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Making smart screening decisions: Part 2: Breast cancer

Learn which breast cancer screening tests you need, and when to have them.

Considering that one out of every eight of us will be diagnosed with breast cancer in her lifetime, screening for this disease is among the most important tests we’ll ever have. In recognition of National Breast Cancer Awareness Month, Harvard Women’s Health Watch asked Dr. Pamela DiPiro, assistant professor of radiology at Harvard Medical School to help us make sense of breast cancer screening recommendations.

Breast self-exams

Breast self-exams

To perform a breast self-exam, move your hand in an up-and-down pattern, starting from the underarm and moving across the breast to the middle of your chest. Look for any changes in size, shape, and contour. Also check for nipple puckering or discharge.

Why is it so important for women to get regular mammograms?

Because the way to save lives is to detect breast cancer at an early stage. By the time you can feel a breast cancer tumor, it may have already spread. A mammogram is a way to potentially detect breast cancer early.

At what age should women start getting mammograms, and how often should we have them?

I follow the guidelines of the American College of Radiology, the Society of Breast Imaging, and the American Cancer Society (among other organizations), which recommend that women have annual mammographic screenings starting at age 40.

Should women stop having mammograms at a certain age?

The U.S. Preventive Services Task Force (USPSTF) recommends stopping mammograms at age 75, but I don’t agree with that. As you age, your risk of getting breast cancer rises. Therefore, a woman should continue to be screened as long as she is in good health. There are certain circumstances under which you’d stop screening. For example, an 80-year-old woman with multiple health problems whose doctor wouldn’t treat her for breast cancer shouldn’t be screened. However, a healthy 80-year-old who would be treated if a breast cancer were found should be screened.

What other screening tests might women need?

If a woman has a mass on a mammogram, then we typically use an ultrasound to determine whether the lump is solid (which could be cancer), or fluid-filled (like a cyst). However, we don’t routinely use ultrasound as a screening tool.

The other test we use is MRI. In general, MRI is not used to screen women in the low-risk, general population. However, women who are at high risk, for example because they have a BRCA mutation or have received radiation for Hodgkin’s disease, should have an annual screening MRI as well as a mammogram. The MRI is often able to pick up cancers in very dense breasts.

Tomosynthesis is an up-and-coming test. Images of the compressed breasts are taken at multiple angles and then are reconstructed using a computer, creating a series of high-resolution images. This reduces or eliminates overlapping breast tissue, allowing a radiologist to differentiate a tumor from superimposed tissue.

Breast cancer screening tests

  • Mammogram—an x-ray of the breast that can detect tumors too small to feel.

  • Magnetic resonance imaging (MRI)—a test that uses magnetic fields and radio waves to create detailed images of the breast on a computer screen.

  • Ultrasound—a test that uses high-frequency sound waves to create an image of the breast on a computer screen.

  • Digital tomosynthesis—a newer screening test that uses x-rays to create a three-dimensional image of the breast.

Should women do breast self-exams?

I would recommend that women do breast self-exams, as long as they are comfortable doing so. Many women find it too anxiety-provoking, but they should at least be aware of any changes in their breasts, including nipple retraction or discharge, and report them to their doctor. At the very least, women should undergo annual clinical breast exams performed by their doctor.

Posted by: Dr.Health

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