Breast Cancer Awareness Month

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Breast Cancer Screening

written by Skye Kalil Written by Skye Kalil
Skye Kalil

Skye Kalil

Skye likes writing about mental health, nutrition, and wellness. She is passionate about sharing information that will educate, and positively affect people's lives.

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reviewBy Reviewed by: Linda Anegawa MD, FACP
Reviewer

Linda Anegawa MD, FACP

Dr. Anegawa graduated from the Univ. of Pennsylvania School of Medicine and completed residency at Stanford. She has over 20 years of practice experience and specializes in Internal Medicine and Obesity Medicine.

October 26, 2021 Read Time - 10 minutes

What Is Breast Cancer Screening?

Breast cancer screenings are tests before there are signs or symptoms of any disease. Breast cancer screenings do not prevent cancer, but can make cancer easier to treat when it is detected earlier. Breast cancer is the most commonly diagnosed cancer for women in the United States, and is the second leading cause of cancer death in American women. 

While regular breast cancer screenings reduce breast cancer mortality in average-risk women,, they can have negative effects like false-positive test results and overdiagnosis of benign lesions. Regardless, all women should understand their options and be informed by their physician about the risks and benefits of breast cancer screening. Through informed and shared decision-making, you and your doctor can work together to decide when screenings are necessary. 

Breast cancer screenings are typically done using the following tests: 

  • Mammogram: A mammogram is an X-ray of the breast. Having regular screening mammograms can lower the risk of dying from breast cancer. 
  • Breast magnetic resonance imaging (MRI): A breast MRI uses magnets and radio waves to take pictures of the breast.
  • Clinical breast exam: A clinical breast exam is a breast exam done by a doctor or nurse who uses their hands to feel for lumps.
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Breast Cancer Screening Guidelines and Recommendations

There are slightly conflicting guidelines and recommendations published by the leading experts in the field of breast cancer prevention. The major consensus groups offering guidelines are:

  • The National Comprehensive Cancer Network
  • The American College of Obstetricians and Gynecologists
  • U.S. Preventive Services Task Force
  • The American Cancer Society

Among these major consensus groups, notable differences in recommendations include:

  • What age to start screening
  • What age to stop screening
  • How frequently to recommend mammography screening in average-risk women

According to the American Cancer Society Guidelines for the Early Detection of Cancer, the general recommendations are: 

  • Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
  • Women ages 45 to 54 should get mammograms every year.
  • Women ages 55 and older should switch to mammograms every two years or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live ten more years or longer.
  •  All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. 

When to Start Breast Cancer Screening

The most important factor to consider for when to start breast cancer screening is your risk factors. 

For average risk women, The National Comprehensive Cancer Network recommends:

  • Women should be offered screening mammography starting at age 40 years, but not before. 
  • If women choose not to start in their 40s, they should begin screening mammography no later than age 50. 
  • The decision about the age to begin mammography screening should be made through a shared decision-making process between patients and their physicians. This discussion should include information about the potential benefits and harms.

If you are at high risk and have a parent, sibling, or child with breast cancer, you may benefit more than average-risk women from beginning screening in your 40s, or from multiple different types of screening tests. Talk to your doctor about the benefits and risks. 

How Often Should You Get Breast Cancer Screening?

How often you should get breast cancer screening depends primarily on your age, and risk factors. 

For average risk women aged 50 and up, The National Comprehensive Cancer Network recommends:

  • Women should have a screening mammography either every one or two years. 
  • The frequency of testing should be based on an informed, shared decision-making process with their doctor that includes a discussion of the benefits and harms of annual and biennial screening and incorporates patient values and preferences. 
  • Biennial screening mammography, particularly after age 55 years, is a reasonable option to reduce the frequency of harm. Patient counseling includes a discussion that with decreased screening comes some reduction in benefits.

Mammogram Benefits and Risks

Like all tests, mammograms have benefits and risks. The goal of screening mammograms is to detect preclinical disease in healthy, asymptomatic patients. Detecting cancer early can prevent adverse outcomes, improve survival, and avoid the need for more intensive treatments. It has been proven that screening tests have benefits, and have improved health outcomes for patients. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. However, there are also adverse side effects that can result from screening mammograms. 

According to The American College of Obstetricians and Gynecologists, some of the adverse consequences of screening mammograms are:

  • False-Positive Test Results: False-positive test results from mammography include callbacks for additional images and follow-up biopsies that are found to be benign. 
  • Anxiety and Distress: Women who received clear communication of negative test results reported minimal anxiety, whereas those called back for further testing reported increased anxiety, breast cancer-specific worry, and emotional distress.  False-positive test results also have financial costs, which often need to be paid all or in part by the patient.
  • Discomfort During Procedures: Many women reported pain during mammography; however, few considered it a deterrent to future screening. False positive mammography results however can lead to painful biopsies, as well as the risk of bleeding and infection.
  • Overdiagnosis and Overtreatment: Overdiagnosis occurs when screening detects cancer that would not have progressed to symptomatic or life-threatening cancer if left undetected. Overtreatment is defined as the initiation of treatment for an overdiagnosed cancer. 
  • Radiation Exposure: While the U.S. Preventive Services Task Force systematic review has found no direct studies of radiation exposure from mammography, a modeling study estimated that the number of deaths caused by mammography radiation-induced cancer was 2 per 100,000 among women aged 50–59 years screened biennially, and 11 per 100,000 among women aged 40–49 years screened annually.

Breast Cancer Risk Factors

According to The Centers for Disease Control and Prevention (CDC), there are risk factors for breast cancer that you cannot change, and those that you can. These risk factors include: 

Risk Factors You Cannot Change

  • Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
  • Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
  • Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
  • Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to be diagnosed with  breast cancer.
  • Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
  • Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
  • Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
  • Women who took the drug diethylstilbestrol (DES). DES was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Risk Factors You Can Change

  • Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
  • Being overweight or having obesity  after menopause. Older women who carry excess weight have a higher risk of getting breast cancer than those at healthier weights.
  • Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.
  • Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
  • Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

Breast Cancer Prevention

Breast cancer prevention can be enhanced by lifestyle factors, but some risk factors cannot be avoided such as inheriting specific genes. 

According to the Mayo Clinic, breast cancer prevention through lifestyle options include: 

  • Limit alcohol. The more alcohol you drink, the greater your risk of developing breast cancer. Based on research on the effect of alcohol on breast cancer risk, the general recommendation is to limit yourself to no more than one drink a day, as even small amounts increase risk.
  • Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If your weight is impacting your health, ask your doctor about strategies for weight loss
  • Be physically active. Physical activity can help you maintain a healthy weight, which helps prevent breast cancer. Most healthy adults should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly, plus strength training at least twice a week. If you are not active currently, starting with even just 10 minutes a day of activity can begin a healthy habit that you can grow over time.
  • Breast-feed. Breast-feeding might play a role in breast cancer prevention. The longer you breastfeed, the greater the protective effect.
  • Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the risks and benefits of hormone therapy. You might be able to manage your symptoms with non-hormonal therapies and medications. If you decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose that works for you and continue to have your doctor monitor the length of time you’re taking hormones.

It is also recommended that you are familiar with your body, and be vigilant about reporting any changes in your breasts. If you notice a new lump, change in the size or shape of a breast, or nipple or skin changes, consult your doctor. Also, ask your doctor when to begin mammograms and other screenings based on your personal history.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

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Talk to Your Doctor About Breast Cancer Screening Tests

Talking to your doctor about breast cancer screenings is the best way to plan for your future. Besides self-checking your own breasts for any changes, inconsistencies, or lumps, planning a formal check is also important.

PlushCare offers virtual health care through our online appointments with board-certified doctors. Each of our online doctors is trained at the top 50 U.S. medical schools, and has an average of 15 years of experience. Our online physicians are highly skilled, experienced, and can give you the peace of mind you are seeking. 

Our doctors can advise you on what to do if you have questions, let you know if something is abnormal and needs medical attention, and refer you for screening tests such as a mammogram in your area. 

Click here to make an appointment with an online doctor. 


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Sources:

PlushCare is dedicated to providing you with accurate and trustworthy health information.

Breast Cancer Risk Assessment and Screening in Average-Risk Women. American College of Obstetricians and Gynecologists (ACOG). Accessed October 14, 2021. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women

Løberg M, Lousdal ML, Bretthauer M, Kalager M. Benefits and harms of mammography screening. Breast Cancer Res. 2015;17(1):63. Accessed October 14, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415291/

What Are the Risk Factors for Breast Cancer?. Centers for Disease Control and Prevention. Accessed October 14, 2021. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm 

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