Breast Cancer

General Information | Treatment Options | Screening | Additional Resources

Screening
  • About Screening
  • Screening Tests
  • Screening Risks

What is screening?

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

See the PDQ summaries on Breast Cancer Prevention and Breast Cancer Treatment for information about prevention, diagnosis, and treatment of breast cancer.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Breast anatomy; drawing shows lobes, lobules, ducts, areola, nipple, fat, lymph nodes, and lymph vessels Anatomy of the breast, showing lymph nodes and lymph vessels.

Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

Breast cancer is the second leading cause of death from cancer in American women.

Women in the United States get breast cancer more than any other type of cancer except for skin cancer. Breast cancer is second only to lung cancer as a cause of cancer death in women. Breast cancer occurs in men also, but the number of cases is small.

Age and health history can affect the risk of developing breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for breast cancer include:

  • Older age.

  • Early age at menarche (menstruation).

  • Older age at first birth or never having given birth.

  • A personal history of breast cancer or benign (noncancer) breast disease.

  • A mother or sister with breast cancer.

  • Treatment with radiation therapy to the breast/chest.

  • Breast tissue that is dense on a mammogram.

  • Taking hormones such as estrogen and progesterone.

  • Obesity.

  • Drinking alcoholic beverages.

  • Being white.

See the PDQ summary on Genetics of Breast and Ovarian Cancer for more information about family history and breast cancer screening.

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person's chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Three tests are commonly used to screen for breast cancer:

Mammogram

A mammogram is an x-ray of the breast. This test may find tumors that are too small to feel. A mammogram may also find ductal carcinoma in situ, abnormal cells in the lining of a breast duct, which may become invasive cancer in some women. The ability of a mammogram to find breast cancer may depend on the size of the tumor, the density of the breast tissue, and the skill of the radiologist.

Photograph shows the right breast positioned between the plates of a mammography machine.Mammography of the right breast.

Clinical breast exam (CBE)

A clinical breast exam is an exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.

Breast self-exam (BSE)

Breast self-exam is an exam to check your own breasts for lumps or anything else that seems unusual.

If a lump or other abnormality is found using one of these 3 tests, ultrasound may be used to learn more. It is not used by itself as a screening test for breast cancer. Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

New screening tests are being studied in clinical trials. MRI (magnetic resonance imaging)

MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRI does not use any x-rays.

In women with a high inherited risk of breast cancer, screening trials of MRI breast scans have shown that MRI is more sensitive than mammography for finding breast tumors. It is common for MRI breast scan results to appear abnormal even though no cancer is present. Screening studies of breast MRI in women at high inherited risk are ongoing.

In women at average risk for breast cancer, MRI scans may be done to help with diagnosis. MRI may be used to:

  • Study lumps in the breast that remain after surgery or radiation therapy.

  • Study breast lumps or enlarged lymph nodes found during a clinical breast exam or a breast self-exam that were not seen on mammography or ultrasound.

  • Plan surgery for patients with known breast cancer.

Tissue sampling

Breast tissue sampling is taking cells from breast tissue to examine under a microscope. Abnormal cells in breast fluid have been linked to an increased risk of breast cancer in some studies. Scientists are studying whether breast tissue sampling can be used to find breast cancer at an early stage or predict the risk of developing breast cancer. Three methods of tissue sampling are under study:

  • Fine-needle aspiration: A thin needle is inserted into the breast tissue around the areola (darkened area around the nipple) to withdraw cells and fluid.

  • Nipple aspiration: The use of gentle suction to collect fluid through the nipple. This is done with a device similar to the breast pumps used by nursing women.

  • Ductal lavage: A hair-size catheter (tube) is inserted into the nipple and a small amount of salt water is released into the duct. The water picks up breast cells and is removed.

Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of breast cancer screening tests include the following: Finding breast cancer may not improve health or help a woman live longer.

Screening may not help you if you have fast-growing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become life-threatening. When such cancers are found, treatment would not help you live longer and may instead cause serious treatment-related side effects. At this time, it is not possible to be sure which breast cancers found by screening will cause symptoms and which breast cancers will not.

False-negative test results can occur.

Screening test results may appear to be normal even though breast cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms.

One in 5 cancers may be missed by mammography. False-negatives occur more often in younger women than in older women because the breast tissue of younger women is more dense. The size of the tumor, the rate of tumor growth, the level of hormones, such as estrogen and progesterone, in the woman's body, and the skill of the radiologist can also affect the chance of a false-negative result.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

Most abnormal test results turn out not to be cancer. False-positives are more common in younger women, women who have had previous breast biopsies, women with a family history of breast cancer, and women who take hormones, such as estrogen and progesterone. The skill of the doctor also can affect the chance of a false-positive result.

Mammograms expose the breast to radiation.

Being exposed to radiation is a risk factor for breast cancer. The risk of developing breast cancer from radiation exposure, such as screening mammograms or x-rays, is greater with higher doses of radiation and in younger women. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure.

The risks and benefits of screening for breast cancer may be different for different groups of people.

The benefits of breast cancer screening may vary among age groups:

  • In women who have a life expectancy of 5 years or less, finding and treating early stage breast cancer may reduce their quality of life without helping them live longer.

  • In women older than 65 years, the results of a screening test may lead to more diagnostic tests and anxiety while waiting for the test results. Also, the breast cancers found are usually not life-threatening.

  • In women 35 years or younger who go to the doctor for breast symptoms, mammogram results may not be helpful in managing their care.

Routine breast cancer screening is advised for women who have had radiation treatment to the chest, especially at a young age. The benefits and risks of mammograms and MRIs for these women are not known. There is no information on the benefits or risks of breast cancer screening in men.

No matter how old you are, if you have risk factors for breast cancer you should ask for medical advice about when to begin having mammograms and how often to be screened.

 

Cancer information from the NCI PDQ service