Breast Cancer Screening

Breast cancer happens when cells that are not normal grow in one or both of your breasts. Screening tests can help find breast cancer early. They can find some cancers that are too small to feel or before they cause other symptoms. Breast cancer may be easier to treat when it's found early.

Having concerns about breast cancer is common. That's why it's important to talk with your doctor about when to start and how often to get screened for breast cancer.

Mammograms are the best screening test for people at average risk of breast cancer. But experts don't all agree on the age at which screening should start. And they don't agree on whether it's better to be screened every year or every two years.

Here are some of the recommendations from experts: ^{1 2 3 4}

• Start at age 40 and have a mammogram every 1 or 2 years.
• Start at age 45 and have a mammogram each year.
• Start at age 50 and have a mammogram every 1 or 2 years.

For transwomen (MTF), discuss screening with your doctor if you are 40 years or older with other risk factors for breast cancer or past or current hormone use for longer than 5 years. For transmen (FTM) with intact breasts, have the same routine screening as people assigned female at birth (AFB). If you are post-mastectomy, yearly chest wall and axillary exams are recommended. Other factors may also be used to determine your screening needs. Talk to your doctor for guidance.

When to stop having mammograms is another decision. You and your doctor can decide on the right age to start and stop screening based on your personal preferences and overall health.

Why should you get screened?

Screening tests can find breast cancer early, before you have symptoms like a lump. When breast cancer is found early, it may be easier to treat. And finding it early helps reduce the risk of dying from breast cancer.

What are the risks of screening?

Screening helps find breast cancer early. This can help save lives. But screening also has some possible risks.

• Screening may give false-positive results. This means the test seems to find cancer even though no cancer is there. This may lead to more tests or a biopsy to make sure you don't have cancer. False-positive results can lead to distress and unneeded tests.
• Screening may find types of breast cancer that would never cause symptoms or be life-threatening.There are some cancers that never cause harm. But doctors can't always tell which cancer will cause problems and which won't. This means that you could have tests and cancer treatments that you don't need. These could cause serious side effects and be costly and stressful.
• Sometimes screening gives false-negative results. This means the test misses breast cancer that is there. This could delay your getting treatment.
• Like all X-rays, mammograms expose you to a small amount of radiation.The amount from mammograms is very small. For most people, the benefits of regular mammograms far outweigh the low risk from radiation.

Your doctor can help you compare the benefits of screening to the possible risks.

What are the screening tests?

Tests used to screen for breast cancer include:

• Mammogram. A mammogram is the main screening test for breast cancer. It uses X-rays to check for cancer.
  • Digital mammogram (DM). This takes X-rays of the breast from at least two angles. The X-rays are stored in a computer file.
  • 3D mammogram. This is also called digital breast tomosynthesis, or DBT. It uses X-rays to make a 3D image of the breast. As a newer test, it may not be covered by insurance.

• Clinical breast exam (CBE). During this exam, your doctor will carefully feel your breasts and under your arms to check for lumps or other changes. If your CBE is not normal, you may need an imaging test. Your doctor may do a CBE if you have a high risk of breast cancer. Talk to your doctor about whether to have this exam if you are not at high risk of breast cancer.

• MRI (magnetic resonance imaging) of the breast.
  • Standard MRI. This may be used as a screening test if you have a high risk of breast cancer. This includes testing positive for the BRCA1 or BRCA2 gene, having a strong family history of breast cancer, or having a history of chest radiation.
  • Abbreviated breast MRI. This takes less time than a standard breast MRI. (You might hear it called a "fast MRI.") This test is something your breast cancer screening center may offer. As a newer test, an abbreviated breast MRI may not be covered by insurance.