Breast cancer screening has come under scrutiny lately. Some studies have raised questions about the value of breast self-examination for certain women. Similarly, a recent, controversial study cited potential risks of screening women under the age of 50. The research found they were more likely to undergo biopsies or be called back for more testing, often unnecessarily.
While scientists search for answers, the American Cancer Society upholds its breast cancer screening guidelines. They suggest regular breast self-examinations as an option for most women beginning in their 20s, and they recommend clinical breast exams, performed by a qualified health-care professional, about every three years for most women throughout their 20s and 30s. After 40, the average woman should get both a clinical breast exam and a mammogram once a year.
But what should a woman do if she finds a lump? And what are the options for women who don’t fit the “average” profile? Breast cancer surgeon Laura Kruper, M.D., assistant professor in City of Hope’s Department of Surgery, provides answers.
EHope: What are the warning signs of breast cancer?
Laura Kruper, M.D.: Unfortunately, there really are no early warning signs of breast cancer. When a woman feels a new lump during her monthly breast self-exam, most are benign, such as cysts or fibroadenomas, but some are not. It takes an experienced professional to know the difference.
EH: What should I do if I find a new lump while performing a breast self-exam?
LK: If you find a new lump, it’s important to know where you are in your monthly cycle; a woman should perform breast self-exams one week after her menstrual cycle ends. If you are still in the middle of your cycle, repeat the examination in one week. If the lump is still present, or if you found it at the end of your cycle, notify your doctor and go in for an appointment to have it evaluated.
EH: Is breast self-examination effective for all women?
LK: I believe all women benefit from self-exams. Regular breast self-exams help ensure women are familiar with the normal look, shape and feel of their breasts, so that they notice any changes. Depending on how dense her breast tissue is, a woman may find breast self-exams more difficult, but she is still her own best ally and knows herself better than anyone when it comes to noticing changes.
EH: What about mammography for women over 40 with dense breasts?
LK: Mammography is still recommended for women with dense breasts. Digital mammography, like we have here at City of Hope, is more sensitive than standard film mammography in this group of women. But that doesn’t mean that a woman should forego having a mammogram if digital mammography is not available. Also, depending on a woman’s relative risk of breast cancer — if family members have had it, for instance — we also might want to use magnetic resonance imagery, or MRI, to be certain we get a clear image. Not all insurance companies will cover MRI for screening purposes only, so a woman may need to discuss the option with her doctor.
EH: What other options do these women have?
LK: Ultrasound scanning of women’s breasts is showing some promise, but it's not included in national screening guidelines. It is a great tool to be used in conjunction with mammography but doesn’t stand alone. It isn’t sensitive enough.
EH: Why should a healthy woman in her 40s who is at low risk for cancer undergo clinical breast exam and mammography? Aren’t regular self-exams enough?
LK: Not every woman will recognize a lump during a breast self-exam, and smaller lumps can be easy to miss. That’s why we perform clinical breast exams, which are very thorough, and mammograms. Mammography can pick up very small cancers, sometimes too small to be detected by examination alone. And the earlier cancer is detected, the less involved the treatment will be.
EH: Doesn’t the health risk from mammography radiation outweigh early-detection benefits for women at low risk of breast cancer?
LK: The risk of developing breast cancer from mammography is very low, and digital mammography has less radiation than standard film mammography. There has been some discussion about doing mammograms less often depending on relative risk, but the current evidence does not yet support changing the screening guidelines. As researchers learn more, we may adapt the guidelines according to the scientific evidence. But for now, we still recommend annual mammograms for women over 40.
The American Cancer Society has more information about early breast cancer detection.