeni or Cowden.
- A lifetime breast cancer risk of 20% or greater based on family history.
If you are at higher risk of breast cancer, you should talk to your doctor about starting screenings earlier.
Special Patient Populations
New ACR breast cancer screening guidelines recently published in the Journal of the American College of Radiology call for heightened screening attention for Black women and other frequently overlooked or underserved populations, such as transgender persons.
- Biological males transitioning to females may be at increased risk for breast cancer compared to males because of certain factors, such as hormone use and surgical history.
- Biological females transitioning to males who do not undergo top surgery remain at their previous risk for breast cancer and should be routinely screened according to their age and risk level.
What Are the Types of Breast Cancer Screenings?
The two types of breast cancer screenings are breast examination and mammography. Both are helpful in the early detection of breast cancer.
Clinical breast examination (CBE) is recommended for women who are at high risk or have symptoms. CBE involves the provider touching your breasts, underarms, and the area just below your breastbone to feel for any changes and abnormalities (such as lumps).
CBE should be performed by a provider who is well-trained in the technique.
The provider should visually check your breasts while you are sitting up and physically examine your breasts while you are lying down.
Screening CBE may be offered to asymptomatic, average-risk women at their annual medical visits in the context of an informed, shared decision-making approach.
- For ages 20 to 39: Have a clinical breast exam by your health care provider at least once every three years.
- For ages 40 and up: Have a clinical breast exam by your health care provider every year.
- If a CBE is not offered at your check-up and you would like one, ask your provider to perform one or refer you to someone who can.
Breast self-awareness (BSA) is an important tool in facilitating good breast health. Become familiar with your breasts and report any changes, such as lumps, rashes, discharge, or pain to your health care provider. Examining your breasts regularly may assist with BSA.
Screening mammography is done to detect signs of cancer before you have any symptoms of the disease. It usually consists of two x-ray images showing different views of each breast.
The first time you have a mammogram, it may be referred to as your “baseline” mammogram — the one that your next mammogram will be compared to. Your most recent mammogram will likely be compared to the baseline or prior mammogram to see if anything has changed. That mammogram will become the baseline for comparison to your next mammogram, and this breast care pattern should continue as you age.
Diagnostic mammography is used to diagnose a breast lump or other abnormality that has been found on a screening mammogram or through CBE or BSE. It consists of more x-rays than screening mammography and takes longer to complete. Diagnostic mammograms also may be ordered if the radiologist has difficulty seeing your breast tissue in a screening mammogram because of dense breast tissue or implants.
Other Diagnostic Procedures
Additional diagnostic procedures might be ordered if more information is needed to conclude whether an abnormality is cancerous or benign (not cancerous). These tests include:
- Breast magnetic resonance imaging (MRI).
- Breast ultrasound.
- Minimally invasive breast biopsy (ultrasound or stereotactic guided).
Are there Risks with Breast Cancer Screenings?
A screening mammogram causes only minor discomfort and minimal exposure to radiation. Screening mammograms can detect most but not all cancers. Sometimes tumors are missed, especially in women with dense breast tissue.
On the other hand, mammograms sometimes spot something that looks suspicious but turns out not to be cancer. This finding may lead to further testing and anxiety.
There’s also concern that screening may lead to over-treatment and over-diagnosis. Once cancer is found, it’s common to feel that you have to treat it. In many cases you will have to treat it; however, there are times when cancer is present but never becomes life-threatening. Doctors can’t always tell which cancers will spread and which ones won’t. That’s why most people opt for treatment.
In general, the risks of mammography are low and don’t outweigh the benefits of getting a mammogram. The earlier you catch breast cancer, the more treatment options are open to you, and the better your chances of recovery.
Always talk with your doctor about your risk and when is best for you to begin annual screening.
UPMC Magee-Womens Hospital provides care for the breast health needs of all patients at any age. We personalize screenings by using the recommended imaging based on age, breast density, and risk. If you have any questions about our personalized screening recommendations, please ask for a brochure made by our breast imaging experts.To learn more about breast cancer screening or to schedule an appointment for your mammogram, visit the Magee-Womens Imaging website.
Haven’t scheduled your mammogram yet? Some UPMC patients are now able to schedule mammograms online. Visit our online scheduling tool to see if you are eligible
Editor's Note: This gallery was originally published on , and was last reviewed on .