Breast Cancer Screening Guidelines

Screening Methods Including Mammograms

Technician explains mammogram to patient


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Breast cancer is the most common type of cancer in women other than skin cancer. It is a disease in which malignant cancer cells form in the tissues of the breast. Screening tests can help find breast cancer in people who are at average risk and don't have symptoms of breast cancer. When found and treated early, the chances of recovery and survival are higher.

Approximately 1 in 8 women in the United States will develop breast cancer over the course of their lifetime. Male breast cancer has a lifetime risk of approximately 1 in 883. Certain risk factors such as family history, age, previous breast cancer diagnosis, dense breasts, and more may increase a person’s risk of developing breast cancer.

Who Should Be Screened?

Breast cancer screening is important even when you feel healthy.  Early breast cancer detection is important—the earlier breast cancer is found, the more easily it can be treated.

Guidelines for when to start getting breast cancer screening—including the type of screening test and frequency—vary depending on a person’s age and risk factors.

Women who have an average risk of breast cancer should start having a discussion with their healthcare provider at age 40 about when to start screening. Leading organizations have slightly varying guidelines regarding when and how often to screen for breast cancer.

For women who are at average risk for developing breast cancer, the American Cancer Society recommends the following guidelines:

  • Women ages 40-44: Should have the option to begin annual breast cancer screening with mammograms if they wish to do so or are at higher risk of developing the disease. 
  • Women age 45-54: Recommended to get a mammogram once a year
  • Women 55 and older: Recommended to get a mammogram every two years, or continue yearly screening if at high risk or the individual chooses to do so. 

Screening guidelines may be different for a person who has risk factors such as a BRCA1 or BRCA2 genetic mutation,. Make sure your provider is aware of any particular risk factors you have so they can determine your screening guidelines.

Risk estimating tools can be used by healthcare providers to determine lifetime risk based on various risk factors, including a family history of breast or ovarian cancer, personal history of breast cancer, use of hormone replacement therapy, Ashkenazi Jewish inheritance, genetic testing, radiation therapy to the chest between the ages of 10 and 30 years, amongst others.

If someone in your family had breast cancer or you have a history of breast cancer, your doctor may recommend that you start getting screened earlier than average guidelines.

Mammogram 

A mammogram is the most common screening test used for breast cancer. A mammogram is an X-ray of the breast. This test can often detect tumors that are too small for you to feel in your breast.

During a mammogram, a technologist will place your breast on a plastic plate, and firmly press another plate on your breast from above. With your breasts flattened, the machine will take images from various angles of your breast. 

Breast density is mandated to be reported on the mammogram report in many states and additional screening modalities such as whole breast ultrasound or breast MRI may be used in addition to screening mammograms if dense breasts are noted.

A screening mammogram is not a guarantee that breast cancer will be found early. The American Society of Clinical Oncology notes that faster-growing cancers are often found through breast examinations between regular mammograms, while mammography detects smaller cancers.

Magnetic Resonance Imaging (MRI) 

Magnetic resonance imaging (MRI) is not used in average-risk women for screening because the breasts may appear abnormal on an MRI test even when there is no cancer. MRI is used as a screening test for those who are at high risk for breast cancer.

MRI is not a substitute for mammograms for high-risk women who meet the criteria for MRI screening. It is done in addition to mammograms.

Physical Exam

A breast physical exam involves careful examination of the breasts manually. An individual can do this themselves, or it may be conducted by a doctor or other healthcare professional.

While they used to be recommended, breast exams are now considered optional as they have not been shown to reduce the risk of dying of breast cancer.

Self Exam

Many people are able to find abnormal lumps in the breast themselves. The American Cancer Society notes that you should be aware of how your breasts look and feel and report any changes to your healthcare provider.

Performing a regular self-examination is optional. Use your hands and eyes to detect any changes or abnormalities in your breasts. If you do a monthly self-exam, it is best to do it about three to five days after your period, because your breasts might be tender or lumpy during and before your period.

Office Exam

A clinical manual breast exam—which involves examining the breasts and underarm area—can help find lumps in the breast that a person may miss during their own self-exams. Sometimes it can be difficult to detect abnormalities in the breast, and a trained healthcare professional who has experience in recognizing lumps and breast tissue thickening can often recognize concerning issues.

The healthcare provider will look for changes and differences in the shape of breasts, differences in skin color and texture in the breasts, rashes, visible lumps, fluid or discharge leaking from the nipple, and tenderness and pain. They will also feel the lymph nodes in the underarm area to check for any hardening or lumps. 

Ultrasound

Breast ultrasound is an imaging test that uses sound waves to look at the tissue inside of your breasts. According to Johns Hopkins Medicine, a breast ultrasound is typically conducted when a change has been detected on the mammogram or a problem is felt by physical examination of the breast.

They are also often done on people who have dense breast tissue, are 25 or younger, or are pregnant, as ultrasound does not use radiation (mammography does). Ultrasound can also help your healthcare provider see how well blood is flowing throughout your breasts.

Thermography

Thermography—sometimes referred to as thermal imaging—uses a special camera to measure the skin’s temperature on the surface of the breast. It is non-invasive and uses no radiation. The theory is that if cancer is growing in the breast, blood flow and metabolism increase, which increases the skin temperature.

Though it has been in existence for several decades, there is no evidence proving thermography as a good screening tool for breast cancer. In February 2019, the U.S. Food and Drug Administration (FDA) stated that thermography is not a safe substitute for a mammogram.

Tissue Sampling

If noninvasive breast cancer screening tests indicate that you might have breast cancer, you will need to have a biopsy, sometimes referred to as tissue sampling.

Breast tissue sampling involves removing cells from breast tissue in the suspicious area so that a pathologist can examine it under a microscope to see if the sampled cells are cancerous. It takes a few days to find out the results of a biopsy/tissue sampling. 

Test Results

After your screening tests have been completed and results have been evaluated by healthcare professionals, your doctor will review these results with you. If your test results are abnormal, additional testing may be required.

Follow-ups After Abnormal Result

If your breast cancer screening has detected abnormal results, further diagnostic tests may be ordered. Many people undergo one or more of the aforementioned diagnostic tests in order for healthcare professionals to make an accurate assessment of whether or not cancer is present.

If you get a breast cancer diagnosis, many tests are used before and during treatment to monitor how well your body is responding to the therapies. Monitoring tests may also be ordered to check for any signs of recurrence. 

Fewer women are dying of breast cancer in the United States than ever before. In fact, nearly 4 million women are breast cancer survivors in the U.S. today.

Possible contributing factors include screening, early detection, and better treatments.

A Word From Verywell

Researchers are always seeking out new methods of screening for breast cancer. Clinical trials are currently underway comparing new screening methods with existing screening tools such as mammograms, and for certain populations (such as people who have not gone through menopause).

When it comes to breast health, it is important to be aware of any changes in your breasts and undergo regular screenings as recommended by your healthcare professional.

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Article Sources
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  8. U.S. Food & Drug Administration.  FDA warns thermography should not be used in place of mammography to detect, diagnose, or screen for breast cancer: FDA Safety Communication. Updated February 2019.

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