Mammograms and Other Tests

Having the regular, recommended screenings before signs or symptoms appear is the key to finding breast cancer in its early, treatable stages. Depending on your age and risk factors, screening may include clinical breast exam by your nurse or doctor, mammograms or other tests.

Types of Screenings:

• Clinical breast exam: Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam. Your doctor will examine your breasts for lumps or other changes and may be able to feel lumps you have missed. He or she also will check for enlarged lymph nodes in your armpit (axilla).
• Mammogram: A mammogram, which uses a series of X-ray images of your breast tissue, is currently the best imaging technique for detecting tumors before you or your doctor can feel them. For that reason, the American Cancer Society has long recommended screening mammography for all women over 40.
• Screening mammograms are performed on a regular basis — about once a year — to check your breast tissue for any changes since your last mammogram.
• Diagnostic mammograms are used to evaluate a breast change detected by you or your doctor. During a diagnostic mammogram, the radiologist performing the exam can take additional views to evaluate the area of concern more closely.

Mammogram Limitations

• A certain percentage of breast cancers, sometimes even lumps you can feel, don't show up on X-rays – or give a false-negative result. The rate is higher for women in their 40s because women of this age and younger tend to have denser breasts, making it more difficult to distinguish abnormal from normal tissue.
• Mammograms may indicate a problem when none exists, or give a false-positive result. This can lead to unnecessary biopsies, to fear and anxiety, and to increased health care costs.
• The skill and experience of the radiologist reading the mammogram also may have a significant effect on the accuracy of the test results. In spite of these drawbacks, however, most experts agree mammography is the most reliable screening test for most women.

Tips for Your Next Mammogram

• During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes X-rays. You may find mammography somewhat uncomfortable and if you experience too much discomfort, inform the technician. If you have tender breasts, schedule your mammogram for a time after your menstrual period. Avoiding caffeine for two days before the test may help reduce breast tenderness.
• Also available at some mammography centers is a soft, single-use, foam pad that can be placed on the surface of the compression plates of the mammography machine, making the test less uncomfortable. The pad doesn't interfere with the image quality of the mammogram.
• If possible, try to schedule your mammogram around the same time as your annual clinical exam. That way the radiologist can specifically look at any changes your doctor may discover.
• If you lack health insurance, don’t skip your mammogram. Many state health departments and Planned Parenthood® clinics offer low-cost or free screenings.

Other Helpful Tests

• Computer-aided detection (CAD). In traditional mammography, a radiologist reviews your X-rays. Therefore, the skill and experience of the radiologist play a large part in determining the accuracy of the test results. In CAD, a computer scans your mammogram after a radiologist has reviewed it and identifies highly suspicious areas on the mammogram, allowing the radiologist to focus on specific spots. Using mammography and CAD together may increase the cancer detection rate.
• Digital mammography. In this procedure, a radiologist uses computer technology to alter contrast and darkness of images, making it easier to identify subtle differences in tissue. Digital images can be transmitted electronically, so mammograms can be read by remote experts, if desired. Digital mammography has been found to be helpful in evaluating dense breast tissue.
• Magnetic resonance imaging (MRI). This technique uses a magnet and radio waves to take pictures of the interior of your breast. Although not used for routine screening, MRI can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. MRI doesn't take the place of mammograms, but rather is performed as an additional (adjunct) study of the breast.
• MRI isn't recommended for routine screening on women at average risk because it has a high rate of false-positive results. It's also expensive, not readily available and requires interpretation by an experienced radiologist. However, the American Cancer Society now recommends annual screening MRI for women with a lifetime breast cancer risk of 20 percent or higher, women who received chest radiation between ages 10 and 30, and women with a strong family history of breast and ovarian cancers.
• Recent recommendations propose that women with newly diagnosed breast cancer in one breast have a one-time MRI. MRI can detect breast tumors in the opposite (contralateral) breast missed by mammograms. The test can also detect additional lesions in the affected breast. However, whether finding early tumors in this situation improves treatment outcomes — and deaths from breast cancer — is still unknown.
• Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to produce images of structures deep within the body. Because it doesn't use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. But breast ultrasound isn't used for routine screening because it has a high rate of false-positive results — finding problems where none exist.