5 things to know about early breast cancer detection

One in eight women will develop invasive breast cancer in their lifetime, according to the American Cancer Society. Regular screenings can help detect cancerous growths early, when they are small and haven’t spread to other areas of the body. This is also when they’re easiest to treat.

Ashley Zilles, DO, a breast surgeon at M Health Fairview Breast Center – Maplewood and Jessica Kuehn-Hajder, MD, a radiologist and medical director of M Health Fairview breast imaging, share five things to know about early breast cancer detection.

Early breast cancer diagnoses come from screening mammograms

Most early cancer diagnoses are made through screening mammograms. This type of mammogram, or an X-ray of the breast, is done preventively. Diagnostic mammograms, however, are used when someone notices a change, like a lump in their breast.

“Mammography is the one screening tool that we know, based on prospective randomized controlled trials, reduces mortality from breast cancer,” Kuehn-Hajder said. “We have other detection tools too, like ultrasound and MRI, that can do a really good job as well. They can be really sensitive for finding any cancer, but the studies aren't there like they are with mammography."

Current medical guidelines recommend that people assigned female at birth who are at average risk of developing breast cancer start getting mammograms every 1 to 2 years beginning at age 40. This helps catch cancer at an early stage. M Health Fairview uses 3D mammograms that can find more cancers than the older 2D machines and reduce the likelihood of getting called back for something that isn’t cancer.

“It can be scary going in for a first mammogram,” Zilles acknowledged. “You're going to find all kinds of stories of people talking about how painful it was, or they got bruises, or it popped their implant. For most people it's painless, it's only slightly awkward.”

Since breasts are often sensitive before your period, scheduling your mammogram for right after might reduce the pain.

You might need mammograms before age 40

In your 20s, your doctor might look at your lifetime breast cancer risk based on your personal and family history. The assessments help determine when you should start getting mammograms or if you should consider genetic testing to see if you carry a gene that could increase your risk of breast and ovarian cancers.

“If we don't start paying attention to a risk of breast cancer until they're 40, we might have missed a period of time where a woman would have benefited from doing more diligent, dedicated, focused screening,” Kuehn-Hajder said.

If you have a close relative – like a biological mother or sister – who had breast cancer, guidelines recommend starting screening 10 years before the age when your relative was diagnosed, or at age 40, whichever comes first.

Breast density can hide cancer

Your mammogram report will include one of four ratings indicating how dense your breast tissue is: almost entirely fatty, scattered areas of fibroglandular density, heterogeneously dense, or extremely dense. 

Dense tissue includes normal breast components, such as blood vessels, milk ducts, and lymph nodes. That dense tissue shows up white in a mammogram, as does cancer. Fatty tissue, however, appears gray. 

Kuehn-Hajder used an analogy of finding a white dog in a field in the summer compared to the winter. Finding cancer in a fatty breast is easier than finding cancer in a dense breast, just like finding a dog in a green field is easier than finding a white dog in a snowy field. But in the same way there are signs of a white dog’s presence in the snow– like movement or paw prints in the snow – signs of cancer can also be visible on a dense mammogram. So it's recommended that even women with dense breast tissue should keep those mammogram appointments.

Notification of having dense breast tissue is an opportunity to talk to your doctor about which form of screening would be most beneficial for you. If you have an increased risk of breast cancer and dense breasts, your doctor might recommend additional screening, like an MRI or contrast-enhanced mammography.

Kuehn-Hajder said that people with dense breasts might have a slightly higher risk of breast cancer, but research on that is limited.

Notice something different? Get screened

Breast cancer doesn’t always start with a noticeable lump. Sometimes the tumor is so tiny that it can’t be felt. 

Early symptoms could include:

If you notice symptoms, tell your healthcare provider and get a mammogram, even if you just had one.

“As soon as someone finds something new, then that old screening mammogram gets thrown out the window and it's time to get an updated mammogram,” Zilles said.

Kuehn-Hajder recommended annual mammograms and becoming aware of what is normal for your body. While breast screenings can be frustrating or cause anxiety, they can also save your life. Just because one mammogram was clear, or one biopsy was negative doesn’t mean the next one will be.

Survivability is good