Breast Cancer Screening and Awareness

By Robyn Fuller-Christenson, DNP
Medically reviewed
October 27, 2021

American Cancer Society (ACS)

  • Age: 40 to 44 (patient’s choice), Frequency: Yearly
  • Age: 45 to 54, Frequency: Yearly
  • Age: 55 and over as long as in good health, Frequency: Every 2 years, or yearly if patient chooses.

National Comprehensive Cancer Network (NCCN)

  • Age: 40 years, Frequency: Yearly, as long as woman is in good health

U.S. Preventative Task Force

  • Age: 40 to 49, shared informed decision making with healthcare provider including frequency.
  • Age: 50 to 74, Frequency: every 2 years

American Congress of Obstetricians and Gynecologists (ACOG)

  • Age: Offered screening at age 40 after shared informed decision making
  • Age: Screening should start by age 50, Frequency: every 1 to 2 years
  • Age: 55 to 75 (decision to discontinue after 75 should be shared decision making, based on woman’s health and longevity), Frequency: every 2 years is reasonable to reduce harm

Studies show that in women with no symptoms of breast cancer, regular annual screening mammography has lowered the death rate by 30 percent.

Why the Differences in Screening Guidelines?

The purpose of screening mammography is to catch the disease in healthy individuals with no symptoms, to improve outcomes, and to decrease needs for extensive treatments.

There are risks and benefits of mammography. Therefore, when determining to screen different organizations have varying opinions on the balance of the risk versus benefits analysis.

These opinions are mainly based on independent studies conducted by each organization.

Benefits of Screening Mammography

  • Reduced death rates from breast cancer
  • Reduced rates of advance breast cancer (stages 2B or higher) in women aged 50 years and older
  • Assumed reduced need for advanced treatment since catching cancer at earlier stage

Potential Risks of Screening Mammography

  • False Positive Test Results- Callbacks for more imaging and follow up biopsies found to be non-cancerous (Most likely to happen to women aged 40-49 and during first mammogram)
  • Discomfort During Procedures-many women report some degree of pain but not to the degree to prevent them from having future mammograms
  • Anxiety and Stress-persisted in women despite negative follow up testing and these women were less likely to return for follow up screening mammograms
  • Overdiagnosis and Overtreatment-finding a cancer that is slow growing or that may not have become symptomatic and then treating that cancer unnecessarily (this is based on research that is not verifiable and better tools are needed to confirm this assumption)
  • Radiation Exposure- mammography radiation induced cancer; however, the benefit of annual screening is 60-fold times greater than the risk of acquiring cancer from mammography radiation exposure

It is important to engage in shared decision-making with your healthcare provider to determine which screening schedule is best for you based on your history and personal choice.

Things that May Affect Mammogram Results

Vaccinations

During this Covid 19 pandemic, many individuals have received at least one dose if not both doses of the Covid 19 vaccine.

Enlargement of lymph nodes under the arm is a common side effect of the vaccine.

This can be problematic when having a mammogram as lymph node enlargement can be a sign of breast cancer and lead to additional imaging, testing, and patient anxiety.

Therefore, the recommendation per the Society of Breast Imaging is:

  • Screening Mammogram: Unvaccinated: Schedule mammogram prior to first dose of Covid 19 vaccine
  • Partially or Fully Vaccinated: Schedule mammogram 4 to 6 weeks after last dose of Covid 19 vaccine (allows lymph nodes time to return to normal size)
  • Diagnostic Mammogram: If you are having symptoms do not delay
  • Other vaccines that can cause similar symptoms include shingles, flu, pneumonia, DTAP/TdaP, as well as receiving more than one vaccination at a time. If receiving screening mammogram, please follow the recommended guidelines above.

Breast Implants

It is safe to receive a mammogram while having breast implants; however, it may be harder to detect any abnormalities as breast implants can hide breast tissue.

Please call ahead and attempt to find a center skilled in working with individuals with breast implants and remind the mammographer the day of your appointment so that she properly positions you and captures four images instead of the traditional two images.

Dense Breast Tissue

Women with dense breasts have a higher risk of developing breast cancer.

It is also harder to find cancerous masses in dense breasts on mammograms.

Some state laws require patients to be notified if they have dense breast tissue, so please follow up with your healthcare provider to find out your state law regarding notification of dense breast tissue.

If you have a history of dense breast tissue and have an appointment with a new healthcare provider, please be sure to inform the provider so that the proper mammogram (Digital or Tomosynthesis) is ordered for you.

Breastfeeding

Breastfeeding makes breast tissue appear denser on mammograms; therefore, it is best to stop breastfeeding prior to a screening mammogram.

If you are due for a screening, please follow up with your healthcare provider to discuss the best timing.

If you have concerning findings in your breast while breastfeeding, follow-up with your healthcare provider immediately.

Healthcare Provider Follow-Up Mammogram

  • Please follow up with a healthcare provider if you have questions about your personal risk factors for breast cancer and when and how often you should receive a mammogram
  • If you have concerns about any abnormal changes in your breasts 
  • If you receive an abnormal result on your mammogram or any breast imaging or testing

Risk Factors for Breast Cancer

Factors That Cannot Be Changed

  • Age-Most breast cancers occur in women older than 50
  • Reproductive history- Early menstrual periods before 12 and late menopause after age 55 (women exposed to hormones longer)
  • Having dense breast- makes it harder to see tumors on mammograms
  • Genetic Mutations- inherited changes BRCA1 and BRCA2
  • Personal history of breast cancer- likely to develop breast cancer a second time
  • Family history of breast or ovarian cancer
  • Previous Radiation Therapy to Chest- Particularly Hodgkin’s Lymphoma Patient’s who were treated under 30 years of age
  • Women who took the drug diethylstilbestrol (DES), while pregnant as well as their children between 1940-1971

Factors that Can be Changed

  • Obesity- especially after menopause
  • Lack of exercise or physical activity
  • Hormone Replacement Therapy (HRT)- taken during menopause particularly with estrogen and progesterone
  • Reproductive History-First pregnancy after 30, no full-term pregnancies, not breastfeeding
  • Smoking
  • Drinking excessive alcohol

Signs and Symptoms of Breast Cancer

  • Feeling a lump or mass
  • Swelling of all or part of breast even if no lump felt
  • Breast or Nipple pain
  • Nipple Discharge (other than breastmilk)
  • Nipple Retraction (turning inward)
  • Breast or Nipple skin that is red, dry, flaking, or thickened
  • Skin Dimpling (can look like an orange peel)
  • Swollen lymph nodes (sometimes cancer can spread to areas under the arm and along the collarbone causing swelling before lump or mass can be felt)

What Does A Lump In My Breast Feel Like?

Breasts, in general, are lumpy and some women have lumpier breasts than others.

The lumpiness of the breasts can also change with where you are in the menstrual cycle. If the lump feels the same as the rest of your breast tissue and the other breast, then it is most likely normal breast tissue. 

Lumps that feel harder or different from the rest of your breast tissue or the other breast should be checked out by a healthcare provider as they may be a sign of cancer or other non-cancerous findings such as a cyst or fibroadenoma.

What Do I Do If I Find A lump?

First, most lumps found in the breast are not cancerous, so try not to panic.

Next, determine if the lump feels different from the rest of your breast tissue or the tissue in the other breast.

If you notice there is a change and it feels different, schedule an in-person appointment with your healthcare provider. 

Your healthcare provider may perform a clinical breast exam at your visit and will ask you where you felt the lump.

Next, you may have some imaging order such as an ultrasound and/or mammogram.

Based on the results from your in-person exam and possible imaging the next steps in your treatment plan will be determined.

When to See A Healthcare Provider For Breast Concerns

  • Lump, hard knot or thickening inside the breast or underarm area
  • Find a new lump (or any change) that feels different from the rest of your breast
  • Find a new lump (or any change) that feels different from your other breast
  • Swelling, redness, warmth, or darkening of the breast
  • Change in the size or shape of the breast
  • Puckering or dimpling of the skin (think orange peel)
  • Itchy, sore, scaly or rash on the nipple
  • Pulling in on various parts of breast or the nipple
  • Nipple discharge that starts suddenly
  • New pain in one spot that doesn’t go away even after menstrual period (if not menopausal)
  • Feel something that’s different from what you felt before
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Robyn Fuller-Christenson, DNP

K Health-affiliated clinician Robyn Fuller-Christenson, DNP, is a double board-certified Family and Women’s Health Nurse Practitioner with over 7 years of primary care, urgent care, and obstetrics and gynecology experience. Prior to becoming a nurse practitioner, Robyn spent over 4 years working as a certified operating room registered nurse in various level one trauma centers across the country. She received her bachelor’s degree from Baylor University. She then attended Vanderbilt University where she obtained her master’s degree in family nurse practitioner, doctor of nursing practice degree, and a postgraduate certificate in women’s health nurse practitioner.