Screening for Breast Disease

Assumptions  ·  Breast Examination  ·  Self Breast Examination  ·  Mammography  ·  Breast Ultrasound  ·  Thermography

If there were no such thing as breast cancer, there would be little need to screen individuals for breast disease. Breast cancer is the issue that drives all breast screening programs.

The primary strategy involves a three-armed effort: Periodic (annual) professional breast examination, monthly self-breast examination, and mammography at appropriate intervals.

Assumptions
The underlying assumption of all breast screening programs is that if we can detect a breast malignancy when it is very small, then the outcome will be better for the patient than if we discover the problem when it is bigger. Just how true that assumption is and the exact parameters of that truth are still under debate, as is the effectiveness of any of the breast cancer screening programs in improving outcome for women with breast cancer.

Breast Examination
Once a year, a woman's breasts should be evaluated by a qualified health professional. Any significant abnormalities in texture, contour, skin, any palpable masses, retractions, dimpling or nipple discharge will require followup appropriate for the abnormality. Professional breast exams are felt to be about 80% reliable in detecting significant breast abnormalities.

Read more about Professional Breast Examinations

Self Breast Examination
Once a month, a woman should examine her own breasts, looking for changes in appearance, texture, or nipple discharge that was not previously present. Examination technique is not obvious, but is a skill to be learned (and taught). Any new findings should be promptly reported to the woman's physician or other qualified healthcare provider. Most breast cancers are first noted by the patient herself.

Some critics of self breast exams have observed that they may cause more problems than they solve. By the time a breast cancer is large enough for the woman to feel herself, it is not likely to be "early." Further, most of the self-discovered breast lumps are benign and do not represent a threat. Nonetheless, they are often subjected to investigation, including biopsy and excision.

Read more about Self Breast Examinations

Mammography
The goal of mammography to to detect very early cancers or pre-cancerous changes before they have a chance to develop into a more advanced and dangerous stage. Mammography is felt to be about 80% effective in detecting significant breast abnormalities, but many of the ones that are missed by mammography can be detected by examination.

There is controversy over how frequently mammograms should be performed. If there is a clinical abnormality, mammograms can be used to gain additional information about the abnormality (a "diagnostic" mammogram). Many physicians recommend that "screening:" mammograms be performed every other year between ages 40 and 50, and annually thereafter. Some physicians dispute the usefulness of mammograms prior to age 50. Some physicians recommend mammograms more often if there is a strong family history of breast cancer. Some physicians dispute the value of screening mammograms after age 75 or 80. Some physicians dispute the value of screening mammograms at any time.

Read more about Mammography

Breast Ultrasound
Breast ultrasound is used in some countries (although not commonly in the United States) to screen for breast cancer. It has the advantage that it is relatively inexpensive, quick, painless, and uses no radiation. It is particularly good at detecting cystic masses (better than mammograms). In skilled hands, it does a fair job of detecting malignancies.

Unfortunately, it is not as good at detecting malignancies as mammograms and so it is not usually used for primary screening in the U.S. It is commonly used in the U.S., however, as an adjunctive method to evaluate abnormalities palpated by the examiner or identified on mammograms.

Thermography
Thermography is a means of looking at the breast with an infrared (heat-sensitive) imaging device. It relies on the principle that cancers have increased metabolic activity, generating more heat, that can be detected with a thermographic process. While this has some theoretical advantages over other imaging techniques, in practice, thermography has not been demonstrated to be effective in early detection of significant lesions, and so is not generally used as a primary screening technique.

Guide to Clinical Preventive Services
U.S. Department of Health and Human Services