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Breast Cancer Detection, Screening & Diagnosis

The sooner breast cancer is diagnosed, the better your odds of getting effective treatment. Dr. Carlie K. Thompson answers the most burning questions on breast cancer screening. 

What are the early signs of breast cancer?

In the majority of cases, there are no early signs or symptoms of breast cancer. This is why screening mammography is important because mammograms can detect changes in the breast tissue that are associated with cancer before anything can be seen or felt.

However, if something is going to be seen or felt, the signs and symptoms of breast cancer can include the following:

  • A lump in the breast tissue or under the arm (in the armpit)
  • Nipple discharge, specifically bloody nipple discharge
  • Changes in the shape, color, or texture of the nipple
  • Changes in the contour or shape and size of the breast.

These changes should be brought to the attention of a doctor.

How often should women go to the doctor for a check-up? 

There's some debate about the benefits of breast exams performed by physicians. Studies on the topic suggest that physician breast exams might result in a slightly increased rate of early detection of breast cancers but they also increase the rate of unnecessary biopsies.

Therefore, there aren’t strict guidelines about how often women need to be seen by their doctors for breast exams.

Average risk women should not start screening for breast cancer prior to the age of 40.

However, if a woman is concerned about anything regarding her breasts (i.e. a lump), then she should be seen by a doctor for a breast exam.

Can self-exams be helpful in terms of breast cancer detection?

This topic has been formally studied and the studies have shown that breast self-exams are not an effective breast cancer screening modality. Breast self exams don't find breast cancers earlier and they don't impact the important outcomes that we look at, such as survival from breast cancer.

Additionally, breast self-exams might even do some harm in the form of causing worry and anxiety in women who find abnormalities in their breast tissue and in the form of unnecessary biopsies. Therefore, there's no strong recommendation for women to do routine breast self-exams.

However, it is still important for a woman to be familiar with what her breast tissue looks and feels like because if a concerning change is noted, it should be brought to the attention of her doctor.

How is breast cancer diagnosed? When should women start screening for breast cancer?

Although breast cancer can be diagnosed after a woman or her doctor notices a mass or change in her breast tissue, the majority of cases of breast cancer are diagnosed on breast cancer screening studies, such as mammograms. 

However, it is still important for a woman to be familiar with what her breast tissue looks and feels like because if a concerning change is noted, it should be brought to the attention of her doctor.

The age at which a woman should start undergoing screening for breast cancer depends on her individual risk of developing breast cancer.

If a woman is at particularly high risk, then she may be recommended to start screening earlier in her life and she may benefit from more frequent screening.

However, the majority of women are not at particularly high risk of developing breast cancer. Average risk women should not start screening prior to the age of 40.

Between the ages of 40 and 50, they should decide with their physician when to start screening and how often to be screened based on their individual risk factors and personal preferences.

Between the ages of 50 and 70, all the societies and guidelines agree that women should be screened with mammography every year to two years.

Past the age of 74, women should decide with their physicians whether or not to continue screening based on their other health issues and their personal preferences. 

Is ultrasound helpful in detecting breast cancer?

There are three main types of breast imaging: mammography, breast ultrasound and breast MRI. The primary type of breast imaging that is used for breast cancer screening is mammography, and there is conflicting data regarding whether or not ultrasound is helpful in detecting breast cancer when added to mammography. 

Because of this questionable balance of benefits and harms, we typically reserve breast cancer screening ultrasounds for women who will benefit from them the most, such as high risk women or women with dense breast tissue.

Some studies have found that adding screening ultrasounds to a screening mammogram finds more breast cancers, but a large study published this year found no difference in breast cancer detection rates between mammogram plus ultrasound and mammogram alone. However, what we do know is that “the more you look, the more you find.” When more imaging studies are done, more abnormalities are identified and recommended for follow-up or biopsy. Not all of these abnormalities end up being cancers, so the follow-up imaging and procedures might be unnecessary. 

Because of this questionable balance of benefits and harms, we typically reserve breast cancer screening ultrasounds for women who will benefit from them the most, such as high risk women or women with dense breast tissue. 

How common are breast biopsies? Can a breast biopsy be performed in a woman who has breast implants? 

Breast biopsies are very common procedures. When a suspicious finding is identified on a breast exam or breast imaging, the first steps in the workup are typically to get more imaging of the abnormality and then to perform a percutaneous needle biopsy. This allows us to look at the suspicious tissue under the microscope in order to determine if there are atypical or cancer cells present.   

Needle biopsies are routinely performed in women with breast implants. However, the presence of a breast implant can make a biopsy more difficult if the suspicious lesion is, for example, close to the implant. Rarely, a breast needle biopsy can not be performed due to concern that the biopsy will damage the implant.  

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