Clinical breast exam
Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam.
During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you miss when you examine your own breasts and will also look for enlarged lymph nodes in your armpit (axilla).
Yet mammograms aren't perfect. About 10 percent to 15 percent of breast cancers - sometimes even lumps you can feel - don't show up on X-rays (false-negative result). The rate is higher - about 25 percent - for women in their 40s. That's because women of this age and younger tend to have denser breasts, making it more difficult to distinguish abnormal from normal tissue.
At other times, mammograms may indicate a problem when none exists (false-positive result). This can lead to unnecessary biopsies, fear and anxiety, as well as to increased health care costs. Even so, the consensus has been that if mammography saves lives, then all eligible women should be screened.
That assumption has been challenged in recent years - especially by a 2001 analysis of several large, long-term studies that raised questions about the benefit of mammography screening for breast cancer. The report concluded that several prior studies didn't clearly show that screening mammograms result in fewer deaths from breast cancer. This led to great confusion about mammography for both women and doctors.
But a study published in April 2003, in which researchers followed more than 200,000 Swedish women for 20 years, hopes to end the confusion. That study found that mammogram screening does indeed reduce breast cancer mortality for women between the ages of 40 and 69 - by as much as 28 percent. What's more, the study's authors say that mammography screening along with improved treatments can halve the number of deaths from breast cancer.
In May 2003, the American Cancer Society issued updated guidelines on breast cancer screening, strongly reaffirming its recommendation that women 40 and older have annual mammograms. Additional American Cancer Society screening guidelines include the following:
If you're in your 20s or 30s, have a clinical breast exam every three years, and have one annually if you're 40 or older.
Know how your breasts normally feel and report any changes to your doctor. Starting in your 20s, breast self-examination is an option.
If you're at greater risk of breast cancer due to a family history, genetic makeup or past breast cancer, talk with your doctor. You may benefit from more frequent exams, earlier mammography or additional tests.
During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes the X-rays. The whole procedure should take less than 30 minutes. You may find mammography somewhat uncomfortable. If you have too much discomfort, inform the technician. If you have tender breasts, schedule your mammogram for a time after your menstrual period. Avoiding caffeine for two days before the test also helps reduce breast tenderness.
Also available at some mammography centers is a soft, single-use, foam pad that can be placed on the surface of the compression plates of the mammography machine, making the test kinder and gentler. The pad doesn't interfere with the image quality of the mammogram.
If possible try to schedule your mammogram around the same time as your annual clinical exam. That way the radiologist can specifically look at any changes your doctor may discover.
Most importantly, don't let a lack of health insurance keep you from having regular mammograms. Many state health departments and Planned Parenthood clinics offer low-cost or free screenings. So does the Encore Plus program available through many YWCAs.