Breast Cancer Screening

If you are confused by what you’ve read about breast cancer screening lately you’re not alone. So, let’s look at what research says, and explore what a false positive test result from mammogram may mean for you.

Checking for Changes

The American Cancer Society (ACS) no longer recommends breast self-exams, but they do advise that you be familiar with your breasts and watch for changes in your 20s. Take note of how your breasts and nipples look and feel: Do you see anything new or different? Any painful spots, rashes, puckering or swelling? Any discharge from your nipples?

You should do a breast check around the same time each month, and many women use the end of their periods to remind them to do a check. The goal is to watch for changes and report any you may find to your healthcare provider.

Get a Mammogram

Mammography remains the main imaging resource to detect early breast cancer before it causes symptoms. For a long time experts have advised that women begin mammography at age 40, and have one every year. However, in the last several years, some groups have issued various recommendations on the age to begin mammograms as well as if annual or every other year screening is best.

The ACS recommends women at average risk for breast cancer begin mammograms at age 45, and the American College of Obstetricians and Gynecologists (ACOG) recommends initial mammography at age 40. Both recommend annual screening. The ACS says to continue as long as a woman is in good health and expected to live 10 or more years; ACOG says a woman should make a decision with her physician about how long to continue mammograms. The US Preventive Services Task Force recommends screening to begin at age 50 and to continue every two years until age 74. Their advice is based on the fact that most breast cancer is found in women ages 50 and older and their concerns about potential harms caused by false positive screens in younger women.

If you’ve been told by your healthcare provider that you’re at high risk for breast cancer—say for example, you have the BRCA1 or BRCA2 gene mutation that causes an increased risk for breast cancer— the ACS recommends you have an annual mammogram and breast MRI starting at age 30, or the age your healthcare provider recommends. When it comes to screening, mammograms aren’t your only option; talk with your healthcare provider about what’s best for you. Breast ultrasound is often used along with mammograms to evaluate a suspected mass, but it shouldn’t be used as primary screening by itself, say experts at the ACS.

Breast MRI is used primarily in women diagnosed with breast cancer to search for other sites of the cancer or to measure the size of the cancer. It’s also not recommended as a screening tool by itself, even for women at high risk for breast cancer, and may not detect cancers that a mammogram will. In fact, it may increase the false positive rate by raising suspicions around a non-cancerous mass, for example.

New technologies such as thermal imaging, molecular breast imaging, and positron emission imaging need more study before we can be certain of their usefulness in detecting cancer.

False Positives

Have you ever had a “false positive,” a suspected mass or tumor that turned out not to be cancer (benign)? In 2012, the Journal of the National Cancer Institute published research that suggests that if you’ve ever had a false positive result with a mammogram, your breast cancer rates may be higher than other women. That’s because having suspicious patterns in your breast tissue may increase long-term risks for developing a cancer (malignancy). If this happened on your first mammogram, you’re risk is not as high as if it occurred on a later or on more than one mammogram. If you’ve had a false positive test result, it’s more important than ever to be vigilant in getting screened for breast cancer.