By Kari Danziger, MS, CGC

Reviewed by Beth Crawford, MS, CGC and Miriam Komaromy, MD
Last updated September 11, 2000

Doctors use a standard set of procedures for detecting breast cancer. The goal of any of these screening procedures is to detect physical changes that occur as a cancer develops but before you notice symptoms. If doctors are able to detect these chances early in a developing cancer, their chances of halting the disease are greatly improved. The age at which you should begin screening and the interval between examinations will vary depending on your level of risk for the disease. (For more information about new types of breast cancer screening procedures that are being developed, see Related News below.)

Breast Self Examination

During a self-examination, you feel your breasts for any changes that may indicate a tumor. The benefit is that it allows you to detect changes in your breasts, often before a physician would notice them during a periodic check-up and clinical breast examination or mammogram. When you detect a breast lump or thickening, you can report it to a physician for prompt follow-up and analysis.

Although breast self-exam has not been definitively shown to improve the likelihood of detecting breast cancer at a stage where it is more curable, many women feel greatly reassured by thoroughly examining their own breasts, and having the ability to detect changes in their breast as soon as they occur rather than waiting for a physician.

Education and instruction programs use several methods to teach the self-exam process. For example, some use models that familiarize participants with they types of lumps that could be found. Some programs now instruct high school and college women in the procedure in order to establish a life-long patterns of self-examination.

Key factors in a successful breast self-exam are knowing what to feel for, and having familiarity with your own breast tissue.

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Clinical Breast Examination

During a clinical breast examination, a physician or another trained health care professional examines your breasts for changes in size, shape, and appearance. The doctor also feels the breasts for any masses or changes in texture, and the area under the arms for lumps in the outer portion of the breast tissue and lymph nodes.

A clinical breast exam is the same as a self-exam, except that it is performed by a healthcare provider who has received training in the procedure.

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Mammogram

On a mammogram, tumor tissue typically appears more dense than normal breast tissue.

A mammogram uses low levels of radiation to provide a black-and-white X-ray image of your breast. This image varies according to breast density, with tumors typically appearing denser than normal breast tissue. However, the breast tissue tends to more dense in young women, which makes it difficult to distinguish between normal breast tissue and potentially cancerous tumors on the mammograms in this group. Therefore, physicians do not typically recommend this screening method for women under age 40 — unless they are at increased hereditary risk for breast cancer. For these high-risk women, because the risk of early breast cancer is so much greater, physicians believe that the chance of a confusing or false positive mammogram result is outweighed by the possibility that early cancer will be detected. For this reason they do recommend screening at a younger age, although this remains somewhat controversial.

Mammograms detect potentially dangerous masses that cannot be felt or seen with the naked eye, which makes them an important screening tool for older women. However, mammograms can also identify benign or precancerous areas that look like cancer but are not. Three of the most common such conditions are cysts, fibroadenomas, and microcalcifications.

More on Benign Conditions of the Breast

Although mammograms can identify potential problems, they cannot be used alone to diagnose cancer.

The value of mammograms is greatly enhanced by annual or repeat screening because when compared with previous mammograms, changes in breast density or the presence of new microcalcifications can be observed. For this reason it is important to follow the screening schedule you and your doctor have discussed. (For news about how mammograms increase breast cancer detections, see Related News below.)

References

Barton M.B. et al. (1999). Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 282(13):1270-80.

Fletcher, S.W. et al. (1990). How best to teach women breast self-examination. A randomized controlled trial. Ann Intern Med. 112(10):772-9.

Kerlikowske K. et al. (1995). Efficacy of screening mammography. A meta-analysis. JAMA. 273(2):149-54.