There is a considerable amount of uncertainty surrounding the guidelines for breast cancer screening, which leads to a great deal of anxiety among women. Here are the guidelines by age that I recommend at the National Breast Center:
Under 20: Generally, only self-exams are recommended at this age. Any symptom of skin changes, constant pain, or a lump in the breast or armpit area should be evaluated by a breast specialist. For specific symptoms, breast ultrasound is the best initial test — it takes seconds, is painless, and has no radiation. If this doesn’t properly explain your concern then using other tests such as mammogram or MRI may be needed. Women with a family history of breast cancer, especially those with gene (e.g. BRCA) carriers should consult with a breast specialist for testing and discussion of screening options. Women with prior radiation to the chest area also need to be seen by a breast specialist to discuss proper screening.
20-39: Same as above but add a clinical exam by your primary care (they must be comfortable and experienced in doing it) or screening specialist (such as our nurse practitioner) at least every other year in your 20s and every year in your 30s. Mammogram and possibly ultrasound or MRI may be needed if there are genetic factors (e.g. BRCA gene carriers) or family history of a primary relative (mother or sister) who developed breast cancer under the age of 50. Breast cancer risk is increasing in women under 40, so it is critical to attend to any new symptom or issues that increase your risk.
40-plus: Same as above but now clinical exams occur every year. Mammograms also start at this age unless done earlier as mentioned above. If your mammogram shows you have dense tissue then you need to consult with a specialist about additional screening such as automated whole breast ultrasound (we use the SonoCiné system). If you have multiple risk factors including things like family history and personal history of prior breast biopsies, additional screening either with ultrasound or MRI should be discussed. Age alone should not limit screening but it is appropriate to discuss with your doctor if you need to continue screening based upon medical conditions that may shorten life expectancy.
Screening for breast cancer is a collaborative effort between a woman, her practitioner, and various methods of breast imaging. It all begins with a personalized assessment of risk because not everyone should be screened the same. Some women have elevated risk due to personal or family history. We use four categories of screening based upon factors such as age, personal history, family history, and breast density. This makes screening easier and consistent and helps us save lives.
Many women, however, don’t have access to proper screening, diagnosis and education about breast cancer. Our area has the highest incidence and mortality rate from breast cancer in the nation, and one of the highest rates of late stage breast cancer in the country. I founded the National Breast Center Foundation to address this crisis by removing the barriers that prevent that access. Our goal is to promote the importance of and provide the access to the screening that will shift the curve of the stage of diagnosis, increasing the survival rate from breast cancer.
For information on the National Breast Center Foundation, please visit www.nationalbreastcenterfoundation.org or contact Executive Director Martha Carucci at Martha.carucci@nationalbreastcenter.org.
Saving lives starts with you!
Dr. David Weintritt is a board certified breast surgeon and founder of the National Breast Center.