ACS Recommendations for Early Breast Cancer Detection

The ACS recommends the following guidelines for finding breast cancer early in women without symptoms:

Mammogram: Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.

Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away.

If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it’s OK not to do BSE or not to do it on a fixed schedule.

The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.

Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. This might mean starting mammograms when they are younger, having extra screening tests, or having more frequent exams. There are charts called risk assessment tools that your doctor can use to figure out whether or not you are at high risk.

Mammograms

A mammogram is an x-ray of the breast. This test is used to look for breast disease in women who do not appear to have breast problems. It can also be used when women have symptoms such as a lump, skin change, or nipple discharge.

During a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only for a few seconds. Although this may cause some discomfort for a moment, it is needed to get a good picture. Very low levels of radiation are used. While many people are worried about exposure to x-rays, the low level of radiation used for mammograms does not significantly increase the risk of breast cancer. To put dose into perspective, if a woman with breast cancer is treated with radiation, she will receive around 5,000 rads (a term used to measure radiation dose). If she had a mammograms every year from age 40 to age 90, she will have received 20 to 40 rads.

For the mammogram, you undress above the waist. You will have a wrap to cover yourself. A technologist (most often a woman) will position your breast correctly for the test. The pressure lasts only a few seconds while the picture is taken. The whole procedure takes about 20 minutes. You should get your results within 30 days or even sooner.

About 1 in 10 women who get a mammogram will need more pictures taken. But most of these women do not have breast cancer, so don’t be alarmed if this happens to you. Only 2 to 4 of every 1,000 mammograms leads to a diagnosis of cancer.

Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. They may benefit from starting mammograms when they are younger, having them more often, or having other tests. If you are at higher risk, your doctor might recommend an ultrasound or MRI (magnetic resonance imaging) be done along with your mammograms.

Medicare, Medicaid, and most private health plans cover all or part of the cost of this test. And breast cancer testing is available to women without health insurance for free or at very little cost through a special program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Your state’s Department of Health will have information about this program. There is also a new program to help pay for breast cancer treatment for women in need. To learn more about these programs, you can contact the Centers for Disease Control and Prevention at 1-800-CDC INFO (1-800-232-4636) or on the Internet at http://www.cdc.gov/cancer/nbccedp.

Clinical Breast Exam

A clinical breast exam (CBE) is an exam of your breasts by a health expert such as a doctor, nurse practitioner, nurse, or physician assistant. For this exam, you undress from the waist up. The examiner will first look at your breasts for changes in size or shape. Then, using the pads of the fingers, she or he will gently feel your breasts for lumps. The area under both arms will also be examined. This is a good time to learn how to do breast self-exam if you don’t already know how.

Breast Awareness and Breast Self-Exam

Women should be aware of how their breasts normally look and feel and report any changes to their doctor right away. Finding a change does not mean that you have cancer.

By being aware of how your own breasts look and feel, you are likely to notice any changes that might take place. You can also choose to use a step-by-step approach to checking your breasts on a set schedule. The best time to do breast self-examination (BSE) is when your breasts are not tender or swollen. If you find any changes, see your doctor right away.

Women with breast implants can do BSE. It may help to have the surgeon help identify the edges of the implant so that you know what you are feeling. It may be that the implants push out the breast tissue and actually make it easier to examine.

It’s OK for women not to do BSE or to do it once in a while. The American Cancer Society has detailed information on how to do BSE for women who want to do it. See How to Perform a Breast Self-Exam.

MRI (Magnetic Resonance Imaging)

For certain women at high risk for breast cancer, screening MRI is recommended along with a yearly mammogram. It is not generally recommended as a screening tool by itself, as it may miss some cancers that mammograms would find. MRI is also more costly than mammograms. Most major insurance companies will likely pay for a screening MRI if a woman can be shown to be at high risk, but it's not yet clear if all companies will do so. More details about MRI can be found below.

Symptoms of Breast Cancer

While the widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms, some are still missed.

The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded. So it's important to have anything unusual checked by your doctor.

Other signs of breast cancer include the following:

• swelling of all or part of the breast 
• skin irritation or dimpling 
• breast pain 
• nipple pain or the nipple turning inward 
• redness, scaliness, or thickening of the nipple or breast skin 
• a nipple discharge other than breast milk 
• a lump in the underarm area