Breast Cancer Screening 101: How to Choose Your Best Options

When it comes to breast cancer detection, sooner is definitely better than later. Screening can find cancers before they’ve had a chance to spread beyond the breast. The benefits of early diagnosis are numerous.

“At an early stage, the cancer is going to be easier to treat, the treatment will be easier to tolerate, and the chance of dying from the cancer will be lower,” says Wendie Berg, MD, PhD, a distinguished professor of radiology at the University of Pittsburgh School of Medicine and the chief scientific adviser to the nonprofit educational website DenseBreast-info.org.

Dr. Berg speaks from experience. Her own breast cancer was caught early enough to be treated with a lumpectomy and a few weeks of radiation. “Everyone deserves that chance, and that’s why having effective screening that finds cancer early is so important,” she says.

But mammogram recommendations from national organizations like the U.S. Preventive Services Task Force (USPSTF), American Cancer Society, and American College of Obstetricians and Gynecologists (ACOG) don’t exactly align when it comes to deciding the age to start mammography, screening frequency, and when to stop.

The differing guidelines can complicate the decision-making process. That’s why it’s important for women to know their breast cancer risks and talk to their primary care doctor or gynecologist about the appropriate screening schedule and methods.

Here are mammogram screening recommendations from four leading health organizations for women at average risk. Average risk means you don’t have any family history or other known risk factors that make you more likely to develop breast cancer.

• National Comprehensive Cancer Network (NCCN) Yearly mammograms should start at age 40.

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• U.S. Preventive Services Task Force (USPSTF) Mammograms every other year from age 40 until age 74.

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• American Cancer Society Women ages 40 to 44 have the option to start getting a yearly mammogram. Women ages 45 to 54 should get a mammogram every year. Women ages 55 and older can continue to get a mammogram every year or switch to once every other year. Screening should continue for as long as women are expected to live for at least another 10 years.

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• ACOG Mammograms should start at age 40 and be done once a year or every other year according to an informed decision made between a woman and her doctor.

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• Family members like your mother, sister, or grandmother who’ve had breast cancer
• Gene mutations such as BRCA1 or BRCA2
• A previous diagnosis of breast cancer
• Radiation treatment to the chest
• Abnormal cells or precancerous growths on a past biopsy of your breast
• Dense breasts, meaning your breasts contain more glandular tissue than fat tissue.

If you don’t know whether you’re at risk, talk to your doctor. “All women should have a risk assessment by age 25,” says Berg.

Next, you need to know your screening options.

Clinical Breast Exam

What is it? An exam where a doctor or nurse checks your breasts for lumps and other changes.

When is it used? During routine checkups with your primary care doctor or ob-gyn, or when you feel something in your breast.

How is it done? The doctor or nurse looks for differences in the size, shape, texture, and color of your breasts. They also feel for lumps or changes in the breast and under the arms.

“It’s hard to recommend clinical breast exams because there aren’t a lot of trained personnel to do them, and any benefit is very small,” says Berg.

Benefits A professional may be able to see and feel suspicious breast changes that should be checked out on imaging tests.

Risks There isn’t any risk from the exam itself, but you could end up having additional tests for something that doesn’t turn out to be cancer.

What is it? A test that uses X-rays to take pictures of the inside of your breasts.

When is it used? Mammogram is the main screening test for breast cancer. Many organizations recommend starting at age 40 and having mammograms once a year or every other year.

How is it done? Older two-dimensional (2D) digital mammograms take four pictures of the breast. Newer three-dimensional (3D) mammograms (also called tomosynthesis) take numerous thin images of the breast from many angles and combine them into a more detailed three-dimensional picture.

A contrast-enhanced mammogram is a newer version of this test that uses a contrast dye injected into your vein, combined with a mammogram. “We can see cancers just like we’d see them on an MRI,” says Berg. “It’s a much more accurate result than a regular mammogram.”

Because the contrast-enhanced mammogram isn’t FDA-approved, it is only used “off-label” (meaning it’s used for a different purpose than what the FDA approved), or for diagnosing women who have breast cancer symptoms, abnormalities that need further testing, or a history of breast cancer.

Risks A mammogram exposes you to a small amount of radiation. Another risk is that the test might show a positive result when you don’t actually have cancer. Doctors call this a false-positive result.

Benefits MRI can sometimes find cancers that mammogram may miss.

What is it? A test that uses sound waves (like the sonogram used during pregnancy) to find breast cancer.

How is it done? A healthcare provider moves a wand called a transducer over the breast. It sends out sound waves that bounce off the tissue inside the breast and create an image on a monitor.

Benefits Breast ultrasound can be helpful for detecting cancer in women with dense breasts, especially for those who can’t get an MRI.

Risks Breast ultrasound doesn’t find as many cancers as MRI, says Berg, and notes that it also has many false positives.

Thermography

Molecular Breast Imaging

Despite the conflicting guidelines, Berg says the evidence points to the benefits of yearly mammograms. “Start by age 40, and possibly earlier if you have a family history, there’s a suspected genetic mutation in your family, you had radiation to your chest at a young age, or you’ve already had breast cancer or a suspicious growth in your breast,” she says. “And if you have dense breasts, seek additional screening — MRI if you can get it, ultrasound if not.”

The Takeaway

The earlier that breast cancer is detected, the better the chances of beating it. Screening recommendations may differ depending on the health organization and your personal risk factors. Have a conversation with your doctor about your options. Together you can weigh screening risks and benefits to figure out the best age for you to start getting mammograms, and the right frequency.