Breast Cancer in Women: Early Detection

Why is it important to find breast cancer early?

Breast cancer is the second most common cancer in women in the US. It is also a leading cause of death from cancer. With regular checks of the breast, most cancers can be found at an early stage, before they spread to other parts of the body. When breast cancer is found early it can often be cured.

Any woman can get breast cancer. A family history of breast cancer increases your risk, but most women who get breast cancer have no family history of it. All women should follow the recommended screening guidelines so cancer can be caught and treated early.

What are the best ways to detect breast cancer early?

You can do 3 things:

• Do self-exams of your breasts.
• Have regular medical checkups that include a check of your breasts by your healthcare provider.
• Have regular mammograms according to your provider's recommendations.

Some women who have a very high risk of breast cancer may also need to be screened with magnetic resonance imaging (MRI).

Breast self-exam

Breast self-exams are not as strongly recommended as they used to be. Researchers have found that they are not as helpful as was thought. However, it can be helpful for you to know what is normal for your breasts. Then it may be easier to notice changes that should be reported to your healthcare provider, especially between regular mammograms.

Breast self-exams may be done as often as once a month. If you are still having periods, the best time to do the exam is a few days after your period.

If you are not sure about how to do the exam, ask your healthcare provider to give you information or to show you how to do it.

If you notice any of the following changes in your breast, see your provider right away for an exam:

• You have a lump of any size. Usually the lump is firm and not tender.
• Your nipple is painful or it turns into the breast.
• You have new wrinkling or dimpling of the skin.
• The nipple and surrounding skin is red or has a scaly rash.
• You have a discharge of fluid from the nipple (other than breast milk if you are breast-feeding).

Exams by your healthcare provider

Have a breast exam by your healthcare provider at least every 3 years if you are 20 to 39 years old and every year after the age of 40. Your provider can find lumps the size of a pea-- smaller than you are likely to find on your own. In addition, a trained examiner can find lumps in areas that are hard for a mammogram to find, such as deep under the breast, near the chest wall.

Mammograms

A mammogram is a special X-ray of the breast. It can show abnormal areas that are too small to feel, so it is an excellent way to screen for early breast cancer. Mammograms find most breast cancers, but they do not find all cancers. Breast self-exams and physical exams by your provider may find cancers not found with a mammogram. The exams may also find cancers that develop between mammograms.

Breast cancer screening guidelines released by the US Preventive Services Task Force (USPSTF) in 2009 recommend a mammogram every 2 years for women 50 to 74 years old. This recommendation is for women of average risk. Not every medical organization agrees with this recommendation and it is being reviewed. The American Cancer Society recommends that women with an average risk should start getting a mammogram at age 40 and then have one every year.

Depending on your personal and family history, your provider may recommend a different screening schedule. Some women with a high risk of breast cancer may need to start screening earlier than age 40 and may need to be screened more often. If you have a risk for breast cancer that is much higher than average and you are 25 years old or older, ask your healthcare provider when you should start having mammograms and how often you should have them. If you have a very high risk, you may want to see a breast specialist.

Magnetic resonance imaging (MRI)

MRI is another way to screen for breast cancer. It may done in addition to mammograms, since neither method alone can find all breast cancers.

You may need an MRI if your risk for breast cancer is very high because you:

• Have a change (mutation) in a gene that makes it more likely you will have breast cancer (the gene is called BRCA1 or BRCA2).
• Have a parent, sister, daughter, brother, or son with the BRCA mutation.
• Have had radiation to the chest for a medical problem.
• Have a history of breast cancer.

You may also need an MRI for screening if you have dense breasts, which can affect the accuracy of mammogram results.

If you are unsure if any of these problems apply to you, ask your healthcare provider if you need a breast MRI.

If you are told that your mammogram is abnormal or that there are changes from your last mammogram, don’t panic. Very often it turns out to be just normal tissue, but you will need to have it checked. This may be done with more mammograms, ultrasound, MRI, or a needle biopsy. The choice of follow-up tests depends on the type, size and location of the abnormal area. Discuss these choices and what is best for your situation with your healthcare provider.

Remember, early detection is your best defense against cancer.