Breast Cancer Screening

Overview

Breast cancer happens when cells that are not normal grow in one or both of your breasts. Screening tests can help find breast cancer early. They can find some cancers that are too small to feel or before they cause other symptoms. Breast cancer may be easier to treat when it's found early.

Having concerns about breast cancer is common. That's why it's important to talk with your doctor about when to start and how often to get screened for breast cancer.

Mammograms are the best screening test for people at average risk of breast cancer. But experts don't all agree on the age at which screening should start. And they don't agree on whether it's better to be screened every year or every two years.

Here are some of the recommendations from experts:^{footnote 1, footnote 2, footnote 3, footnote 4}

• Start at age 40 and have a mammogram every 1 or 2 years.
• Start at age 45 and have a mammogram each year.
• Start at age 50 and have a mammogram every 1 or 2 years.

When to stop having mammograms is another decision. You and your doctor can decide on the right age to start and stop screening based on your personal preferences and overall health.

Why should you get screened?

Screening tests can find breast cancer early, before you have symptoms like a lump. When breast cancer is found early, it may be easier to treat. And finding it early helps reduce the risk of dying from breast cancer.

What are the risks of screening?

Screening helps find breast cancer early. This can help save lives. But screening also has some possible risks.

• Screening may give false-positive results.

  This means the test seems to find cancer even though no cancer is there. This may lead to more tests or a biopsy to make sure you don't have cancer. False-positive results can lead to distress and unneeded tests.

• Screening may find types of breast cancer that would never cause symptoms or be life-threatening.

  There are some cancers that never cause harm. But doctors can't always tell which cancer will cause problems and which won't. This means that you could have tests and cancer treatments that you don't need. These could cause serious side effects and be costly and stressful.

• Sometimes screening gives false-negative results.

  This means the test misses breast cancer that is there. This could delay your getting treatment.

• Like all X-rays, mammograms expose you to a small amount of radiation.

  The amount from mammograms is very small. For most people, the benefits of regular mammograms far outweigh the low risk from radiation.

Your doctor can help you compare the benefits of screening to the possible risks.

What are the screening tests?

Tests used to screen for breast cancer include:

• Mammogram. A mammogram is the main screening test for breast cancer. It uses X-rays to check for cancer.
  • Digital mammogram (DM). This takes X-rays of the breast from at least two angles. The X-rays are stored in a computer file.
  • 3D mammogram. This is also called digital breast tomosynthesis, or DBT. It uses X-rays to make a 3D image of the breast. As a newer test, it may not be covered by insurance.

• Clinical breast exam (CBE). During this exam, your doctor will carefully feel your breasts and under your arms to check for lumps or other changes. If your CBE is not normal, you may need an imaging test. Your doctor may do a CBE if you have a high risk of breast cancer. Talk to your doctor about whether to have this exam if you are not at high risk of breast cancer.

• MRI (magnetic resonance imaging) of the breast.
  • Standard MRI. This may be used as a screening test if you have a high risk of breast cancer. This includes testing positive for the BRCA1 or BRCA2 gene, having a strong family history of breast cancer, or having a history of chest radiation.
  • Abbreviated breast MRI. This takes less time than a standard breast MRI. (You might hear it called a "fast MRI.") This test is something your breast cancer screening center may offer. As a newer test, an abbreviated breast MRI may not be covered by insurance.

Overcoming Barriers

What keeps you from getting screening?

Many things can keep people from getting mammograms to screen for breast cancer. But screening could help save your life.

Here are some common reasons people don't get a mammogram and ideas for how to get around many of them.

• I can't afford it.

  Most insurance companies, Medicaid, and Medicare cover screening mammograms. For those without insurance, the National Breast and Cervical Cancer Early Detection Program provides free or low-cost mammograms. Go to www.cdc.gov/cancer/nbccedp/screenings.htm to find out if you qualify.

• I can't get there.

  If transportation is a problem, find out if a mobile mammogram van comes to your area. Or find out if there is a screening center closer to your home, work, or school.

• I've heard that a mammogram hurts.

  It is true that it can be uncomfortable, and it's painful for some people. The discomfort is brief. It may help to ask your technician about what to expect during your scan and let them know if you need a break. Try to schedule your test a week after your period when your breasts are less likely to be tender.

• I don't have time or child care.

  If it's hard to get time off work or if you're a caretaker, ask if there's a screening center with hours that might work better for you. Or maybe you could get screened at a place closer to your home, work, or school.

• Modesty is important to me.

  If you're concerned about your breasts being uncovered, it may help to know a few things. Most breast cancer screening centers have female staff, and you always can ask to be sure. The staff will keep you as covered as possible. Getting screened is a way to take care of your body.

• I'm not worried about breast cancer.

  People may skip mammograms for different reasons. For example, they don't have any symptoms or there's no breast cancer in their family. But breast cancer may grow for years before it causes a lump you can feel. And most breast cancers occur in people without a family history. People can have a healthy lifestyle and still get breast cancer. Go to www.cancer.gov/bcrisktool for more information about your personal breast cancer risk.

• I'm afraid of finding out that I have cancer.

  That is a common fear. Screening helps find breast cancer early. Treatment is easier and works better for early breast cancer than for cancer that's found later. Treatment is also much better than it used to be, and it works very well for most people.

• I'm worried that I'll need more tests after I get screened.

  After a mammogram, some people are called back for more tests. This is more common in younger people. It can be stressful. The extra tests help make sure you don't have breast cancer. Keep in mind that most of the time, the results of the extra tests are normal.

• I wouldn't treat breast cancer if I had it.

  This may be a good reason not to get a mammogram. Some people have health problems that make it too hard to treat cancer. Or they may not want to treat cancer for other reasons. If you're sure that you don't want to know if you have cancer, tell your doctor.

• I don't trust the system.

  It can be hard to trust the health care system if you haven't felt heard or respected in the past. It might help to ask someone to go with you to your appointments. Choose someone who understands and supports you. They can help you ask questions and take notes.

Share your thoughts and questions about screening with your doctor. Your concerns are real, and you deserve to have your questions answered.