Health Watch: Breast Cancer Screening

Dr. Brett Parkinson with Mountain Medical breaks down the recommendations.


A breast cancer screening examination is a test which detects disease in a patient who has no symptoms. Mammography is the only screening test that has been shown to actually decrease the death rate from breast cancer.
The goal of screening mammography is to find cancers before they cause symptoms, or can be felt on clinical or self breast examination. When cancers are detected during screening examinations, they tend to be smaller and are more likely to be confined to the breast. Prognosis is dependent on size and whether or not the cancer has spread to other parts of the body.

If women adhere to the American Cancer Society’s guidelines for breast cancer screening, they will dramatically decrease their chances of dying from the disease.

Breast Cancer Guidelines:

20-30 years old

-Clinical breast exam every 3 years

-Self breast exam (optional)

40 & older

-Annual screening mammogram

-Annual clinical breast exam

High Risk Women:

-Annual MRI and Mammogram

Who is considered “High Risk”?

• Women with the breast cancer gene (BRCA 1 or BRCA 2)

• First-degree relative (mother, daughter or sister) of BRCA carrier, but herself untested

• Radiation treatment to chest between the ages of 10 and 30

• Certain rare syndromes: Li-Fraumeni, Cowden and Bannayan-Riley-Ruvalcaba

Women with dense breast tissue, women for whom mammography may be limited, should not be screened with MRI. There is no evidence that MRI will actually decrease the death rate in this particular subset of women. Moreover, since the pre-test probability of finding a cancer in this group is low–as opposed to the high-risk women–the chances of a false positive result are not insignificant, and may lead to unnecessary biopsies.

Although there is an ongoing clinical trial sponsored by the American College of Radiology investigating this very issue, there is still no long-term data that suggest that screening breast ultrasound saves lives. Currently, ultrasound is a useful adjunct to mammography, principally in evaluating abnormal mammographic findings and characterizing palpable lumps that cannot be seen on a mammogram.

Self Breast Exams: What to Look For

• Lumps or swelling

• Skin irritation or dimpling

• Nipple pain or retraction (turning inward)

• Redness or scaliness of the nipple or breast skin

• A clear or bloody nipple discharge

Keep in mind women with implants can still be screened. Even though the implants may obscure some tissue, mammograms–using special positioning techniques–can still be performed on augmented breasts.

Analog or film mammography is still considered acceptable for the general population

Digital mammography has conclusively been shown to be superior in detecting pre-clinical breast cancers in three sub-groups: Women with dense breasts; pre-or peri-menopausal women; and women over 50.

Digital mammography, contrary to the perception of some, still uses radiation and compression.

After a slow, but steady increase in the incidence of breast cancer over many years, there has been a new, and somewhat startling development: an actual decline in the recorded incidence of breast cancer in the United States. Initially some felt that the decrease was due to a decline in the utilization of screening mammography. Indeed, there has been a slight decrease in the number and percentage of eligible women undergoing screening over the last few years. However, a new study, just published in the Journal of the National Cancer Institute (5 September 2007) demonstrated that was a substantial decline in the incidence of invasive breast cancer, which was not linked to a decline in screening. Rather, the decrease was attributed to a sharp drop off in the use of hormone replacement therapy that occurred between 2001 and 2003. The data was collected from four screening mammography registries and included 603,411 screening exams, performed between January 1997 and December 2003.

Additional Information:



Mountain Medical Physician Specialists is a partnership of over 50 board-certified radiology and vascular professionals providing patients along the Northern Wasatch Front with the latest imaging and vascular care available. Mountain Medical professionals specialize in vascular surgery, vascular and interventional radiology, CT, neuroradiology, orthopedic imaging, MRI, women’s imaging, ultrasound, nuclear medicine and body imaging.

For more information visit

Add comment