Breast Cancer Screening and Diagnosis

People with heterogeneously dense or extremely dense breasts may benefit from additional screening, such as MRI (starting at age 50 for extremely dense breasts) or ultrasound, starting annual mammography no later than age 40 but not before 30.

Breast cancer screening aims to find breast cancer early, when it is more treatable and the chances of successful treatment are higher. Detecting cancer early can reduce the risk of dying from breast cancer.

Annual screening mammograms should start at 40 years of age for those at average risk.

A screening mammogram is done on a regular basis when there are no symptoms, to detect cancer early. A diagnostic mammogram is used when there are symptoms such as a lump, nipple discharge, or changes in breast appearance, or to further investigate abnormal findings on a screening mammogram.

The main types are mammogram, breast ultrasound, breast MRI, contrast-enhanced mammography, and molecular breast imaging.

Dense breasts have more fibroglandular tissue compared to fatty tissue, making it harder to detect cancer on mammograms. Dense breast tissue is associated with an increased risk of breast cancer.

BI-RADS (Breast Imaging Reporting and Data System) is a standard system used to describe mammogram results and breast density, assigning numbers (0-6) for results and letters (A-D) for density.

See your health care provider for further evaluation and possibly diagnostic imaging tests, such as a mammogram or ultrasound. Additional tests or a biopsy may be needed to determine the cause.

Those with a family history or genetic predisposition, a 20% or greater residual lifetime risk, prior chest radiation between ages 10–30, certain abnormal breast biopsy results, a 5-year invasive breast cancer risk of 1.7% or higher (Gail model), or dense breasts with no other risk factors.

Risk is calculated using assessment models such as Tyrer-Cuzick (IBIS), Gail model (BCRAT), BRCAPRO, CanRisk/BOADICEA, or BCSC, using personal and family medical history.

Clinical breast exams and mammograms can safely continue during pregnancy and breastfeeding. Mammograms use low radiation. MRI is generally avoided during pregnancy but may be used during breastfeeding. Ultrasound can also be used.

Generally, no, unless they have symptoms or a known genetic risk such as a BRCA2 mutation. Those with symptoms may need diagnostic tests similar to those for people assigned female at birth.

Undergo breast cancer risk assessment by age 25, keep your care provider informed of any changes in family history, and consider seeing a genetic counselor.

Annual MRI screening for those at increased risk may start as early as 25 years of age, but no later than 40.

Focused breast pain, a lump or mass, skin changes (such as thickening, redness, puckering), nipple discharge (especially if bloody or clear), or new nipple inversion should prompt evaluation.

A biopsy, such as a core needle biopsy or fine-needle aspiration, removes tissue or fluid from the suspicious area for examination by a pathologist. Imaging may be used to guide the biopsy.

Breast implants can rarely be associated with a cancer called BIA-ALCL. Those with implants should alert their provider to unusual symptoms. Standard mammograms may be affected by implants, and special imaging techniques may be used.

Resources include patient advocacy organizations, cancer support networks, genetic counseling services, and breast cancer information websites (list provided in the guide, e.g., breastcancer.org, FORCE, CancerCare, etc.).

No. Screening can continue as long as a person is healthy and expected to live more than ten years, but decisions may be individualized in consultation with a health care provider.

Suggested questions include: Do I have dense breasts? Should I have other imaging tests? What does my BI-RADS result mean? When should I start screening? Should I have a biopsy? What is my risk level? What resources are available?

A clinical breast exam is a physical examination performed by a health care provider to check for lumps or other changes. It is part of routine breast health assessments, especially for those under 40.

People with heterogeneously dense or extremely dense breasts may benefit from additional screening, such as MRI (starting at age 50 for extremely dense breasts) or ultrasound, starting annual mammography no later than age 40 but not before 30.

Breast cancer screening aims to find breast cancer early, when it is more treatable and the chances of successful treatment are higher. Detecting cancer early can reduce the risk of dying from breast cancer.