American Cancer Society Recommendations for the Early Detection of Breast Cancer

Finding breast cancer early and getting state-of-the-art cancer treatment are two of the most important ways to prevent deaths from breast cancer.

If breast cancer is found early, when it’s small and has not spread, treatment is more likely to be successful. Getting regular screening tests is the most reliable way to find breast cancer early.

The American Cancer Society (ACS) has screening guidelines for women at average risk for breast cancer and for those at high risk for breast cancer.

American Cancer Society screening recommendations

ACS provides separate screening guidelines for women at average risk and high risk of breast cancer.

Mammograms

Mammograms are low-dose x-rays of the breast. Regular mammograms can often find breast changes that could be cancer years before physical symptoms develop.

Results from decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found earlier, are less likely to need aggressive treatments, like surgery to remove the entire breast (mastectomy) and chemotherapy, and are more likely to be cured.

Risks and limitations of mammograms

Mammograms are not perfect, and there are some risks. It's important that people getting mammograms know what to expect and understand the benefits and limitations of screening.

• Discomfort: In order to get the best pictures during the test, you might experience pain or discomfort. Your care team will try to minimize distress during the testing.
• Missed diagnosis: Not all breast cancers are found on screening mammograms. These are called false-negative tests.
• Overdiagnosis: There’s a small chance of being diagnosed with cancer that never would have caused any problems had it not been found during screening.
• False-positives: A false-positive test occurs when an area that was thought to be cancer is actually benign (not cancer). This can result in extra tests, emotional distress, and extra financial costs.

2D vs. 3D mammograms

In recent years, a newer type of mammogram called digital breast tomosynthesis, commonly known as 3D mammography, has become much more common, although it’s not available in all breast imaging centers.

Many studies have found that 3D mammography appears to lower the chance of being called back after screening for follow-up testing. It also appears to find more breast cancers, and several studies have shown it can be helpful in women with dense breasts.

However, 3D mammograms often cost more than 2D mammograms, and this added cost might not be covered by insurance.

The ACS breast cancer screening guidelines recommend both 2D and 3D mammograms. ACS believes that women should be able to choose between 2D and 3D mammography if they or their doctor believes one would be more appropriate, and that out-of-pocket costs should not be a barrier to having either one.

Breast MRI

Breast MRI (magnetic resonance imaging) uses strong magnets instead of radiation to make detailed, cross-sectional pictures of the body. An MRI scanner takes pictures from many angles, as if someone were looking at a slice of your body from the front, from the side, or from above your head. MRI creates pictures of soft tissue parts of the body that would sometimes be hard to see using other imaging tests.

Unlike mammograms or breast ultrasound, breast MRI requires that you have a contrast dye injected into your vein (through an IV line) before the pictures are taken. This helps make any abnormal areas in your breasts easier to see.

Clinical breast exam (CBE) and breast self-exam (BSE)

Breast self-exams or clinical breast exams (done by a health professional) are not sufficient for cancer screening and are unlikely to find breast cancer early in people at average risk of breast cancer.

When breast cancer is detected because of symptoms, such as a lump in the breast, it usually occurs during usual activities such as bathing or dressing.

People should be familiar with how their breasts normally look and feel and should report any changes to a healthcare provider right away.

Breast exams may be appropriate in some situations, particularly for women at higher-than-average risk or those who have a new breast symptom. Healthcare providers might still offer clinical breast exams along with counseling about risk and early detection. And some people might do self-exams to keep track of how their breasts look and feel.

Tools used to assess breast cancer risk

Several risk assessment tools can help estimate a person’s breast cancer risk based on different combinations of risk factors and different data sets.

Because each of these tools uses different factors to estimate risk, they might give different risk estimates for the same person. A person's risk estimates can also change over time.

Risk assessment tools, such as the BRCAPRO tool, that include family history in first-degree relatives (parents, siblings, and children) and second-degree relatives (such as aunts and grandparents) on both sides of the family should be used with the ACS guidelines to decide whether a person is at high risk of breast cancer and should have MRI screening.

Discuss with your healthcare provider whether using a breast cancer risk assessment tool might be helpful for you.