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Surgery to Reduce the Risk of Breast Cancer

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Surgery to Reduce the Risk of Breast Cancer

Breast Cancer Treatment

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Surgery to Reduce the Risk of Breast Cancer

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Breast Self-Exam (BSE)

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What Kinds of Surgery Can Reduce the Risk of Breast Cancer?

Two kinds of surgery can be performed to reduce the risk of breast cancer in a woman who has never been diagnosed with breast cancer but is known to be at very high risk of the disease.

A woman can be at very high risk of developing breast cancer if she has a strong family history of breast and/or ovarian cancer, a deleterious (disease-causing) mutation in the BRCA1 gene or the BRCA2 gene, or a high-penetrance mutation in one of several other genes associated with breast cancer risk, such as TP53 or PTEN.

The most common risk-reducing surgery is bilateral prophylactic mastectomy (also called bilateral risk-reducing mastectomy). Bilateral prophylactic mastectomy may involve complete removal of both breasts, including the nipples (total mastectomy), or it may involve removal of as much breast tissue as possible while leaving the nipples intact (subcutaneous or nipple-sparing mastectomy). Subcutaneous mastectomies preserve the nipple and allow for more natural-looking breasts if a woman chooses to have breast reconstruction surgery afterward. However, total mastectomy provides the greatest breast cancer risk reduction because more breast tissue is removed in this procedure than in a subcutaneous mastectomy.

Even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed. The chest wall, which is not typically removed during a mastectomy, may contain some breast tissue, and breast tissue can sometimes be found in the armpit, above the collarbone, and as far down as the abdomen—and it is impossible for a surgeon to remove all of this tissue.

The other kind of risk-reducing surgery is bilateral prophylactic salpingo-oophorectomy, which is sometimes called prophylactic oophorectomy. This surgery involves removal of the ovaries and fallopian tubes and may be done alone or along with bilateral prophylactic mastectomy in premenopausal women who are at very high risk of breast cancer. Removing the ovaries in premenopausal women reduces the amount of estrogen that is produced by the body. Because estrogen promotes the growth of some breast cancers, reducing the amount of this hormone in the body by removing the ovaries may slow the growth of those breast cancers.

Source: National Cancer Institute (NCI)

Additional Materials (9)

4:55

Prophylactic Mastectomy and Breast Reconstruction: Kerry’s Story

Center for Restorative Breast Surgery/YouTube

4:04

What is a Prophylactic Mastectomy?

Breast Cancer Answers®/YouTube

4:04

Prophylactic Mastectomy

Breastcancer.org/YouTube

2:55

Bilateral Prophylactic Mastectomy Surgery — Mayo Clinic

Mayo Clinic/YouTube

1:50

Prophylactic Mastectomy

Lee Health/YouTube

3:10

What to Expect Following Bilateral Prophylactic Mastectomy Surgery — Mayo Clinic

Mayo Clinic/YouTube

1:56

Previving cancer: Ashley Cenk's story

Cleveland Clinic Martin Health/YouTube

1:46

Positive BRCA Options

Sutter Health/YouTube

1:54

BRCA The Breast Cancer Gene

Lee Health/YouTube

Who Should Consider Surgery

Inheritance and Family Medical History

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Which Women Might Consider Having Surgery to Reduce Their Risk of Breast Cancer?

Women who inherit a deleterious mutation in the BRCA1 gene or the BRCA2 gene or mutations in certain other genes that greatly increase the risk of developing breast cancer may consider having bilateral prophylactic mastectomy and/or bilateral prophylactic salpingo-oophorectomy to reduce this risk.

In two studies, the estimated risks of developing breast cancer by age 70 years were 55 to 65 percent for women who carry a deleterious mutation in the BRCA1 gene and 45 to 47 percent for women who carry a deleterious mutation in the BRCA2 gene. Estimates of the lifetime risk of breast cancer for women with Cowden syndrome, which is caused by certain mutations in the PTEN gene, range from 25 to 50 percent or higher, and for women with Li-Fraumeni syndrome, which is caused by certain mutations in the TP53 gene, from 49 to 60 percent. (By contrast, the lifetime risk of breast cancer for the average American woman is about 12 percent.)

Other women who are at very high risk of breast cancer may also consider bilateral prophylactic mastectomy, including:

those with a strong family history of breast cancer (such as having a mother, sister, and/or daughter who was diagnosed with bilateral breast cancer or with breast cancer before age 50 years or having multiple family members with breast or ovarian cancer)
those with lobular carcinoma in situ (LCIS) plus a family history of breast cancer (LCIS is a condition in which abnormal cells are found in the lobules of the breast. It is not cancer, but women with LCIS have an increased risk of developing invasive breast cancer in either breast. Many breast surgeons consider prophylactic mastectomy to be an overly aggressive approach for women with LCIS who do not have a strong family history or other risk factors.)
those who have had radiation therapy to the chest (including the breasts) before the age of 30 years—for example, if they were treated with radiation therapy for Hodgkin lymphoma [Such women are at high risk of developing breast cancer throughout their lives.]

Source: National Cancer Institute (NCI)

Additional Materials (5)

1:00

Can you explain BRCA 1 and BRCA 2 genes?

Premier Health/YouTube

1:28

What is a BRCA Gene Mutation?

Centers for Disease Control and Prevention (CDC)/YouTube

4:08

Testing Positive for BRCA - Patient Story

Sutter Health/YouTube

3:12

BRCA Genes and Breast Cancer

Centers for Disease Control and Prevention (CDC)/YouTube

1:42

BRCA gene test Q & A

Mayo Clinic Health System/YouTube

Diagnosed With Breast Cancer

Breast Cancer and family history

Image by acousticsoul215/Pixabay

Can a Woman Have Risk-Reducing Surgery If She Has Already Been Diagnosed with Breast Cancer?

Yes. Some women who have been diagnosed with cancer in one breast, particularly those who are known to be at very high risk, may consider having the other breast (called the contralateral breast) removed as well, even if there is no sign of cancer in that breast. Prophylactic surgery to remove a contralateral breast during breast cancer surgery (known as contralateral prophylactic mastectomy) reduces the risk of breast cancer in that breast, although it is not yet known whether this risk reduction translates into longer survival for the patient.

However, doctors often discourage contralateral prophylactic mastectomy for women with cancer in one breast who do not meet the criteria of being at very high risk of developing a contralateral breast cancer. For such women, the risk of developing another breast cancer, either in the same or the contralateral breast, is very small, especially if they receive adjuvant chemotherapy or hormone therapy as part of their cancer treatment.

Given that most women with breast cancer have a low risk of developing the disease in their contralateral breast, women who are not known to be at very high risk but who remain concerned about cancer development in their other breast may want to consider options other than surgery to further reduce their risk of a contralateral breast cancer.

Source: National Cancer Institute (NCI)

Additional Materials (3)

2:11

Living with Metastatic Breast Cancer

Dr. Susan Love Foundation/YouTube

1:48

Lumpectomy & Mastectomy for Treating Breast Cancer - SLUCare Breast Surgery

SLUCare/YouTube

4:04

Prophylactic Mastectomy

Breastcancer.org/YouTube

Potential Harms of Surgery

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Matuschka's controversial self portrait baring her mastectomy combined with her face.

Image by Matuschka

What Are the Potential Harms of Risk-Reducing Surgeries?

As with any other major surgery, bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy have potential complications or harms, such as bleeding or infection. Also, both surgeries are irreversible.

Bilateral prophylactic mastectomy can also affect a woman’s psychological well-being due to a change in body image and the loss of normal breast functions. Although most women who choose to have this surgery are satisfied with their decision, they can still experience anxiety and concerns about body image. The most common psychological side effects include difficulties with body appearance, with feelings of femininity, and with sexual relationships. Women who undergo total mastectomies lose nipple sensation, which may hinder sexual arousal.

Bilateral prophylactic salpingo-oophorectomy causes a sudden drop in estrogen production, which will induce early menopause in a premenopausal woman (this is also called surgical menopause). Surgical menopause can cause an abrupt onset of menopausal symptoms, including hot flashes, insomnia, anxiety, and depression, and some of these symptoms can be severe. The long-term effects of surgical menopause include decreased sex drive, vaginal dryness, and decreased bone density.

Women who have severe menopausal symptoms after undergoing bilateral prophylactic salpingo-oophorectomy may consider using short-term menopausal hormone therapy after surgery to alleviate these symptoms. [The increase in breast cancer risk associated with certain types of menopausal hormone therapy is much less than the decrease in breast cancer risk associated with bilateral prophylactic salpingo-oophorectomy.]

Source: National Cancer Institute (NCI)

Additional Materials (6)

3:10

What to Expect Following Bilateral Prophylactic Mastectomy Surgery — Mayo Clinic

Mayo Clinic/YouTube

1:03

Sex After Mastectomy, A Survivor's Story

Breast Cancer Answers®/YouTube

3:19

Sex and relationships after having a mastectomy

Macmillan Cancer Support/YouTube

3:54

How Will My Breast Look and Feel after Breast Reconstruction Surgery?

Breast Cancer Answers®/YouTube

6:40

Menopause after salpingo-oophorectomy

Fondation cancer du sein du Québec/YouTube

1:19

How Surgical Menopause Affects Hormones By Menopause Doctor Louise Newson

balance Menopause/YouTube

Options for Women Who Are Not at Highest Risk

Tamoxifen Raloxifen

Image by Bill Branson (photographer)/National Cancer Institute

Cancer Risk Reduction Options for Women Who Are at Increased Risk of Breast Cancer But Not at the Highest Risk

Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer (that is, for those who do not carry a high-penetrance gene mutation that is associated with breast cancer or who do not have a clinical or medical history that puts them at very high risk). However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.

Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool (BCRAT), a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years (lifetime risk). Women who have an estimated 5-year risk of 1.67 percent or higher are classified as "high-risk," which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff (that is, an estimated 5-year risk of 1.67 percent or higher) is widely used in research studies and in clinical counseling.

Two drugs, tamoxifen and raloxifene hydrochloride, are approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of breast cancer in women who have a 5-year risk of developing breast cancer of 1.67 percent or more. Tamoxifen is approved for risk reduction in both premenopausal and postmenopausal women, and raloxifene is approved for risk reduction in postmenopausal women only. In large randomized clinical trials, tamoxifen, taken for 5 years, reduced the risk of invasive breast cancer by about 50 percent in high-risk postmenopausal women; raloxifene, taken for 5 years, reduced breast cancer risk by about 38 percent in high-risk postmenopausal women. Both drugs block the activity of estrogen, thereby inhibiting the growth of some breast cancers. The US Preventive Services Task Force (USPSTF) recommends that women at increased risk of breast cancer talk with their health care professional about the potential benefits and harms of taking tamoxifen or raloxifene to reduce their risk.

Another drug, exemestane, was recently shown to reduce the incidence of breast cancer in postmenopausal women who are at increased risk of the disease by 65 percent. Exemestane belongs to a class of drugs called aromatase inhibitors, which block the production of estrogen by the body. It is not known, however, whether any of these drugs reduces the very high risk of breast cancer for women who carry a known mutation that is strongly associated with an increased risk of breast cancer, such as deleterious mutations in BRCA1 and BRCA2.

Some women who have undergone breast cancer surgery, regardless of their risk of recurrence, may be given drugs to reduce the likelihood that their breast cancer will recur. (This additional treatment is called adjuvant therapy.) Such treatment also reduces the already low risks of contralateral and second primary breast cancers. Drugs that are used as adjuvant therapy to reduce the risk of breast cancer after breast cancer surgery include tamoxifen, aromatase inhibitors, traditional chemotherapy agents, and trastuzumab.

Source: National Cancer Institute (NCI)

Additional Materials (3)

2:21

Breast Cancer Risk Assessment Tool

AllHealthGo/YouTube

3:42

Hormone Therapy for Breast Cancer and the Side Effects of Tamoxifen

Seattle Cancer Care Alliance/YouTube

13:39

Hormonal Therapy for Breast Cancer: We Teach You

Breast Cancer School for Patients/YouTube

Women Who Do Not Want Surgery

Mammogram - The Noun Project

Image by By Healthcare Symbols - In the Health Care Symbols Collection

What Can Women at Very High Risk Do If They Do Not Want to Undergo Risk-Reducing Surgery?

Some women who are at very high risk of breast cancer (or of contralateral breast cancer) may undergo more frequent breast cancer screening (also called enhanced screening). For example, they may have yearly mammograms and yearly magnetic resonance imaging (MRI) screening—with these tests staggered so that the breasts are imaged every 6 months—as well as clinical breast examinations performed regularly by a health care professional. Enhanced screening may increase the chance of detecting breast cancer at an early stage, when it may have a better chance of being treated successfully.

Women who carry mutations in some genes that increase their risk of breast cancer may be more likely to develop radiation-associated breast cancer than the general population because those genes are involved in the repair of DNA breaks, which can be caused by exposure to radiation. Women who are at high risk of breast cancer should ask their health care provider about the risks of diagnostic tests that involve radiation (mammograms or x-rays). Ongoing clinical trials are examining various aspects of enhanced screening for women who are at high risk of breast cancer.

Chemoprevention (the use of drugs or other agents to reduce cancer risk or delay its development) may be an option for some women who wish to avoid surgery. Tamoxifen and raloxifene have both been approved by the FDA to reduce the risk of breast cancer in women at increased risk. Whether these drugs can be used to prevent breast cancer in women at much higher risk, such as women with harmful mutations in BRCA1 or BRCA2 or other breast cancer susceptibility genes, is not yet clear, although tamoxifen may be able to help lower the risk of contralateral breast cancer among BRCA1 and BRCA2 mutation carriers previously diagnosed with breast cancer.

Source: National Cancer Institute (NCI)

Additional Materials (5)

4:35

What is a mammogram and how often should I have it?

You and Breast Cancer/YouTube

1:18

What is a Mammogram?

Women's Care Florida/YouTube

1:08

Mammogram questions | Mercy Health

Bon Secours Mercy Health/Vimeo

2:08

Tamoxifen reduced breast cancer risk in chest-irradiated cancer survivors

VJOncology/YouTube

Chances of Developing Breast Cancer by Age 70

National Cancer Institute (NCI)

Mammogram

Mammogram

Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography

A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.

Mammogram

Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography

A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.

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Use the slider below to see how your results affect your health.
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Your result is Negative.
This score confirms that your mammogram results are negative, indicating that the breast tissue shows no signs of a mass or calcifications. However, it’s important to continue regular screening mammograms.
Related conditions
- Screening mammograms are done for women who have no symptoms of breast cancer. It usually involves two x-rays of each breast. Screening mammograms can detect lumps or tumors that cannot be felt. They can also find microcalcifications or tiny deposits of calcium in the breast, which sometimes mean that breast cancer is present.
- Diagnostic mammograms are used to check for breast cancer after a lump or other symptom or sign of breast cancer has been found. Signs of breast cancer may include pain, thickened skin on the breast, nipple discharge, or a change in breast size or shape. This type of mammogram also can be used to find out more about breast changes found on a screening mammogram, or to view breast tissue that is hard to see on a screening mammogram. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician can magnify a problem area to make a more detailed picture, which helps the doctor make a correct diagnosis.
A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:
- Long-distance consultations with other doctors may be easier because the images can be shared by computer.
- Slight differences between normal and abnormal tissues may be more easily noted.
- The number of follow-up tests needed may be fewer.
- Fewer repeat images may be needed, reducing exposure to radiation.
A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. Women ages 50 to 74 years should get a mammogram every 2 years. Women younger than age 50 should talk to a doctor about when to start and how often to have a mammogram.
Mammograms can not find all problems. So, every woman should work with her doctor to check her breasts. Call your doctor or clinic if you notice any change in your breasts like:
- a lump
- thickening
- liquid leaking from the nipple or changes in how the nipple looks
First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:
- If you are still having menstrual periods, try to avoid making your mammogram appointment during the week before your period. Your breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better.
- If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
- Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
- Don't wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
- If you have had mammograms at another facility, have those x-ray films sent to the new facility so that they can be compared to the new films.
- Tell the clinic if you have physical disabilities that may make it hard for you to sit up, lift your arms, or hold your breath.
- Talk with the staff about how they will handle issues of modesty that you may have due to your religion.

Breast tissue that shows no signs of a mass or calcifications is considered normal. Most abnormal findings on a screening mammogram turn out to be benign (not cancer) or nothing to worry about. New findings or changes must be further evaluated.

What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

Possible mammogram findings include:

Lumps (mass or tumor). Lumps come in different sizes and shapes. Fluid-filled cysts are usually smooth and rounded, with clear, defined edges and are not cancer. Lumps that have a jagged outline and an irregular shape are of more concern.
Calcifications. There are two types of breast calcifications, or calcium deposits:
- Macrocalcifications, which look like small white dots on a mammogram. They are often caused by aging, an old injury, or inflammation and are usually benign.
- Microcalcifications, which look like white specks on a mammogram. If found in an area of rapidly dividing cells or grouped together in a certain way, they may be a sign of DCIS or breast cancer.
Dense breast tissue: A dense breast has relatively less fat and more glandular and connective tissue. This mammogram finding is both common and normal, especially among younger women and women who use menopausal hormone therapy. Dense breast tissue can make a mammogram more difficult to interpret because both dense breast tissue and breast tumors appear as solid white areas in the image.

What happens if my mammogram is normal?

Continue to get mammograms according to recommended time intervals. Mammograms work best when they can be compared with previous ones. This allows the radiologist to compare them to look for changes in your breasts.

What happens if my mammogram is abnormal?

An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems. Doctors may order some of these tests:

Diagnostic mammogram, to focus on a specific area of the breast
Ultrasound, an imaging test that uses sound waves to create a picture of your breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.

What is the Breast Imaging Reporting and Database System (BI-RADS®)?

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.

Breast Imaging Reporting and Database System (BI-RADS)

Category	Assessment	Follow-up
0	Need additional imaging evaluation	Additional imaging needed before a category can be assigned
1	Negative	Continue regular screening mammograms
2	Benign (noncancerous) finding	Continue regular screening mammograms
3	Probably benign	Receive a 6-month follow-up mammogram
4	Suspicious abnormality	May require biopsy
5	Highly suggestive of malignancy (cancer)	Requires biopsy
6	Known biopsy-proven malignancy (cancer)	Biopsy confirms presence of cancer before treatment begins

BI-RADS also includes four categories of breast density that may be reported. The radiologist who reads the mammogram chooses the category that best describes the level of breast density seen on the mammogram film. The categories, from the least amount of breast density to the highest, are as follows:

The breasts are almost entirely fatty
There are scattered areas of dense glandular tissue and fibrous connective tissue (together known as fibroglandular density)
The breasts are heterogeneously dense, which means they have more of these areas of fibroglandular density. This may make it hard to see small masses in the breast tissue on a mammogram.
The breasts are extremely dense, which makes it hard to see tumors in the breast tissue on a mammogram.

Many states in the U.S. have enacted laws requiring mammography providers to tell women if they have dense breasts (i.e., breasts that are heterogeneously or extremely dense on a mammogram) and to inform them of risks associated with having dense breasts. In addition to making mammograms harder to read, dense breasts are a risk factor for breast cancer.

Although they are not perfect, mammograms are the best method to find breast changes that cannot be felt. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.
As with any medical test, mammograms have limits. These limits include:
- They are only part of a complete breast exam. Your doctor also should do a clinical breast exam. If your mammogram finds something abnormal, your doctor will order other tests.
- Finding cancer does not always mean saving lives. Even though mammography can detect tumors that cannot be felt, finding a small tumor does not always mean that a woman's life will be saved. Mammography may not help a woman with a fast growing cancer that has already spread to other parts of her body before being found.
- False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don't happen often. Younger women are more likely to have a false negative mammogram than are older women. The dense breasts of younger women make breast cancers harder to find in mammograms.
- False positives can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women, women who have had breast biopsies, women with a family history of breast cancer, and women who are taking estrogen, such as menopausal hormone therapy.
- Mammograms (as well as dental x-rays and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause cancer. The benefits nearly always outweigh the risk. Talk to your doctor about the need for each x-ray. Ask about shielding to protect parts of the body that are not in the picture. You should always let your doctor and the technician know if there is any chance that you are pregnant.
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Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (48)

Mammography Fact Sheet

Mammography is an x-ray imaging method used to examine the breast for the early detection of cancer and other breast diseases. It is used as both a diagnostic and screening tool.

Document by www.nibib.nih.gov

Mammograms

Document by Office on Women's Health, U.S. Department of Health and Human Services

Top Four Mammogram Myths

Knowing the truth about mammograms could help save your life, or the life of someone you love. Over 60% of breast cancer cases are diagnosed before they spread. Nearly 90% of women who find and treat their breast cancer are cancer-free at five years. Mammograms can help reduce the number of deaths from breast cancer among women ages 40 to 70.

Image by The U.S. Food and Drug Administration

Screening for Cancer

Common Screening Tests and American Cancer Society Recommendations

Image by TheVisualMD

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This media may include sensitive content

Mammography

A woman getting a mammogram, showing a cone in position on her right breast.

Image by National Cancer Institute / Unknown Illustrator

Mammography

Image by BruceBlaus

Sensitive content

This media may include sensitive content

Mammogram

An adult female is assisted in a mammogram machine by an African-American technician.

Image by National Cancer Institute / Alan Hoofring (Illustrator)

Woman Having Mammogram

Photograph of woman having mammogram. Mammograms are considered the gold standard for breast cancer screening. Mammography requires the breasts to be compressed between plates while the image is captured. Typically, two views are taken of the breast: cranial-caudal (top to bottom) and mediolateral oblique (angled side view).

Image by TheVisualMD

Mammography

Mammogram being conducted

Image by CDC

Woman Receives Mammogram

An African-American female technician positions a Caucasian woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

A Caucasian female technician positions an Asian woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

A Caucasian female technician positions a Hispanic woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

An Asian female technician positions an African-American woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Mammography Patient

A female technician prepares to give an older Caucasian female patient a mammogram. the patient is preparing for the exam next to machine with technician in background adjusting controls.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A woman's breast being compressed to get the optimum mammographic image.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A Caucasian female patient, while sitting, is receiving a mammogram with a technician is standing in the background. The conical tip is compressing the right breast and the left breast is visible. Note the older machine.

Image by National Cancer Institute / Unknown Photographer

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Mammography

A Caucasian female patient receives a lateral mammogram treatment. She is lying on her left side with the left breast compressed and she is holding her right breast out of the way so as to not block the x-ray. Note the older methods of the diagnostic procedure.

Image by National Cancer Institute / Unknown Photographer

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Mammography

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle that compresses the breast. The patient's face is turned towards the technician, away from the camera, and her right shoulder and breast are exposed.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera, with her right shoulder and breast are exposed.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography Patient

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera. Her right shoulder is raised obscuring the breast.

Image by National Cancer Institute / Bill Branson (Photographer)

Male Breast Cancer

Senior Airman Elisabeth Stone compresses a male patient's breast tissue during a baseline screening of mammogram at Joint Base Elmendorf-Richardson, Alaska

Image by Staff Sgt. Sheila deVera

Doctor Viewing Mammogram

A doctor examines mammograms on a view box.

Image by National Cancer Institute / Bill Branson (photographer)

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Mammogram Showing Dense And Fatty Breasts

Title Mammogram Showing Dense And Fatty Breasts Description A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.

Image by Dr. Kathy Cho. NIH Radiology / National Cancer Institute

Abnormal Mammogram

This abnormal mammogram is not necessarily cancerous. Also seen are calcifications through ductal patterns. Patient would be avised to have follow-up at 3-month intervals.

Image by National Cancer Institute / Unknown Photographer

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Mammogram vs. MRI

A mammography on left and a Magnetic resonance image (MRI) on right. Breast imaging technology has changed over the years. Note MRI's enhancement ability to confirm diagnosis.

Image by Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer

Bilateral digital mammography images of the breasts

Bilateral digital mammography images of the breasts; mediolateral oblique view.

Image by © Nevit Dilmen

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Normal (left) versus cancerous (right) mammography image.

Normal (left) versus cancerous (right) mammography image.

Image by National Cancer Institute

Duct ectasia of breast

Detail of a mammography showing liponecrosis (round/oval calcifications) and plasma cell mastitis with typical rod-like calcifications

Image by Hellerhoff

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal projection.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal reconstruction.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left mediolateral oblique projection.

Image by National Cancer Institute (NCI)

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Mammogram Showing Dense And Fatty Breasts

A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.

Image by Dr. Kathy Cho. NIH Radiology / Unknown Photographer

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Thermography of breast

Image by FDA

Mammograms vs Breast Ultrasounds

Video by Lee Health/Vimeo

Breast Density: Higher Risk & New Screening Options

Video by Breast Cancer School for Patients/YouTube

This browser does not support the video element.

Mammography: NCI B-roll [video]

NCI B-roll of female patient (simulated) receiving a digital mammogram. This video is intentionally silent. This footage, which was filmed at Sibley Memorial Hospital (a Johns Hopkins affiliate institution), includes images of a technician setting up the equipment, a Caucasian female being positioned to receive a mammogram, and mammography images of of dense breasts and fatty breasts. Downloadable video files are 960x540 at 30 fps. This image is part of the NCI B-Roll Videos collection. View video using embedded player on this page or at youtube.com.

Video by National Cancer Institute (NCI)

What to Expect -- Digital Mammography

Video by Hologic, Inc./YouTube

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Mammography

Breast radiologist Dr.Gillian Newstead of the University of Chicago Medical Center explains the process of a typical mammogram screening.

Video by TheVisualMD

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Breast Density

Women with dense breast tissue often require a further look with ultrasound for screening. University of Chicago Medical Center breast radiologist Dr. Gillian Newstead and a breast cancer survivor with dense breast tissue explain.

Video by TheVisualMD

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Breast Cancer Screening & Diagnosis

Breast cancer is one of the most common cancers among women in the U.S., with about 1 in 8 women developing the disease within her lifetime. Breast cancer is an uncontrolled growth of breast cells that has the potential to spread into the breast and possibly to other parts of the body. Early detection through screening saves the lives of thousands of women every year. If there is a history of breast cancer in the family, women should consider the BReast CAncer susceptibility test (or BRCA) to identify a gene that may indicate an increased risk of developing the disease. Women forty and over should be screened for abnormalities yearly to detect and evaluate changes in breast tissue. If an abnormality is found, a biopsy and pathological exam are necessary for a definitive diagnosis and prognosis. After diagnosis, your doctor may want to learn more about your specific cancer through immunohistochemistry (IHC) and HER2 protein tests. IHC testing can help determine if a specific abnormality is present in the cancer cells. HER2 tests can tell your physician if the breast cancer is turned on by the HER2 gene, and can help determine the best course of treatment. Knowing what type of breast cancer is involved, what stage the cancer is, and the characteristics of that specific cancer, allows a woman's physician to determine best possible therapy for her individual case.

Video by TheVisualMD

A closer look at modern mammography

Video by Siemens Healthineers/YouTube

Mammogram

A mammographic image is displayed on state of the art mammography monitors at the David Grant USAF Medical Center. (U.S. Air Force photo/Staff Sgt. Liliana Moreno)

Image by U.S. Air Force photo/Staff Sgt. Liliana Moreno

Nipple Aspirate Test No Substitute for Mammogram

Some companies are marketing a new test—the nipple aspirate test—as the latest and greatest tool in early breast cancer screening. But FDA warns that the nipple aspirate test is no substitute for a mammogram.

Image by The U.S. Food and Drug Administration

Do More Screening Tests Lead to Better Health? Choosing Wisely

Video by DocMikeEvans/YouTube

New Guidelines for Mammograms

Video by Lee Health/Vimeo

Mammogram questions | Mercy Health

Video by Bon Secours Mercy Health/Vimeo

Getting Screened for Breast Cancer

Video by Lee Health/Vimeo

Mammography Fact Sheet

www.nibib.nih.gov

Mammograms

Office on Women's Health, U.S. Department of Health and Human Services

Top Four Mammogram Myths

The U.S. Food and Drug Administration

Screening for Cancer

TheVisualMD

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Mammography

National Cancer Institute / Unknown Illustrator

Mammography

BruceBlaus

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Mammogram

National Cancer Institute / Alan Hoofring (Illustrator)

Woman Having Mammogram

TheVisualMD

Mammography

CDC

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Mammography Patient

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Unknown Photographer

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Mammography

National Cancer Institute / Unknown Photographer

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography Patient

National Cancer Institute / Bill Branson (Photographer)

Male Breast Cancer

Staff Sgt. Sheila deVera

Doctor Viewing Mammogram

National Cancer Institute / Bill Branson (photographer)

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Mammogram Showing Dense And Fatty Breasts

Dr. Kathy Cho. NIH Radiology / National Cancer Institute

Abnormal Mammogram

National Cancer Institute / Unknown Photographer

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Mammogram vs. MRI

Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer

Bilateral digital mammography images of the breasts

© Nevit Dilmen

Sensitive content

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Normal (left) versus cancerous (right) mammography image.

National Cancer Institute

Duct ectasia of breast

Hellerhoff

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram Showing Dense And Fatty Breasts

Dr. Kathy Cho. NIH Radiology / Unknown Photographer

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Thermography of breast

FDA

1:51

Mammograms vs Breast Ultrasounds

Lee Health/Vimeo

8:30

Breast Density: Higher Risk & New Screening Options

Breast Cancer School for Patients/YouTube

2:39

Mammography: NCI B-roll [video]

National Cancer Institute (NCI)

4:07

What to Expect -- Digital Mammography

Hologic, Inc./YouTube

0:37

Mammography

TheVisualMD

0:43

Breast Density

TheVisualMD

4:57

Breast Cancer Screening & Diagnosis

TheVisualMD

3:37

A closer look at modern mammography

Siemens Healthineers/YouTube

Mammogram

U.S. Air Force photo/Staff Sgt. Liliana Moreno

Nipple Aspirate Test No Substitute for Mammogram

The U.S. Food and Drug Administration

10:18

Do More Screening Tests Lead to Better Health? Choosing Wisely

DocMikeEvans/YouTube

1:41

New Guidelines for Mammograms

Lee Health/Vimeo

1:08

Mammogram questions | Mercy Health

Bon Secours Mercy Health/Vimeo

1:45

Getting Screened for Breast Cancer

Lee Health/Vimeo

Breast Exam

Breast Exam

Also called: Clinical Breast Exam, CBE

A clinical breast exam (CBE) is a physical exam of the breast performed by a health care provider to check for lumps or other changes. It’s often done during your regular medical check-up. If a CBE is not offered at your check-up and you would like one, ask your health care provider to perform one (or refer you to someone who can).

Breast Exam

Also called: Clinical Breast Exam, CBE

A clinical breast exam (CBE) is a physical exam of the breast performed by a health care provider to check for lumps or other changes. It’s often done during your regular medical check-up. If a CBE is not offered at your check-up and you would like one, ask your health care provider to perform one (or refer you to someone who can).

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal result means that the nipples, breast tissue, and areas around the breast look normal and are normal in size and shape. A normal result does not mean that breast cancer is not present. Depending on your age and your personal and family history of breast cancer, your health care provider may do other tests, such as a mammogram.
Related conditions
1. PDQ® Screening and Prevention Editorial Board. PDQ Breast Cancer Screening. Bethesda, MD: National Cancer Institute. [accessed on Jan 15, 2022]
2. Breast Exam | Michigan Medicine [accessed on Jan 15, 2022]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (8)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining her. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining her. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hand examining. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up with a doctors hands examining. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

This is a series of 16 photos demonstrating the 16 steps of a clinical breast examination. The image shows a female nude from the waist up. The steps are as follows: 1) arms in normal position 2) arms on hips 3) pressed forward elbows 4) pressed forward 5) arms overhead 6) arms overhead 7) arms raised and pressing down 8) exam of cervical nodes 9) exam of supraclavicular 10) infraclavicular 11) axilla 12) exam of breast 13) axilla 14) breast exam 15) exam of nipple 16) exam of nipple for discharge.

Image by National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

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Breast Exam (Series of 16)

National Cancer Institute / Photogroup (Photographer)

Who to Talk To

Getting a Second Opinion

Image by www.patientpower.info

Who Should a Woman Talk to When Considering Surgery to Reduce Her Risk of Breast Cancer?

The decision to have any surgery to reduce the risk of breast cancer is a major one. A woman who is at high risk of breast cancer may wish to get a second opinion on risk-reducing surgery as well as on alternatives to surgery.

A woman who is considering prophylactic mastectomy may also want to talk with a surgeon who specializes in breast reconstruction. Other health care professionals, including a breast health specialist, medical social worker, or cancer clinical psychologist or psychiatrist, can also help a woman consider her options for reducing her risk of breast cancer.

Many factors beyond the risk of disease itself may influence a woman’s decision about whether to undergo risk-reducing surgery. For example, for women who have been diagnosed with cancer in one breast, these factors can include distress about the possibility of having to go through cancer treatment a second time and the worry and inconvenience associated with long-term breast surveillance. For this reason, women who are considering risk-reducing surgery may want to talk with other women who have considered or had the procedure. Support groups can help connect women with others who have had similar cancer experiences.

Finally, if a woman has a strong family history of breast cancer, ovarian cancer, or both, she and other members of her family may want to obtain genetic counseling services. A genetic counselor or other healthcare provider trained in genetics can review the family’s risks of disease and help family members obtain genetic testing for mutations in cancer-predisposing genes, if appropriate.

Source: National Cancer Institute (NCI)

Additional Materials (4)

16:54

Cancer Support Groups: When, Why, and How

Yerbba – Breast Cancer/YouTube

2:05

Breast Cancer Support Groups

NBC4 Columbus/YouTube

1:06

What Is A Genetic Counselor & The Importance of Genetic Counselling | Ambry Genetics

Ambry Genetics/YouTube

3:41

What Is A Genetic Counselor?

National Society of Genetic Counselors/YouTube

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