Current Screening Guidelines:
Here are mammogram screening recommendations from four
leading health organizations for women at average risk. Average risk means you
don’t have any family history or other known risk factors that increase your
likelihood of developing breast cancer.
· National Comprehensive Cancer Network (NCCN):
Yearly mammograms should start at age 40.
· U.S. Preventive Services Task Force (USPSTF):
Mammograms every other year from age 40 until age 74.
· American Cancer Society
· Women ages 40 to 44 have the option to start
getting a yearly mammogram.
· Women ages 45 to 54 should get a mammogram every
year.
· Women ages 55 and older can continue getting a mammogram yearly or switch to once every other year. Screening should
continue as long as women are expected to live for at least another 10 years.
· American College of Obstetricians and
Gynecologists (ACOG): Mammograms should start at age 40 and be done once a year
or every other year based on an informed decision made between a woman and her
doctor.
Where to Start: Know Your Risk
The above recommendations are for women who are at average
risk for breast cancer. High-risk screening guidelines may differ. Women at
higher risk may need to start breast cancer screening as early as age 25 and
have yearly magnetic resonance imaging (MRI) of the breasts in addition to
their annual mammogram, according to the American College of Radiology.
You're at higher risk for breast cancer if you have:
- Family members like your mother, sister, or grandmother
who’ve had breast cancer
- Gene mutations such as BRCA1 or BRCA2
- A previous diagnosis of breast cancer
- Radiation treatment to the chest
- Abnormal cells or precancerous growths on a past biopsy of
your breast
- Dense breasts, meaning your breasts contain more glandular
tissue than fat tissue
If you don’t know whether you’re at risk, talk to your
doctor. “All women should have a risk assessment by age 25,” says Berg.
All Screening Options:
1. Clinical Breast Exam
What is it?
An exam where a
doctor or nurse checks your breasts for lumps and other changes.
When is it used?
During routine
checkups with your primary care doctor or ob-gyn, or when you feel something in
your breast.
How is it done?
The doctor or nurse looks for differences in the size,
shape, texture, and color of your breasts. They also feel for lumps or changes
in the breast and under the arms.
Effectiveness: There’s very little evidence that clinical
breast exams help to find breast cancer early in women who also get screening
mammograms, according to the American Cancer Society, which doesn’t recommend
them. Other organizations, like ACOG and the NCCN, recommend these exams every
one to three years.
Benefits: A professional may be able to see and feel
suspicious breast changes that should be checked out on imaging tests.
Risks: There isn’t any risk from the exam itself, but you
could end up having additional tests for something that doesn’t turn out to be
cancer.
2. Mammography
What is it?
A test that uses X-rays to take pictures of the inside of
your breasts.
When is it used?
A mammogram is the
main screening test for breast cancer. Many organizations recommend starting at
age 40 and having mammograms once a year or every other year.
How is it done?
Older two-dimensional (2D) digital mammograms take four
pictures of the breast. Newer three-dimensional (3D) mammograms (also called
chemosynthesis) take numerous thin images of the breast from many angles and
combine them into a more detailed three-dimensional picture. A
contrast-enhanced mammogram uses a contrast dye injected into your vein,
combined with a mammogram.
Effectiveness: Mammograms have a sensitivity of about 87
percent. The 3D mammogram may improve cancer detection and lower the chance
you'll be called back for additional screening, especially for women with dense
breasts.
Benefits: Mammograms are the best way to find breast cancer
early. Regular mammograms reduce the risk of death from breast cancer,
according to the U.S. Centers for Disease Control and Prevention.
Risks: A mammogram exposes you to a small amount of
radiation. Another risk is a false-positive result, where the test might show a
positive result when you don’t actually have cancer.
3.Breast MRI
What is it?
An imaging test that
uses radio waves and strong magnets to take detailed images of the inside of
your breasts.
When is it used?
In addition to mammograms, breast MRI is used once a year for women who are at
high risk for breast cancer.
How is it done?
The MRI takes images of your breasts as you lie facedown on
a table that slides into the MRI machine. You might inject a contrast dye into
a vein to make the images clearer.
Effectiveness: MRI is more accurate than mammograms at
detecting breast cancer, with a sensitivity of more than 90 percent, according
to the American Society of Breast Surgeons.
Benefits: MRI can sometimes find cancers that mammograms may
miss.
Risks: There’s a rare chance of an allergic reaction to the
contrast dye, and the test can have false positive and false negative results.
4. Breast Ultrasound
What is it? A test that uses sound waves (like the sonogram
used during pregnancy) to find breast cancer.
When is it used? Breast ultrasound is used in women younger
than 30 who have breast symptoms, or with mammograms in women ages 30 and older
who are at high risk for breast cancer and can’t have an MRI.
How is it done? A healthcare provider moves a wand called a
transducer over the breast. It sends sound waves that bounce off the tissue
inside the breast and create an image on a monitor.
Effectiveness: Breast ultrasound has a sensitivity of 76
percent, according to a study in the journal Medicine.
Benefits: Breast ultrasound can help detect cancer in women
with dense breasts, especially for those who can’t get an MRI.
Risks: Breast ultrasound doesn’t find as many cancers as MRI
and has many false positives.
5.Other Screening Tests
Thermography: Uses a special camera to detect heat on the
surface of the breast. The FDA cautions that this test should only be used with
a proven screening method like mammography.
Molecular Breast Imaging: A radioactive material is injected
into your vein, which then collects in parts of the breast with abnormal cells.
These areas can be viewed with a special camera. It may improve detection for
women with dense breasts but isn't used often due to higher radiation exposure
compared to a mammogram.
How Do You Know Which Option Is Best for You?
Despite the conflicting guidelines, the evidence supports
the benefits of yearly mammograms. “Start by age 40, and possibly earlier if
you have a family history, a suspected genetic mutation, you had radiation to
your chest at a young age, or you’ve already had breast cancer or a suspicious
growth in your breast,” says Berg. “And if you have dense breasts, seek
additional screening—MRI if you can get it, ultrasound if not.”
The Affordable Care Act requires most health insurers to
cover screening mammograms with no out-of-pocket costs starting at age 40. Most
carriers will also cover mammograms and additional tests like ultrasound or MRI
for women under age 40 who are at high risk for breast cancer.
The Takeaway
The earlier that breast cancer is detected, the better the
chances of beating it. Screening recommendations may differ depending on the
health organization and your personal risk factors. Discuss your options with
your doctor to weigh the risks and benefits and determine the best age and
frequency for starting mammograms.
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