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Breast cancer screening

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By Kathe Gallagher, MSW

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The type and frequency of breast cancer screening that is best for you changes as you age.

  • Ages 18 to 39: Some experts recommend that women have a clinical breast exam every 3 years, starting at age 20. Talk with your doctor about how often you should have a breast exam. If you have a high risk for developing breast cancer, talk to your doctor about when to begin having annual mammograms and other screening tests, such as magnetic resonance imaging (MRI).
  • Ages 40 to 69: Annual clinical breast exams are recommended by all experts for women in this age group. Annual mammography is recommended for women older than age 50. Women in this age group should discuss the medical evidence concerning mammograms with their doctors when deciding how often to have a mammogram.
    • Many organizations, such as the American Cancer Society and the American College of Radiologists, recommend mammograms every year for women between the ages of 40 and 49.
    • The U.S. Preventive Services Task Force (USPSTF) recommends a mammogram, with or without a clinical breast exam, every 1 to 2 years for women age 40 and older.1
    • Other organizations, such as the National Cancer Institute, recommend mammograms every 1 to 2 years for women between the ages of 40 and 49.
  • Age 70 and over: Very few studies give information about how effective a breast cancer test is for women older than age 70. But the risk of breast cancer increases with age, and the age at which testing no longer helps reduce death from breast cancer is not known. If you are 70 or older, talk to your health professional about mammography as a regular part of your health care plan.

Early detection is an important factor in the success of breast cancer treatment. The earlier breast cancer is found, the more easily and successfully it can be treated. The three methods commonly used for early detection are:

  • Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Your doctor may suggest that you have a screening mammogram if you are older than 40, especially if you have any risk factors for breast cancer. Screening mammograms are most useful after age 50, but most experts recommend starting screening at age 40.
  • Clinical breast exam (CBE). During a clinical breast exam, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
  • Breast self-exam (BSE). A breast self-exam is a simple procedure to help you detect breast lumps. Do not use BSE in place of clinical breast exam and mammography. Studies have shown that BSE does not help find more early breast cancers.2 It also does not reduce the number of deaths from breast cancer.3 But it may help familiarize you with your normal breast tissue. This may help you identify any new or unusual changes in your breasts.4

Magnetic resonance imaging (MRI) of the breast may be most useful for very high-risk women, such as those who test positive for the BRCA1 or BRCA2 gene, or have two or more close family members who have had breast cancer before age 50.5 MRI may also be used to evaluate the opposite breast in women diagnosed with breast cancer.6

For more information, see the topic Breast Cancer.

References

Citations

  1. U.S. Preventive Services Task Force (2002). Screening for breast cancer: Recommendations and rationale. Annals of Internal Medicine, 137(5, part 1): 344–346.

  2. Thomas DB, et al. (2002). Randomized trial of breast self-examination in Shanghai: Final results. Journal of the National Cancer Institute, 94(19): 1445–1457.

  3. Mahon SM (2003). Evidence-based practice: Recommendations for the early detection of breast cancer. Clinical Journal of Oncology Nursing, 7(6): 693–696.

  4. Smith RA, D'Orsi CJ (2004). Screening for breast cancer. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 103–130. Philadelphia: Lippincott Williams and Wilkins.

  5. Saslow D, et al. (2007). American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA: A Cancer Journal for Clinicians, 57(2): 75–89. Available online: http://www.caonline.amcancersoc.org/cgi/content/full/57/2/75.

  6. Lehman CD, et al. (2007). MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. New England Journal of Medicine, 356(13): 1295–1303.

Credits

Author Kathe Gallagher, MSW
Editor Kathleen M. Ariss, MS
Editor Cynthia Tank
Associate Editor Michele Cronen
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer Douglas A. Stewart, MD - Medical Oncology
Last Updated August 31, 2007
Last Updated: 08/31/2007

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