SCREENING  &  DIAGNOSTICS

Breast cancer takes years to develop. Early in the disease, most cancers of the breast cause no symptoms. When breast cancer is detected in the localized stage without spread to lymph nodes, the five year survival rate is 97%. If the cancer has spread regionally to axillary (underarm) lymph nodes the rate drops to 76%. If distant metastasis (spread) to other organs such as the lungs, bone marrow, liver, or brain is present, the five year survival rate is 20%.
Screening mammography is an x-ray examination of the breast in a woman who is asymptomatic (has no breast complaints).  The goal of screening mammography is to detect cancer when it is still too small to be felt by her physician or the woman. Early detection of small breast cancers by screening mammography greatly improves a women's chances for successful treatment.

Breast cancer
This image is showing a  color-enhanced X-ray mammogram of a female breast in side view, showing cancer. The breast is orange at center; its' connective tissue and milk ducts make it appear fibrous. A cancerous tumor is seen within the breast as a yellow core with radiating contours of color. At far right are ribs (blue) of the ribcage. Breast cancer is the most common cancer in women. Most deaths from breast cancer occur when the cancer is not detected early enough and it spreads to other parts of the body. Mammography is a special X-ray technique used to visualize soft tissues of the breast as a means of screening women for breast cancer, and to detect tumors at an early stage.

Screening mammography usually involves two views (x-ray pictures) of each breast. For some patients, additional pictures may be needed at screening to include as much breast tissue as possible.

The American Cancer Society Board of Directors voted on March 23,1997 to change the Society's breast cancer detection guidelines to include yearly screening mammography for all women 40 years of age and older. The Society's decision was based on the following evidence:

  • 1 in 66 women in their forties will develop breast cancer. About 18% of all breast cancers occur in women in their forties. 13% of the 44,000 women expected to die of breast cancer during 1997 will be in their forties.

     

  • Results from the most recent meta-analysis (a compilation of many studies) of all 8 randomized clinical trials found 17% fewer deaths from breast cancer among women in their forties who had mammography.

     

  • Results from two individual randomized clinical trials in Sweden found fewer deaths from breast cancer in women in their forties undergoing screening mammography. In one study, breast cancer deaths in this age group were reduced by 44%, in the other study they were reduced by 36%.

     

  • Breast cancers found by mammographic screening of women in their forties were smaller and at an earlier stage (with less spread to lymph nodes or other organs) than cancers found in women not having mammography.

     

The American Cancer Society believes that the benefits of yearly mammography for women in their forties and older outweigh the impact of occasional false positive results leading to biopsy of noncancerous abnormalities, and the economic cost of these examinations. The exposure of radiation has been previously suggested as a disadvantage, but the low dose of radiation from modern mammography is not felt to pose a significant risk.

Because mammography cannot find 100% of breast cancers, the American Cancer Society recommends use of three tests for breast cancer detection in asymptomatic women - mammography, clinical breast exams by a physician or other health care professional, and breast self examination (BSE).

The American Cancer Society guidelines for the detection of breast cancer in asymptomatic women are:

  • Women 20 years of age and older should perform breast self-examination every month.

  • Women 20-39 should have a physical examination of the breast every three years, performed by health care professional such as a physician, physician assistant, nurse or nurse practitioner.

  • Women 40 and older should have a physical examination of the breast every year, performed by a health care professional, such as a physician, physician assistant, nurse or nurse practitioner.

  • Women 40 years of age and older should have a mammogram every year.

These guidelines apply only to women at usual risk for breast cancer, who have no symptoms of breast cancer. Women with certain risk factors, such as a family history of breast cancer should discuss their risk factors with their doctor. In some cases, mammography may be started before age 40 and a more vigilant schedule of early detection tests may be appropriate. For example, doctors suggest starting mammography before age 40 for women whose genetic testing results show changes in breast cancer susceptibility genes (BRCA1 and/or BRCA2).

Diagnostic Mammogram

This is an x-ray of the breast used to diagnose unusual breast changes such as a lump, pain, nipple thickening, or discharge or a change in breast size or shape.

Prep for Mammography

Avoid the use of powder, deodorant, and perfumes on the day of your examination. If there is or has been breast tenderness, notify the tech prior to the exam.

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