5 Breast Cancer Screening Exams Every Woman Should Know About

Plus: Here's what you need to understand about the FDA's recent changes to mammography regulations.

Healthcare: Reminder note to schedule mammogram
Photo: Getty Images

Breast cancer screenings are among the key health appointments that every woman should make. These preemptive medical check-ups can detect signs of breast cancer as early as possible when the chances of survival are highest.

Since about one in eight women will develop breast cancer during their life, it's important that all women chat with their doctor or OB/GYN about what the best options for breast screening are for them. Women with a higher risk (for example, with breast cancer in the family) will likely have a more rigorous screening routine than women with an average risk.

The Latest in Mammography Screening Rules

Recently, the FDA released a new set of guidelines regarding dense breast tissue, which has emerged as another possible risk factor for cancer. The mandate requires screening facilities to inform women about their breasts' density and to provide information on the implications: Dense tissue can make it harder for mammograms to detect cancer.

"It's also critical that women with dense breasts talk to their doctors about the impact of breast density on breast cancer risk in order to identify if they are a candidate for supplemental imaging," says Gene van den Ende, head of Global Medical Affairs Radiology at Bayer Pharmaceuticals. "These conversations can save lives. For women looking for guidance on how to start this dialogue, I encourage them to visit densebreastresources.com."

Various tests are used to screen for different types of cancer in asymptomatic people. Below are the best standard screening exams widely available to women today. Know your options to make a smart, informed decision for your health.

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Clinical Breast Exam

A clinical breast exam (CBE) is a physical exam to check for tissue abnormalities in the breast. A doctor, nurse practitioner, or another well-trained healthcare provider will manually feel the breasts and underarm areas for potential lumps, irregularities, or other notable changes. It can tell you whether a cancerous breast lump or thickening is present.

When to Have It

Generally, your doctor should give you a manual breast exam starting in your early 20s. By age 30, you should have a manual clinical exam every year. That said, recommendations for CBE vary slightly by health organization—here are a few to consider, in addition to consulting your doctor to determine when to start and how often to get a CBE.

  • The National Comprehensive Cancer Network has recommended starting CBE every one to three years, starting at age 25 and increasing to yearly exams starting at age 40.
  • Similarly, Memorial Sloan Kettering Cancer Center recommends an annual physical breast exam for all women of average risk between 25 and 40. (It also encourages all women to give themselves breast checks once a month, starting at age 20, to "become familiar with their breasts, so they are better able to notice changes.")
  • However, the American Cancer Society does not necessarily recommend regular clinical breast exams as part of a cancer screening routine since research indicates CBE doesn't contribute much to early detection when mammography screening is readily available.

The Risks

Not all doctors are trained or skilled in this kind of examination. Lumps may be missed, or normal variations in breast tissue may be mistaken for tumors (false positives), leading to needless worry and expensive procedures.

That said, CBE remains a good way to keep tabs on your body, and women will often receive this check-up every time they visit the gynecologist or on their annual trip to the doctor. Become familiar with the look and feel of your breasts so you and your doctor can recognize if something does change or appears unusual. Don't hesitate to tell your doctor if you have concerns.

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A mammogram is a low-dose X-ray of the breast that helps reveal changes and/or abnormalities in breast tissue. For the exam, each breast is flattened between two plates to compress the tissue, so X-rays pass through it.

Suspicious findings from a mammogram come in two forms, calcifications (small white dots) and masses (larger abnormal areas of breast tissue). Calcifications are tiny calcium deposits in the breast tissue; most are benign, but certain calcification patterns may indicate precancerous changes to breast tissue and need further testing (biopsied). A mass may be biopsied or examined with ultrasound to determine whether it is a cyst or a benign tumor.

When to Have It

According to the American Cancer Society, "results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found early, are less likely to need aggressive treatment like surgery to remove the breast (mastectomy) and chemotherapy, and are more likely to be cured."

Medical groups have generally agreed that starting at age 40, healthy women with an average risk for breast cancer should begin looking into mammography screenings and consult their doctor to determine how often.

However, a new draft recommendation statement by the U.S. Preventive Services Task Force in May 2023 now urges "biennial screening mammography for women ages 40 to 74 years." In other words, all women should get mammogram screenings every other year starting at age 40. This change, a news release states, "could result in 19 percent more lives being saved."

Task Force immediate past chair Carol Mangione, MD, MSPH, cites "new and more inclusive science about breast cancer in people younger than 50," as the catalyst and reason for the newly expanded guidelines.

Women 50 and over with no lumps or other breast abnormalities are strongly advised to have an annual mammogram. To be safe, many doctors recommend starting mammograms at 40 and having them either annually or biennially (every other year).

For more specific recommendations, see the Centers for Disease Control and Prevention's extensive breakdown of breast cancer screening and mammography guidelines for women by health organization and age group.

The Risks

False-positive and false-negative results both occur. According to the American Cancer Society, "about half of the women getting annual mammograms over a 10-year period will have a false-positive finding at some point."

False positives can lead to unnecessary further testing (often expensive) and undue anxiety. False negatives are a possibility, too. The National Cancer Institute reports that "screening mammograms miss about 20 percent of breast cancers present at the time of screening."

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3D Mammogram (Digital Breast Tomosynthesis)

3D mammograms—or breast tomosynthesis (DBT)—are a relatively new advancement in mammography screening, made available starting in 2011. This scan takes multiple low-dose breast X-rays from different angles. A computer then combines them to make a three-dimensional image of the breast.

A 3D mammogram allows doctors and radiologists to see a clearer, more detailed image of the breast and view breast areas from multiple angles. They may be especially helpful for women with dense breast tissue, which can obscure potential cancers in a standard mammogram. DBT has been found to increase both sensitivity (correct identification of someone with cancer) and specificity (correct identification of someone without cancer) of mammography.

When to Have It

Women 40 and older are encouraged to get yearly mammograms and should consider 3D mammograms if available. They are becoming more common, but aren't available at all facilities.

More research is underway to determine whether a 3D mammogram alone is more effective at detecting breast cancer than the standard 2D mammogram alone. But studies show, and medical groups like the Mayo Clinic agree, that undergoing both exams can reduce the need for follow-up testing, lower the rate of false positives, and catch an increased number of cancers during screening.

The Risks

Exposure to low-level radiation (though the benefits tend to outweigh the risk of radiation exposure—chat with your doctor if you're concerned). False positives and missed cancers are also possible.

The majority of insurance companies and Medicare pay for 2D mammograms. But 3D mammograms, which cost an average of over $1,000, are often not covered, according to the American Cancer Society.

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An ultrasound uses high-frequency sound waves to create detailed images (sonograms) of the inside of the breast. Ultrasound imaging can help further identify suspicious abnormalities seen on a mammogram and may be recommended by a doctor if a woman has dense breasts.

Ultrasounds are often used as a follow-up to mammography to determine whether a suspicious breast lump apparent in a mammogram is a solid mass or a fluid-filled cyst (typically benign and can be drained). A solid mass may require a biopsy to determine if it's cancerous. (Ultrasound may also be used to guide a needle biopsy.)

When to Have It

Besides showing whether a lump is a mass or a cyst, ultrasound is often recommended in addition to mammography in women with dense breasts to see if it can help detect cancers that do not appear on mammograms.

The Risks

False positives (which can lead to further unnecessary testing and stress) and false negatives are possible. Some potential early signs of cancer, like breast calcifications, don't show up with an ultrasound.

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Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging, or MRI, uses magnets and radio waves to create an extremely detailed image of breast tissue. MRI is used at some centers to screen high-risk women. It's most helpful for those with dense breasts, where it works better than mammography, which is limited in revealing lumps in dense breasts.

When to Have It

Women with risk factors (such as having a mother or a sister who had breast cancer) should consider a yearly MRI scan in addition to a mammogram. If a mammogram has already found a tumor, MRI can help map the extent of the disease and look for other tumors. If a mammogram is questionable, MRI can help rule out a tumor. It's not recommended, however, as a screening test on its own since it can miss some cancers that a mammogram would find.

The Risks

MRI scans are quite expensive. "Further work needs to be done to ensure supplemental breast screenings, such as breast MRI, are covered by health insurance so more women can have access to these potentially lifesaving tests," says van den Ende.

MRI scans also have a high rate of false positives due to their high sensitivity—their ability to pick up even the slightest abnormality regardless of whether or not it's problematic. Therefore, MRI is not recommended as a regular screening for women with an average risk of breast cancer.

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