Breast cancer is one of the most “visible” cancers in our society, with organizations and events devoted to finding a cure and advancing treatments being extremely prevalent. And it’s no surprise: According to the Centers for Disease Control and Prevention (CDC), not counting some forms of skin cancer, breast cancer is the most common cancer in women in the United States. And according to estimates from the American Cancer Society, nearly 253,000 new cases of invasive breast cancer will be diagnosed in women in 2017.
The good news? Survival rates continue to rise in breast cancer patients (there are currently more than 3.1 million survivors in the U.S.) And a huge part of continuing that trend is early detection. “Finding breast cancer early and starting treatment as soon as possible is key to a patient’s overall success and health,” says Lydia Liao, a radiologist and director of the Breast Imaging Center at Mount Sinai Radiology Associates West in New York City.
In fact, according to the American Cancer Society, while the five-year relative survival rate for women with metastatic, or stage four breast cancer is 22 percent, that number jumps to nearly 100 percent for women with stage 0 or stage 1 breast cancer. (Worth noting: The American Cancer Society points out that, because treatments are constantly improving, it’s possible the prognoses are even better than those statistics — which are necessarily based on patients who were treated at least five years ago — indicate.)
Here’s what you should know about breast cancer detection, screenings, and signs.
1. It may be worthwhile to start self-exams in your 20s.
Though there are some conflicting views on whether or not people should perform self exams, and the American Cancer Society states that research hasn’t shown “a clear benefit,” Liao still recommends doing them, starting when you’re 20 years old. “I think if breast self examination (BSE) is performed properly, it has value for early breast cancer detection,” she says.
Keep in mind, though, that self exams are not substitutes for clinical screenings. But BSEs are a good way to get to know your breasts and be attuned to the (common) changes that occur over the years. “Most women will have some lumps or lumpy breasts, and most of those lumps are not cancer,” Liao says. “Only 20% of those with suspicious lumps turn out to be breast cancer.” She recommends keeping a journal or even drawing a diagram or “map” of your breasts so you can keep track of what you feel each month and can more easily identify new findings.
Liao recommends you perform a self exam once a month, and aim for several days after your period ends, “when the breasts are least likely to be swollen and tender.” (If you don’t get a regular period, she says to set a day to conduct your BSE and do it the same day each month.) Do the exam in front of the mirror and use the opposite hand in circular motions to feel for any abnormalities in the breast itself, as well as your armpit, which is also home to lymph nodes, where breast cancer can spread. Johns Hopkins Medicine Breast Center recommends doing the exam standing up and lying down, so you get to know the feeling of your breasts in different positions.
2. It’s important to check for lumps and other abnormalities.
The most common direction we hear for breast self exams is to feel for new lumps which, Liao notes, should be reported to your doctor regardless of size. But lumps aren’t the only thing you should be looking for. Liao points out that breast swelling (even without lumps), skin irritation (like a rash, redness, or scaling) or dimpling, breast or nipple pain, newly inverted nipples, and nipple discharge (other than breast milk) are all possible symptoms of breast cancer as well. If you’re experiencing any of those, make an appointment with your doctor. “[Some of] those are relatively non-specific, but when a patient has new, suddenly-occurring symptoms with no explanation, that needs to be examined,” she says.
3. Mammograms are crucial screenings.
Mammograms, which are X-rays of the breasts, are crucial in diagnosing breast cancer. The process itself involves having your breast compressed between two plates (to get a high-quality image) while the machine takes images from different angles. Today, some patients undergo 3D mammograms, or breast tomosynthesis, which Liao says are becoming increasingly more common and available. “Instead of looking at one [flat] picture, [a 3D mammogram] actually looks into the breast with multiple images of the breast at different angles,” she says. For example, she says breast cancer in a dense breast full of tissue is like an airplane in a sky full of clouds. With a flat picture, you may not be able to see the airplane, but with a 3D image, you can. “[The 3D mammogram] looks through layers of tissue to find something hiding within the breast tissue,” she says. “It does increase the power for detecting breast cancer.”
While self-exams help you get to know your breasts, they’re no substitution for mammograms, which can detect small lumps and abnormalities that you (or your doctor) may not be able to feel manually. “Annual mammograms can detect cancer early…before [breast cancer] can be palpated by the patient [during a] self breast examination,” Liao says.
Though there are varying guidelines as to when women should start getting these screenings, she agrees with those that state you should get your first mammogram by the age of 40. (If you have a family history of breast cancer, though, it’s advised to start getting mammograms even earlier. If you’re in that high-risk group, talk to your doctor about the best course of screening action for you.)
4. Some people undergo additional screenings as well.
When reviewing your mammogram pictures, Liao says the doctor will look for calcifications (calcium deposits), masses, and any sort of distortion. If any of those are found, the doctor will likely follow up with a diagnostic mammogram(using a different technique from a screening mammogram) and breast ultrasound for assessment. If a diagnostic exam confirms the suspicious finding, a needle biopsy can be performed to ensure an accurate diagnosis.
And if the mammogram is inconclusive, Liao says your doctor may follow up with an MRI (magnetic resonance imaging) or an ultrasound as well, which can provide an even clearer image. “[An MRI] has the ability to detect breast cancer at a very early stage, [even] when there is no mammographic finding,” she says. If a patient is at high-risk for breast cancer, an MRI may be used as a regular screening tool, along with the yearly mammogram. And if a patient has dense breasts, a breast ultrasound may be used in regular screening as well — but, as the American Cancer Society points out, ultrasounds can reveal more findings that aren’t cancer and lead to unnecessary testing.
“The most important thing [to remember] is breast cancer detection cannot be done only by one thing, like a self- breast examination,” Liao says. “It has to be combined with screening tools when the patient is at the right age, so the breast cancer can be detected…when it’s small and before it spreads to other parts of the body. The key point is to make sure that cancer is diagnosed at an early stage so it can be treated completely.”
As with any medical concern, it’s important to have an open dialogue with your doctor — whether you simply want more information on preparing for tests like these or feel like you’ve detected something potentially concerning. Rather than fret or fear, make that call, schedule that appointment, and put your health first.