Breast cancer is the most frequently diagnosed cancer for women in the United States and accounts for nearly one in every three cancers diagnosed. It is also the second leading cause of death in women in the United States.
One in eight women will get breast cancer in her lifetime. Men can get breast cancer, too -- the disease is diagnosed in more than 1,200 U.S. men each year.
Benefits of Breast Cancer Screening
The size of a breast cancer and how far it has spread are the most important factors in predicting the chances of survival for a woman with this disease. Finding breast cancer early improves the likelihood that treatment will be successful.
The goal of breast cancer screening examinations is to identify cancers before they cause symptoms, while they are still small and confined to the breast. A significant number of women who find and treat breast cancer early will be cancer-free after five years.
Breast Cancer Screening Techniques
The three screening tests routinely done for breast cancer are breast self-exam, breast physical exam, and mammography.
Breast awareness and self-examination
Women can notice changes by being aware of how their breasts normally feel, by feeling their breasts for changes (breast awareness), and by using a step-by-step approach to examine their breasts.
Some women find it helpful to maintain a journal with small "maps" or notes of their breast self-exam (BSE) findings. If you choose not to do BSE, you should still be aware of your breasts and report any changes without delay to your doctor.
Clinical breast examination
To perform a clinical breast examination (CBE), a doctor, nurse practitioner, nurse, or doctor's assistant will first look at the breasts for changes in size or shape. Then, using the pads of the fingers, the examiner will gently feel (palpate) your breasts.
Mammography
A mammogram is an x-ray of the breast taken while the breast is pressed between two plates to flatten and spread the tissue. Although this may be uncomfortable, it is necessary to produce a good, "readable" mammogram. The procedure produces an image of the breast tissue that is interpreted by a radiologist.
Screening mammography is used to look for breast disease in women who appear to have no breast problems; a diagnostic mammogram focuses on a particular area of potential concern. Because mammography is imperfect at finding breast cancer, you should have any breast lumps checked by your doctor, even if your mammogram is normal.
About 10 percent of women will require additional mammograms or other imaging studies. Fewer than one in 10 of these women will need a biopsy, and 80 percent of those biopsies will not be cancer.
Other screening techniques
- MRI: For young women with dense breasts and a family history of breast cancer, MRI screening may be recommended.
- Ultrasound breast imaging: Ultrasound of the breast uses high-frequency sound waves to create a detailed computer image of the breast tissue. From this image, a doctor can distinguish between fluid-filled cysts and solid masses to determine the size, shape, texture, and density of a breast lump.
- Fine needle biopsy: A small amount of tissue from a suspect breast lump is removed and examined under a microscope to determine whether cancer is present. If the needle biopsy does show cancer, the full lump must be removed (either with lumpectomy or mastectomy). Learn more about breast biopsy at Duke Raleigh Hospital.
- Digital mammography: Digital mammography uses the same technique as film screen mammography, except that the image is recorded directly into a computer. If there is a suspicious area, your doctors can use the computer to take a closer look. The technique is still being perfected and not yet widely available.
- Ductal lavage: This relatively new technique, sometimes referred to as a “breast pap smear", is used in combination with an imaging study to detect pre-cancerous and cancerous breast cell changes in women who are at high risk for developing breast cancer. Suction is applied to the nipple to bring out fluid from the many little milk ducts that end in the nipple; the fluid is then sent to the laboratory for evaluation under the microscope.
Recommended Screening Schedule for Breast Cancer
Women in their 20s and 30s:
- Self-breast exam monthly
- Clinical breast exam by a health professional every three years
Women age 40 and older:
- Annual breast exam by a health professional
- Annual screening mammogram
Women who may be at increased risk for breast cancer should talk with their doctors about the benefits and limitations of starting mammograms when they are younger, having additional tests (such as breast ultrasound or MRI), or having more frequent exams.
