The need for breast exams
Katherine McCuaig, MD, practices at Banner Baywood Medical Center in Mesa.
Question: My screening mammogram was negative, but my doctor says I need a breast exam. Why?
Answer: Breast cancer is the most common cancer in American women and approximately one in eight women will be diagnosed with breast cancer in her lifetime.
A screening mammogram is one of the most useful methods doctors have to detect breast cancer at an early, treatable stage, but it is not infallible. Approximately 10 to 20 percent of breast cancers are not identified by mammography. Moreover, a mammogram is less sensitive in dense, fibroglandular breasts, which are common in young women.
Therefore, all clinical abnormalities need evaluation, even if the mammogram is negative. These include:
- breast lumps
- skin retraction
- spontaneous nipple discharge
- skin changes such as redness and thickening
Further studies, including an ultrasound, ductogram (an x-ray with injection of contrast into a nipple duct) and an MRI may be used to investigate these abnormalities in more detail and a biopsy may be necessary to rule out cancer.
The American Caner Society recommends a clinical breast exam every three years for women 20 to 39 years of age, and an annual clinical exam and mammogram for women 40 years of age and older. Any abnormalities identified by a patient should be reported to her doctor.
Higher risk women, such as those with a mother or sister with premenopausal breast cancer, should start screening before the youngest age breast cancer was diagnosed in the family.