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Detection

Cleveland Clinic's Comprehensive Breast Cancer Program offers a large range of early detection options that can mean the difference in your fight against breast cancer.

Detection and Prevention of Breast Cancer: The Best Defense

Even with all the latest advances in the treatment options for breast cancer, the best chance for survival is early detection by screenings. Survival rates are associated with finding breast cancer at its earliest stages.

  • This year 180,000 women will be diagnosed with breast cancer and approximately 43,500 will die.
  • Although these numbers may sound frightening, research reveals that the mortality rate could decrease by 30 percent if all women age 50 and older in need of a mammogram had one.
  • Additionally, if detected early, breast cancer has a five-year survival rate of over 95 percent.

Detecting Breast Cancer

Although several methods of detection are available, mammography remains the most effective.
Other methods include:

  • Breast MRI
  • Image-guided biopsy
  • Monthly self breast examination

If you’re confused about when to have a mammogram and what kind you should have, you’re not alone. Download this fact sheet for answers to all of your questions.

Recommendations for Breast Cancer Screenings

  • Clinical breast exam about every three years for women in their 20s and 30s
  • Annual breast exam by a health care provider starting at age 40
  • Annual screening mammography starting at age 40
  • Women in high-risk categories (first-degree relative with breast cancer; personal history of breast cancer; prior biopsy with atypical ductal hyperplasia or lobular carcinoma in situ) may want to consider starting breast screenings and breast exams at age 30

Recommendations for Self Breast Exams

Our specialists and state-of-the-art mammography facilities help encourage patients to stay on top of their breast health. Patients who note changes in breasts should always seek evaluation. Remember you play the biggest role in prevention.

What is Mammography?

Mammography is a way to detect abnormal growths or changes in the breast tissue. To perform mammography, a health care provider takes an X-ray, or picture, of the breast tissue. This X-ray is called a mammogram.

What is a Digital Mammogram?

A digital mammography is a newer technology which allows for more digital manipulation of a breast X-ray exam than is possible with film mammography.

A recent study involving 42,760 women nationwide found that digital mammography was more accurate for more than half the women who undergo breast-cancer screenings. Younger women with dense breast tissue, which makes it harder to detect tumors, particularly benefited from use of the new technology, the study found. Other advantages offered by a digital mammography include the ease of storing and retrieving images and storing them as part of a patient's electronic medical record.

Both film mammography and digital mammography are available at Cleveland Clinic centers.

How is a Mammogram Performed?

You will be asked to stand in front of an X-ray machine for mammography. A health care provider will place your breast between two plates. The plates will be pressed together, gently flattening your breast. By flattening the breast, the health care provider can get a clear picture while using a low dose of radiation.

You may feel some discomfort or slight pain from this pressure, but it will only last for a few seconds while the X-ray is being taken. For a routine breast screening, two pictures are taken of each breast.

Your cooperation is important to get a clear picture. If you feel that the pressure on your breast is too great, tell the person performing the exam.

Why are Mammograms Performed?

Mammography are performed:

  • As part of a regular physical exam
  • To evaluate any unusual changes in the breast

Mammography can help your health care provider decide if a lump, growth, or change in your breast needs further testing. The mammogram is also used to look for lumps that are too small to be felt during a physical exam.

Why Should I get a Mammogram?

Mammography is your best defense against breast cancer because it can detect the disease in its early stages. Remember, most breast lumps are not cancer. In many cases, it’s normal for breasts to have lumps or feel tender. But if cancer does occur, mammography can improve your chances of a full recovery.

How Often Should I Have a Mammogram?

The American Cancer Society recommends:

  • First mammogram by age 40
  • Annual mammogram after age 40, as long as in good health

Your risk of breast cancer increases as you age, so a regular mammogram is especially important if you are over 50. If you think you need a mammogram, don’t wait for your yearly physical. Contact your health care provider right away.

How Should I Prepare for a Mammogram?
  • If you are pregnant, or think you are pregnant, tell your health care provider.
  • Do not wear body powder, creams, deodorants or lotions on your chest the day of the test.
What Else Can I Do to Protect Myself From Breast Cancer?
  • Perform a breast self-examination each month or on a regular basis.
  • Have your breasts examined by your health care provider at least once a year.
Where Can I Learn More about Breast Cancer and Mammography?

National Cancer Institute
The Cancer Information Service
1.800.4.CANCER (1.800.422.6237)
www.cancer.gov

American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA 30329
1.800.227.2345
www.cancer.org

Susan G. Komen Foundation
3500 Gaston Ave.
Dallas, Texas 75246
1.877.GO.KOMEN (1.877.465.6636)
komen.org

What if They Think They See Something on My Mammogram?

Despite the fear an abnormal mammogram may evoke, most instances of abnormal mammograms are not breast cancer. Questionable abnormalities often require additional evaluation. With further examination, most of these abnormal mammograms are found to be normal breast tissue or benign (non-cancerous) tissue.

What is a Screening Mammogram?

Screening mammograms are recommended annually for all women starting at age 40, regardless of whether symptoms are present.

In a screening mammogram, the breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram is viewed, breast tissue appears white and opaque, and fatty tissue appears darker and translucent.

A Potentially Abnormal Mammogram

Potential abnormal mammograms are found in six to eight percent of women who have screening mammograms. Abnormal mammograms require further evaluation that may include breast physical examination, diagnostic mammography, breast ultrasound or needle biopsy. Most cases of abnormal mammograms are found to be benign (i.e., no disease is present).

What is a Diagnostic Mammogram?

Diagnostic mammograms are done for women whose screening mammogram indicated potential abnormalities as well as for women who have signs or symptoms related to the breasts. In some women, only additional mammographic images are needed. In other women, additional mammographic images and an ultrasound are done following the abnormal mammogram.

How Does an Abnormality Appear on a Mammogram?

A potential abnormality on a mammogram may be called a nodule, mass, lump, density or distortion. A mass (lump) with a smooth, well-defined border is often benign. Ultrasound is needed following an abnormal mammogram to characterize the inside of a mass – if the mass contains fluid, it is called a cyst. A mass (lump) that has an irregular border or a star-burst appearance (spiculated) may be cancerous and a biopsy is usually recommended.

Microcalcifications (small deposits of calcium) are a third type of abnormal mammography. Microcalcifications can be classified as benign, suspicious or indeterminate. Depending on the appearance of the microcalcifications on the additional studies (magnification views), a biopsy may be recommended.

How Accurate is Mammography?

Mammography is 85 to 90 percent accurate. Mammograms have improved the ability to detect breast abnormalities before they are large enough to be felt. However, it is possible that a mass which can be felt (palpable) may not be seen on a mammogram. Any abnormality that you feel when examining your breasts should be evaluated by your health care provider. A diagnostic mammogram may be recommended.

Monthly Self Examination is Essential

The best opportunity for a positive outcome is early detection. Breast cancer may be curable if detected at an early stage.

Every woman should follow the American Cancer Society’s breast screening recommendations listed below.

American Cancer Society Breast Screening Guidelines

If you are between the ages of 20 and 40, you should:

  • Do a breast self-exam once a month and
  • Have a breast physical examination by your health care provider every three years.

If you are age 40 or older, you should:

  • Do a breast self-exam once a month,
  • Have a breast physical examination by your health care provider once a year, and
  • Have a mammogram once a year.
What is a Breast MRI?

Magnetic resonance imaging (MRI) is a test that produces very clear pictures, or images, of the human body without the use of X-rays. Breast MRI uses a large magnet, radio waves and a computer to produce these images.

Uses and Benefits of Breast MRI

Breast MRI may be used to distinguish between benign (non-cancerous) and malignant lesions, which can reduce the need for breast biopsies. It is used primarily to evaluate breast implants for leaks or ruptures and to assess abnormal areas that are seen on a mammogram or are felt after breast surgery or radiation therapy. It can be used after breast cancer is diagnosed to determine the extent of the tumor in the breast. Breast MRI is also sometimes useful in imaging dense breast tissue, which is often found in younger women, and in viewing breast abnormalities that can be felt but are not visible with conventional mammography or ultrasound.

Although breast MRI can detect tumors in dense tissue, it is not a complete solution. MRI cannot detect microcalcifications (tiny specs of calcium), which account for one-half of the cancers detected by mammography.

What to Expect During Your Breast MRI

During breast MRI, the patient lies on her stomach on the scanning table. During the breast MRI, the breast hangs into a depression or hollow in the table, which contains coils that detect the magnetic signal. During a breast MRI, the table is moved into a tube-like machine that contains the magnet. After an initial series of Breast MRI images have been taken, the patient may be given a contrast agent intravenously (by injection into a vein). The contrast agent used in a breast MRI is not radioactive; it is sometimes used to improve the visibility of a tumor. Additional breast MRI images are then taken. The entire breast MRI session takes about 45 minutes.

The breast MRI exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by the radiologist.

Lumps or masses in the breast are not unusual, and most of them are not cancerous. Some breast masses can be felt during a breast exam. Others are detectable only by mammogram breast X-ray. How a mass is detected does not determine whether it is cancerous. Breast lumps should be evaluated by a physician experienced in diagnosing breast cancer. This is often done with a stereotactic breast biopsy.

When a breast biopsy is recommended for an abnormal mammogram finding, patients should always undergo a biopsy when possible. Minimally invasive biopsies do not require surgery and include a stereotactic biopsy.

How is a Stereotactic Breast Biopsy Performed?

During the stereotactic breast biopsy procedure, the patient lies on her abdomen on a specially designed exam table. An opening in the table allows access to the breast. The table is raised and the stereotactic breast biopsy is done from below the table. The area to be biopsied is centered in the window of a specially designed compression paddle. Using a local anesthetic, the radiologist makes a small opening in the skin. A sterile breast biopsy needle is placed into the breast tissue area to be biopsied. Computerized pictures help confirm the needle placement for a stereotactic breast biopsy using digital imaging. Tissue samples are taken through the needle. It is common to take multiple tissue samples during the breast biopsy. This part of the stereotactic breast biopsy takes approximately 15 minutes. Upon completion, sterile strips and a Band-Aid are applied to the skin. Results of a stereotactic breast biopsy require three to five working days.

What are the Benefits of an Ultrasound Guided Biopsy?
  • Minimal scarring instead of a large incision
  • Reduced post-procedural pain
  • Lower costs
  • Immediate return to work following breast biopsy
  • Shorter recovery time and immediate resumption of daily activities following stereotactic breast biopsy
How Safe is a Minimally Invasive Breast Biopsy?

A minimally invasive breast biopsy is as safe as “open” surgery, when performed by specialists in this field.

What are the Risk Factors for Breast Cancer?

Certain factors increase the risk of developing breast cancer. However, having many risk factors does not mean a woman will develop breast cancer, and having no risk factors does not mean she will not develop the disease.

A prior personal history of breast cancer at a young age is a risk factor for breast cancer. The chances of developing the disease increase with age. About 70 percent of women diagnosed with breast cancer each year are over age 50, and almost half are age 65 and older.

A personal risk is also greater if an immediate family member (mother, sister or daughter) has had breast cancer, particularly if it was at an early age. Also, women who have had a breast biopsy that shows certain types of benign disease, such as atypical hyperplasia, are more likely to get breast cancer.

Other risk factors include:

  • Being female
  • Having cancer in one breast (may develop in other)
  • Late menopause (after age 50)
  • Starting menstruation early in life (before age 12)
  • Having a first child after age 30
  • Never having children
How Can I Protect Myself?

Know your family history and discuss this with your doctor. Detection of breast cancer in its early stages - hopefully before it moves outside the breast – can significantly improve the chances that treatment will be successful. The survival rate from breast cancer increases when the disease is detected and treated early. Other types can be managed in a high level risk program depending on calculation of risk.

When a cancer is found in its earliest stages (within the breast), the 5-year survival rate is >97 percent. This means that of 100 women diagnosed with breast cancer at this stage, 97 will be alive after five years. More than half of all breast cancers are diagnosed at this stage. Much of this early detection is done via self-exams and self-screening for breast lumps.

When the cancer has spread outside the breast to nearby tissues (usually the lymph nodes), the 5-year survival rate drops to 77 percent. When the cancer has spread to more distant parts of the body, the >5-year survival rate is 22 percent.

What are Good Strategies for Early Detection?

There are two methods of early detection that involve physical examination of the breast: breast self examination and clinical breast examination. The American Cancer Society recommends that women age 20 and older do a breast self exam each month. By doing the exam regularly, a woman becomes familiar with the normal feel of her breasts and can more easily notice breast lumps. Any change or breast lump should be reported promptly to a physician.

A clinical breast examination is performed by a physician. Women ages 20 to 39 should have one done every 3 years, and then every year once they turn 40.

Mammography is an important method of early detection that uses low doses of X-rays to take a picture of breast tissue. The purpose of a mammogram is to find abnormalities and breast lumps that are too small to be seen or felt. However, mammograms will not detect all breast cancers, which is why physical breast exams are very important.

To find out if you are at increased risk for breast cancer, consult your physician. The National Cancer Institute (NCI) has made available computer models for predicting risk. Your doctor can tell you your estimated 5-year and lifetime risks for breast cancer.

What is the Link Between Breast Cancer and Genetics?

Only 5 to 10 percent of breast cancer cases are thought to be hereditary. The two most common genes associated with breast cancer – BRCA1 and BRCA2 – can be inherited from either parent. Therefore, the father's family history of breast cancer is important as well.

At-risk families can take blood tests to screen for mutations in these genes. However, genetic testing is done only when definitely indicated by a strong family history.

What Are my Options if I am at High Risk or Have the "Cancer Genes?"

Through genetics generally only play a small role in breast cancer, high-risk candidates and carriers of the genes associated with breast cancer can exercise several options, including beginning screenings at an earlier age and conducting more frequent mammograms and clinical exams. Some women choose preventive mastectomy to decrease the chances of developing breast cancer, although this doesn't offer complete protection.

Another approach includes chemo-prevention strategies using an oral medication tamoxifen.

The NCI and the National Surgical Adjuvant Breast and Bowel Project (NSABP) published a report of their breast cancer prevention trial. The trial was designed to determine whether tamoxifen would reduce the incidence of breast cancer in healthy women known to be at high risk. A total of 13,388 women at increased risk of getting breast cancer were given tamoxifen therapy or a placebo daily.

The results of the trial showed a 50 percent reduction in both invasive and non-invasive breast cancer in the treated women. However, tamoxifen may not be suitable for all women at high risk for developing the disease. An informed discussion between a woman and her physician is essential in determining the appropriateness of this treatment option. Those women who should definitely not use tamoxifen include pregnant women or women planning to become pregnant, women with a history of blood clots or stroke or who are taking anticoagulants.

There are an estimated 29 million women at increased risk for breast cancer in this country, and tamoxifen may offer another alternative to watchful waiting or prophylactic mastectomy.

Raloxifene is a new drug that has been approved for the prevention of osteoporosis in postmenopausal women. Early clinical studies of this drug did not find it to be effective in the treatment of breast cancer. However, some recent data suggest that it may have an effect in reducing breast cancer in healthy women. Further studies are being conducted by the NSABP to investigate this theory.

What if I've Detected a Breast Lump?

Cleveland Clinic's Breast Center offers a full range of services from detection to treatment of breast cancer. Contact a specialist at 216.444.3024 or 800.223.2273 ext. 4-3024 today if you have questions or concerns.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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