Are Yearly Mammograms Really Necessary
Myth #1: I dont have any symptoms of breast cancer or a family history, so I dont need to worry about having an annual mammogram. Fact: The American College of Radiology recommends annual screening mammograms for all women over 40, regardless of symptoms or family history. Early detection is critical, says Dr.
A Change In Prescription For Monthly Self
In theory, performing your own breast exam should give you an early heads-up that something is amiss. If you have long lived by this belief and practice, youre not alone. For years, doctors and patients alike thought that self-exams gave women the best chance of detecting lumps and preventing the spread of cancer.
Yet in more recent years, multiple reports including one from the U.S. Preventive Services Task Force have pointed to a different reality.
It turns out women who do monthly breast exams at home do not have a higher breast cancer survival rate than women who dont do their own exams. In fact, doing a self-exam is actually associated with its own unique problems.
Women who do monthly self-exams have higher rates of:
Why Are Breast Exams Recommended
Clinical breast examinations can detect lumps or other changes in your breasts that might indicate the need for further testing. Breast exams are one of the most important early screenings for breast cancer. These exams improve the chance of finding breast cancer in the early stages when it is easier to treat.
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Why The Acs No Longer Recommends Breast Self
Breast self-exams have long been framed as a “life-saving habit” that would help people easily detect changes in their breasts that could potentially be cancerous. But research doesn’t support those claims, says Dr. Lindnerâwhich is why the ACS changed their recommendations in 2015. , followed suit in their own recommendations.) “Breast self-exams have never been shown to decrease the mortality of breast cancer,” Dr. Lindner says. ” people die of breast cancer at the same rate whether they do breast self-exams and mammograms, or just skip the self-exam and do mammograms as recommended.”
According to Dr. Lindner, breast self-exams can also cause a lot of unnecessary anxiety. “Doing a monthly breast self-exam while thinking it is your responsibility to catch your own cancer lead to increased anxiety, depression, and fear,” she says. Breast self-exams also increase the chance of finding a lump that isn’t cancer, she adds, which can then lead to going through unnecessary testing, biopsies, and surgeryâall of which are expensive and can add extra stress.
What To Do Instead Of Breast Self
As an alternative, Stevens advocates for breast self-awareness. She says, Instead of promoting this really intensive examination regimen, it’s better to simply try to be in tune with your own body, having a general idea on the baseline look and feel of your breasts. It’s not uncommon for people to have breasts that are lumpy-bumpy, unequal in size, or changing in texture through various times of the month. This also goes for cis and trans men.
This gentler approach is important, Pearlman says, because there is so much fear around breast cancer. Not everyone gets breast cancer, but almost everybody knows someone who has had breast cancer before. This leads people with breasts to be much more proactive about their health sometimes, more proactive than they need to be.
The biggest thing you can do for your chest health is see your doctor every year. Theyll do a breast exam, and actually know what to look for. Stevens encourages people to share their family histories, as that also impacts how soon and how often you should get mammograms. Bring up anything that worries you, she adds. Maybe it’s nothing, but it’s better to get that reassurance than to avoid bringing up an issue that might ultimately be dangerous.
So dont stress out if you havent felt your boobs in a while. We know that doing routinely doesnt change peoples outcomes, says Pearlman. We dont need to be guilting women into thinking they have to find their own breast cancer.
Experts:
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What Are The Risk Factors For Breast Cancer
There are different types of risk factors for breast cancer. Some risk factors are inherent – you can’t change them. Other risk factors are related to lifestyle choices and can be changed. Some factors can put you at higher risk than others and risk factors can change over time. Some of the risk factors that cannot be changed include:
Risk factors that are related to lifestyle choices that can possibly be changed include:
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Not having children – people who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk.
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Oral contraceptive use – studies have found that oral contraceptive users may have a slightly greater risk of breast cancer than those not using them, although the level of risk is still not clear.
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Hormone replacement therapy – most studies suggest that long-term use of hormone replacement therapy after menopause will increase your risk of breast cancer.
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Not breast-feeding – many studies have shown that breast feeding lowers breast cancer risk.
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Alcohol consumption – if you drink 2 to 5 alcoholic beverages a day it can increase the risk of developing breast cancer to 1.5 times the risk of non-drinkers.
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Obesity and high-fat diets – being overweight is associated with an increased risk of developing breast cancer, especially after menopause.
What Are Breast Exams And Why Are They Important
Breast exams are the first-line defense against breast cancer and come in several forms: self-examination, clinical examination, mammogram, ultrasound, and MRI. Using a combination of exams in tandem consistently is the most effective way to detect breast cancer early.
Although having a family history of the disease can increase your risk, you do not have to have a hereditary breast cancer link for it to develop. Seventy percent of all breast cancer cases occur in women with no known family history of the disease. Because of the spontaneous nature of the disease, its crucial that all women learn about the various exams for breasts and when to get them.
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Potential Harms Of Screening
Mammography
False-positive results are common with mammography and can cause anxiety and lead to additional imaging studies and invasive procedures . False-positive results and accompanying additional imaging studies are more common in younger women. Biopsies may occur as a consequence of false-positive mammography results biopsy rates are more common among older women. Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient, and some research suggests that these effects are not a barrier to screening. False-negative results occur at a relatively low rate for all ages, but are slightly higher in women older than 70 years. Other potential harms, such as pain caused by the procedure, exist but are thought to have little effect on mammography use.
Radiation exposure may increase the risk for breast cancer, but usually only at much higher doses than those used in mammography, although regular mammography could contribute to cumulative radiation doses from additional imaging for other reasons 7.
Digital Mammography and Magnetic Resonance Imaging
Clinical Breast Examination
A theoretical harm of CBE is that its lower specificity than that of mammography may result in more women undergoing biopsy. Few data are available to evaluate harms associated with CBE.
Breast Self-Examination
A Visual Check Of Skin And Tissue
During a clinical breast exam, your healthcare provider checks your breasts appearance. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. These postures allow your healthcare provider to look for differences in size or shape between your breasts. The skin covering your breasts is checked for any rash, dimpling, or other abnormal signs. Your nipples may be checked to see if fluid is expressed when lightly squeezed.
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What Are The Three Parts Of Breast Screening That Assist In The Early Diagnosis Of Breast Cancer
Breast self-examination should begin at age 20 and be performed monthly. The breast is usually easiest to examine on the days immediately following the menstrual cycle. BSE can be frustrating to patients, particularly when they have fibrocystic change because they are not certain what they are feeling or supposed to feel. The technique of BSE should be taught early and reinforced regularly. If a palpable tumor develops, women who regularly perform BSE present with tumors 1 cm or smaller more frequently than women who do not perform BSE. Improvement in survival from breast cancer has not been demonstrated, however. Some women should not practice BSE because of the psychological trauma they suffer from repetitive false-positive findings. Those women need to rely on their physician to do a breast examination once or twice a year.
Clinical or physician breast examination also should begin at age 20 and be performed annually for women at average risk for breast cancer. Although tumors between 0.5 cm and 1.0 cm occasionally can be detected by an experienced physician, tumors between 1.0 and 1.5 cm can be detected 60% of the time. As the tumor grows, 96% of tumors larger than 2.0 cm can be identified on physician physical examination. Clinical breast examination should be part of the primary care physician’s health maintenance and screening program.
Mehra Golshan, in, 2009
In Recognition Of Breast Cancer Awareness Month Cedars
For women of a certain age, monthly breast self-exams wereand areas much a part of their health regimens as eating right and exercising often. Conflicting recommendations about the practice from healthcare providers over the years, however, have left many women of all ages confused and wondering whether they should continue the practice.
The simple answer to that question is no if a woman is at average risk for breast cancer, according to a 2009 U.S. Preventive Services Task Force recommendation. The task force advised that clinicians should not be required to teach women how to perform breast self-exams, echoing 2003 guidance from the American Cancer Society. The task force, anindependent, volunteer panel of national experts in disease prevention, left itsrecommendationunchanged in an updated, 2016 breast cancer screening review.
The groups recommendations followed published findings from large studies conducted in 2003 that showed no benefit to self-exams, while also noting potential harm from unnecessary biopsies and a false sense of security when women do not detect small lumps and therefore forgo screening mammograms.
Breast cancer is the most common cancer in American women, except for skin cancers. The American Cancer Society estimates that about281,500 new cases of invasive breast cancer will be diagnosed this year.The average lifetime risk of a woman in the U.S. developing breast cancer is about 13%, or a 1 in 8 chance.
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Benefits Of Mammographic Screening
The ACS systematic review also examined the effect of screening mammography on life expectancy. Although the review concluded that there was high-quality evidence that mammographic screening increases life expectancy by decreasing breast cancer mortality, the authors were not able to estimate the size of the increase 23.
Primary And Adjunctive Screening In Women With Dense Breasts
The USPSTF found insufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
Epidemiology of Dense Breasts
In the United States, the most commonly used classification system for breast density is the American College of Radiologys Breast Imaging Reporting and Data System 4-category scale . Data from the BCSC indicate that about 25 million women aged 40 to 74 years are classified as having heterogeneously or extremely dense breasts. The proportion of women with dense breasts is highest among those aged 40 to 49 years and decreases with age.14
Increased breast density is a risk factor for breast cancer. Data from the BCSC indicate that, compared with women with average breast density, women aged 40 to 49 years with heterogeneously or extremely dense breasts have a relative risk of 1.23 for developing invasive breast cancer. For women aged 50 to 64 years with heterogeneously or extremely dense breasts, the RR is 1.29, and for women aged 65 to 74 years, it is 1.30.7 However, women with dense breasts who develop breast cancer do not have an increased risk for dying from the disease, after adjustment for stage, treatment, method of detection, and other risk factors, according to data from the BCSC.15
Primary Screening Test Performance Characteristics
Primary Screening Frequency
Assessment
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What Is Breast Cancer Screening
CDCs Dr. Lisa Richardson talks about the best time for women to start getting mammograms in this video.
Breast cancer screeningexternal icon means checking a womans breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for youand if so, when to have itthis is called informed and shared decision-making.
Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.
American Cancer Society In A Shift Recommends Fewer Mammograms
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By Denise Grady
One of the most respected and influential groups in the continuing breast-cancer screening debate said on Tuesday that women should begin mammograms later and have them less frequently than it had long advocated.
The American Cancer Society, which has for years taken the most aggressive approach to screening, issued new guidelines on Tuesday, recommending that women with an average risk of breast cancer start having mammograms at 45 and continue once a year until 54, then every other year for as long as they are healthy and likely to live another 10 years.
The organization also said it no longer recommended clinical breast exams, in which doctors or nurses feel for lumps, for women of any age who have had no symptoms of abnormality in the breasts.
Previously, the society recommended mammograms and clinical breast exams every year, starting at 40.
The changes reflect increasing evidence that mammography is imperfect, that it is less useful in younger women, and that it has serious drawbacks, like false-positive results that lead to additional testing, including biopsies.
This year, 231,840 new cases of invasive breast cancer and 40,290 deaths are expected in the United States.
We would all love to avoid diagnosing and treating a breast cancer that doesnt need treatment, Dr. Oeffinger said. But we dont have the tools.
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Harms Of Early Detection And Treatment
Primary Screening With Conventional Mammography
Screening mammography has several potential harms. The most common is a false-positive result, which can lead to psychological harms, as well as additional testing and invasive follow-up procedures. Studies show a fairly consistent association between a false-positive screening mammogram and increased breast cancerspecific distress, anxiety, and apprehension, particularly in women who have an associated procedure, such as fine-needle aspiration or breast biopsy. These effects improve over time for most women.2, 4Table 5summarizes BCSC data on the cumulative probability of a woman receiving at least 1 false-positive mammogram or a recommendation for what turns out to be a false-positive biopsy over a 10-year period.39
Primary Screening With DBT
Currently, DBT is most frequently performed in combination with conventional digital mammography this practice essentially doubles the resulting radiation exposure to the patient. The U.S. Food and Drug Administration has approved a method to generate synthetic reconstructions of 2-dimensional images from 3-dimensional views, which reduces the total radiation dose emitted. However, study data on the performance of DBT in isolation is limited to 1 mammography reading study that compared sensitivity and specificity and 1 prospective clinical trial,42 and the method is not yet thought to be in widespread clinical use.
Adjunctive Screening in Women With Dense Breasts
American Cancer Society Recommendations For The Early Detection Of Breast Cancer
Finding breast cancer early and getting state-of-the-art cancer treatment are two of the most important strategies for preventing deaths from breast cancer. Breast cancer thats found early, when its small and has not spread, is easier to treat successfully. Getting regular screening tests is the most reliable way to find breast cancer early. The American Cancer Society has screening guidelines for women at average risk of breast cancer, and for those at high risk for breast cancer.
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What Happens During A Breast Exam
During a breast exam, your provider is checking your breasts for any signs of possible cancer or other breast problems. They may also talk to you about your risks for breast cancer as well as prevention strategies.
To prepare for the exam, you will be asked to take off your shirt and bra. Your provider will do a visual examination of your breasts to note the size, shape and texture of the skin. They will do a manual exam with the tips of their fingers to check for lumps or anything else that doesn’t feel normal. They will check one breast at a time, including nipples and armpits.