Detecting breast cancer before you see symptoms is important. Screening can help our breast surgeons find and start breast cancer treatments as soon as possible. Breast cancer treatment is more likely to work better when breast cancer is found in the early stages. The concept of screening for breast cancer refers to our attempt to detect breast cancer in women who do not have any symptoms such as pain, a lump, nipple discharge, etc. If a woman does have breast-related symptoms, she is evaluated in more detail in reference to those symptoms.
In general, when we are referring to screening, we are talking about screening mammograms, breast self-examination, and an examination by one of our breast care specialists. Please note that the screening discussions below refer to the woman at average risk. Women with a strong family history of breast cancer will need more aggressive screening, which is discussed in the section under high risk.
Breast Self-Examination (BSE)
Clinical Breast Examination
High Risk Screening
A mammogram is a picture of the breast made with x-rays. Mammograms (as well as other routine x-rays such as dental x-rays) use very small doses of radiation. The risk of any harm is very minor, but repeated x-rays could cause problems. The benefits usually outweigh the risk. Mammograms could show a breast lump before you could be able to feel it. They also might show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Additional tests are required to determine if abnormal cells are present. To discover breast cancer early, it is recommended that:
- Women in their 40s and older should have mammograms every 1 to 2 years
- If you are younger than 40 and have risk factors for breast cancer, ask our breast care specialist if and when you need to have mammograms and how often you should have them
If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to completely know if cancer is present.
Mammograms are the best tool our breast specialists have to detect breast cancer early. But please note that, mammograms are not without fault:
- A mammogram might not detect some cancers which is called a “false negative”
- A mammogram might show things that are not cancer which is called a “false positive”
- Some fast-growing tumors can grow or spread to other areas of the body before being detected by a mammogram
Breast self-examination (BSE)
We believe women should start doing monthly BSE as soon as she develops breasts, and should continue to do it with confidence throughout her life. Menstruating women should do it 7-10 days after their periods (when the breasts are the least engorged and tender). After menopause, it should be done once a month (we usually suggest the first day of every month). Peri-menopausal women should also do monthly examinations, but if they feel as though they are premenstrual (with tender, engorged breasts) at the time of scheduled self-examination, the examination should be postponed a week or two.
Our experience convinces us that women can find breast cancers at a very early stage in their development. In many cases, these are potentially curable cancers that don’t show up on the mammogram or are discovered between routine yearly mammograms. The challenge is for the physician to teach proper self-examination. This is best done at the time of the physical examination, and should be repeated by the patient for several nights in a row until she has a clear mental image of her baseline (normal) breast pattern. Following this, BSE should be done monthly. Any change(s) should be reported to your physician.
Clinical Breast Examination
A comprehensive clinical breast exam can take about 10 minutes. Our breast specialist will check your breast during a clinical breast exam. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Our breast specialist will check for differences in size or shape between your breasts. They will also check the skin of your breasts for a rash, dimpling, or other abnormal signs. The breast care specialist may squeeze your nipples to check for fluid.
Using the pads of the fingers to feel for lumps, our breast care specialist checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Our breast care specialist checks the lymph nodes near the breast to see if they are enlarged.
Approximately 95% of lumps are found by women themselves, and less than 5% are found by a member of the medical team. Unfortunately, most lumps found by women are not found during a routine breast self-examination (they are found incidentally, perhaps while bathing or dressing), so our screening examination can still be lifesaving. We believe that the main role of our breast specialists is to teach the women to do BSE with confidence. Once our physician determines that the breast examination is normal, it becomes an ideal time to teach the woman to do BSE. Once a woman becomes aware of her normal pattern of lumpiness, she can spend the next few days repeating her self-examination until she has a clear mental image of her normal baseline examination.
High Risk Screening
High-risk women include women with a strong family history of breast or ovarian cancer, previous high risk biopsies (such as those with atypia), and women with a previous history of breast cancer.
In these women, Texas Breast Care will provide special counseling and individualized plans of action. One of our many specialties includes specializing in caring for women at high risk of developing a future breast cancer
The concept of screening women with yearly ultrasound is gaining some momentum, but this procedure is not a standard of care, and hence is not covered by most insurances. One of the major problems of mammographic screening is that the mammogram can miss a cancer. This is especially true in the case of dense breast tissue, which is most commonly found in younger women. We are particularly concerned about young, high-risk women with dense breasts. It would be valuable for us to have an inexpensive screening device for this subset of women.
Several test models for have been developed for ultrasound screening, and we are impressed with the progress to date. The major problem has been a high level of false positives. In other words, changes are seen on the ultrasound which are concern, but on biopsy, most turn out to be benign. Until some of these basic problems are resolved, ultrasound will not be available for general/standard use in the community.
The MRI is an excellent tool for the early detection of breast cancer. When an MRI is negative, the chances are about 98% that there is no cancer in the breasts (compared to a negative mammogram, which reflects about an 80% chance of having no cancer in the breasts). The problem with MRI is the high rate of finding areas of concern which, when biopsied, prove to be benign (a high false positive rate). The second problem is cost. An MRI costs thousands of dollars and is only reimbursed by insurance companies in selected high-risk cases, such as a woman with a very strong family history, previous history of breast cancer or high-risk biopsy, or suspected implant rupture.
Women who have MRIs should also have a yearly mammogram since some changes (such as microsopic calcifications) are best detected on the mammogram.