Breast Cancer Screening

RWJBarnabas Health’s 3-Step Plan for Preventative Care

The best way to prevent breast cancer is to make sure you are following the recommendations of your doctor for routine breast care.

What is the 3-Step Plan?

Finding breast cancer early is the primary goal of the plan because it gives you the best chance for successful treatment. Routine care can also help find other noncancerous or benign conditions, too.

Step 1. Breast Self-Exam (BSE)

A BSE is when a woman feels her breasts for lumps. There is some debate among health professionals about the effectiveness of monthly BSEs because evidence suggests they do not lower the risk of dying from breast cancer. However, the American Cancer Society (ACS) says all women should get to know how their breasts typically look and feel so changes can be detected.

If you recognize any of the changes below, see your health care provider right away.

• A lump
• Leaky fluid, or discharge, other than breastmilk
• Swelling
• Skin irritation or dimpling
• Nipple problems (for example, pain, redness, flaking, or turning inward)

Talk with your healthcare provider about the benefits and limitations of BSEs.

Step 2. Clinical Breast Exam (CBE)

Your yearly physical exam should include a clinical breast exam (CBE) by a physician or nurse trained to check for breast problems. A CBE exam is done very much like a breast self-exam. If you do regular BSEs, be sure to ask questions and talk about any concerns with your provider during your CBE.

The American College of Obstetricians and Gynecologists recommends:

• Ages 29 to 39 - women should have a CBE by a health professional every 1 to 3 years
• After age 40 - women should have a breast exam by a health professional every year

Talk with your healthcare provider about your risk factors and the appropriateness of a CBE during your visit. That will help you and your doctor decide if you should have a CBE.

Step 3. Mammogram

A mammogram is a low-dose x-ray of your breasts, and it is the most common imaging test for breast cancer screening. A mammogram can find cancer or other problems early, before a lump can be felt. It can also help diagnose other breast problems. Health experts have different recommendations for mammograms:

• The American Cancer Society recommends yearly screening for all women ages 45 to 54
  • Women 40 – 44 have the option of a mammogram
  • The ACS also suggests women ages 55 and older could change to screening mammograms every two years if they have a health history that supports such a decision.
• The U.S. Preventative Services Task Force recommends screening every two years for women ages 50 to 74.

Both the National Cancer Institute and the ACS recommend that women who may be at higher risk for breast cancer talk with their health care providers about beginning yearly mammograms at an earlier age. Discuss personal risk factors with your health care provider. This conversation will help you and your doctor decide when to start getting mammograms, and how often to have them.

Wondering if a yearly mammogram is right for you? Find an RWJBarnabas Health physician or breast center.

Breast Cancer Detection Methods

• Clinical breast exam (CBE). Your physical exam should include a clinical breast exam (CBE) by a health care provider or nurse trained to check breast problems. The American College of Obstetricians and Gynecologists recommends:

• Between ages 29 and 39, women should have a CBE by a health care provider every one to three years.
• After age 40, women should have a breast exam by a health care provider every year.

The USPSTF and the ACS believe there isn't enough evidence to know if CBEs are helpful for women ages 40 and older. Talk with your health care provider about your personal risk factors. That will help you decide if you should have a CBE.

• Mammography: A mammogram is an x-ray used to find breast tumors before symptoms of cancer appear. During the test, your breast is placed between two metal or plastic plates that flatten and spread the tissue. Low levels of radiation are used to take a picture of the inside of your breast. Some facilities have digital mammography, which display results on a computer instead of on film. The test can be uncomfortable, but it only lasts a few moments.
• Breast MRI: An MRI uses magnets, radio waves and a computer to make detailed pictures of the inside of the breast. Before the MRI, you may be injected with a contrast dye. This helps to better outline the breast tissue and possible tumors.

These screening methods can improve your chances of catching cancer early. Women at high risk for breast cancer may be advised to start breast cancer screening at a younger age, and have an MRI in addition to a mammogram. For some women with dense breast tissue, ultrasound may be done in addition to a mammogram. And for some women at high risk for breast cancer, a screening MRI may be advised along with mammograms.