Breast Cancer

According to an article published by the US Preventive Services Task Force (UPSTF) in April 2024, breast cancer is the second most common cancer and the second most common of cancer death for women in the United States. Previous recommendations for mammograms were for women between the ages of 40 and 50 years of age, however, with the increase number of women in their 40's being diagnosed with breast cancer, that recommendation has been updated to women 40 and over to begin screening every other year.

Unfortunately for women of color, particularly black women, the risk of breast cancer is higher. Black women are 40 % more likely to die of breast cancer than white women and too often get deadly cancers at younger ages. Ensuring black women start screening at age 40 is an important first step, yet it is not enough to improve the existing inequities.

Understanding health disparities and higher rates of breast cancer in black women, it is crucial that we encourage all women to get screened for breast cancer. This simple screening, which is covered by health insurance, can make such a difference. Organizations provide free mammogram services to underserved communities such as rural and low-income areas. To find free screening sites, visit:  Mammogram Facilities website provided through the U.S Food and Drug Administration. The Mammogram Facility Database is easy to use, and does not require any personally identifiable information, and it is FREE.

What are the screening tests for breast cancer?  According to Memorial Sloan Kettering Cancer Center (MSK) there are four screening tests:  Clinical Breast Exam, Mammograms, Breast MRI and Breast Ultrasound.

Clinical Breast Exam:  A clinical breast exam is performed by your healthcare provider during an office visit. Some of the changes your practitioner will look for are any unusual lumps, or changes in skin color and feel. 

You will lie down for this exam. Your healthcare provider will use their hands to feel different parts of your breasts and underarms. They will look for any lumps or thickening that may need testing. 

It's a simple and quick exam that helps catch breast cancer early. Regular clinical breast exams are important for your overall breast health.

You may have also heard about breast self-exams and breast self-awareness. This can help you notice changes in your breasts. You should talk to your healthcare provider about any changes you notice. 

Mammography: Mammography uses low-dose X-rays to take pictures of a breast to check for signs of breast cancer.  Some providers offer mammograms that use, 3D Mammography and contrast-enhanced mammography. 3D Mammography (tomosynthesis) helps to see breast tissue and tumors more clearly. It’s helpful for people who have dense breasts. The pictures it takes are so detailed that most people will not need to come back for more images.

Contrast Enhanced Mammograms, or CEM uses contrast to show the blood flow in the breast. Tumors often have more blood flow than normal tissue. They show clearly on the images.

Breast MRI:  This test uses radio waves, a powerful magnet, and a computer to take detailed pictures of breast tissue. You lie face down on a special table which is built with special openings for your breasts. The table then slides into an MRI machine where the images are taken.

This test helps doctors see more details than a regular mammogram. A breast MRI is helpful if you have dense breasts or are at a higher risk for breast cancer. 

Breast Ultrasound:  A breast ultrasound uses high-frequency sound waves to make pictures of the inside the breasts. This method uses ultrasound to see both structure and movement.

For example, this can be used to check blood flow or see if a mass is solid or filled with liquid. The care team can see what's inside a lump so they can provide treatment options.

During an ultrasound, the technician places a handheld probe close to the breast. The probe gives off sound waves that bounce off breast tissue and make echo patterns. These patterns are shown as images, called sonograms, on the ultrasound machine’s screen. 

Insurance covers clinical breast exams provided by your doctor and Mammograms at no cost.  This is part of an initiative for preventive screenings, like colorectal screenings for individuals over the age of 50 and vaccinations such as shingles (50 and over) and pneumococcal vaccinations (start at age 65, and every 5 years after), and annual Influenza and Covid vaccinations. However, for Breast MRI and Breast Ultrasound, there are additional steps needed for insurance to pay for these testing options.

It is imperative that women get screened for breast cancer on a regular basis. Early detection can be the difference between life and death.

Paula Wolter BSW, RN, MS

References: Memorial Sloan Kettering, Contrast Enhanced Mammograms: https://www.mskcc.org/cancer-care/patient-education/contrast-enhanced-mammogram

US Preventive Services Task Force: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening