Breast Cancer Screening and Early Detection

What Approach to Breast Cancer Screening Is Right For Me?  

Breast cancer is the second leading cause of cancer death in women in the United States. The five-year relative survival rates for all stages of breast cancer combined are 91%, according to the American Cancer Society. This rate is thanks to the increased prevalence of early detection through varying forms of breast cancer screening. 

Since screening was introduced, breast cancer mortality rates have decreased significantly. The COVID-19 pandemic, however, caused a decline in screening rates in recent years—a concerning trend to those who screen for and treat breast cancer. Melissa Reichman, M.D., assistant attending radiologist at NewYork-Presbyterian Hospital/Weill Cornell Campus, encourages all women to look into the screening options available to them. 

“Screen-detected cancer can lead to less extensive surgeries and treatment for the patient,” Dr. Reichman says. “The American College of Radiology recommends annual mammography screening starting at age 40 for women of average risk for developing breast cancer.” 

Women of average risk are defined as women who: 

  • Do not have a personal or family history of breast cancer. 
  • Do not have a history of chest radiation.  
  • Do not have a genetic mutation that increases the risk of breast cancer (the BRCA gene mutation, for example). 

Your doctor can help you determine the best approach to screening for your personal risk level. 

Should I Be Screened for Breast Cancer? 

More than 70% of women who die from breast cancer in their 40s are part of the 20% of women who don’t receive breast cancer screenings, according to Dr. Reichman. While the U.S. Preventive Services Task Force (USPSTF) recommendations say to start at age 40, she recommends erring on the side of caution. Breast cancer rate increases as a woman ages, and early detection can lead to early—and often successful—treatment.  

“The USPSTF uses limited, older data that basically underestimates mortality reduction gain from screening,” Dr. Reichman says. “All studies acknowledge that this screening mammography does reduce mortality in women, and that screening every year, starting at age 40, would save the most lives.” 

The most common type of breast cancer screening is mammography. Many providers now choose to use three-dimensional (3D) mammography to get a clearer look at the structures inside the breast for a more accurate result.  

“A 3D mammogram, also known as breast tomosynthesis, is an imaging test that combines multiple breast X-rays, taken at different angles, and creates a three-dimensional picture of the breast,” Dr. Reichman says. “This is compared to the conventional mammogram, which is a 2D picture of the breast. Tomosynthesis can decrease recall rates and the need for follow-up imaging, can detect slightly more cancers than a 2D mammogram, and really improve breast cancer detection in dense breast tissue.” 

Patients at Weill Cornell Medicine will receive their results in a timely manner. Upon the finalization, they can access their report and view images via Weill Cornell Connect. We are also available via phone should patients need additional assistance.

Women are also encouraged to do periodic breast self-exams at home. Being familiar with the look and feel of your breasts helps you detect any changes—any new lumps, pain or redness, for example—that might be of concern. If you find anything during these self-checks, you can then make an appointment with your doctor for further screening at that time, rather than waiting to be screened at your yearly appointment. 

Supplemental Options for Breast Cancer Screening 

Dr. Reichman notes that women at higher risk can benefit from starting screening earlier and utilizing supplemental types of screening. In addition to other factors already noted, breast cancer risk can be higher in certain populations. 

“I’d like women, especially Black women and those of Ashkenazi Jewish descent, to know they should be evaluated for breast cancer risk no later than [age] 30,” Dr. Reichman says, “so that if they are at higher risk they can be identified and can benefit from supplemental screening.”  

Supplemental screening modalities include: 

  • Breast magnetic resonance imaging (MRI): Much like MRIs in other parts of the body, a breast MRI uses radio waves and magnets to create a detailed image of the structures inside the breast. For women at high risk or with dense breast tissue, pairing a breast MRI with 3D mammography helps to provide early detection. However, a breast MRI can also highlight things that end up not being cancer, which is why it isn’t recommended as a solo screening method. Breast MRIs are useful for determining the stage of already-diagnosed breast cancer.  
  • Breast ultrasound: While breast ultrasound is another method that isn’t used as a standalone screening option, it can provide a closer look at concerning lumps or other changes. The sound waves and echoes used during this imaging study can highlight areas like cysts that might be more difficult to detect on a regular mammogram. 

Determining the screening methods and frequency that are best suited to your personal level of risk is a conversation for you and your doctor. At the end of the day, the overarching goal is simply this—if there’s something to be concerned about, screening allows your doctor to find it and jump on a treatment plan quickly.   

“If you remember one thing from this conversation,” Dr. Reichman says, “the goal of screening is to find cancer as early as possible and to save as many lives as possible.” 

Talk to your primary care provider about the right approach to breast cancer screening for your risk level. Find a provider today.