Breast practices: Putting your health front and center

Breast cancer makes up about 30% of new cancer cases in women each year in the United States and is the second leading cause of cancer-related death among women, following lung cancer. While  incident rates have increased in recent years, death rates are decreasing, a trend experts attribute to early detection and advances in treatment.

Amy Waer, MD, FACS, MPSA, dean of the Texas A&M University Naresh K. Vashisht College of Medicine and general surgeon specializing in breast surgery and breast cancer, says understanding screening guidelines and options is key to detecting breast cancer early, when it’s easier to treat successfully.

Breast cancer screening guidelines have evolved significantly in recent history, with the most recent and significant change occurring in 2024 that lowered the age from 50 years of age to 40 years of age, Waer said. This change was made by the United States Preventive Services Task Force (USPSTF) to assist with earlier detection with the goal of potentially reducing breast cancer deaths.

Although this is the general current recommendation, Waer recommends discussing a personalized screening plan and risk assessment with your provider based on your medical history, background and family history. Ideal screening plans and modalities of screening vary between patients. While mammograms—the most common screening option—may come to mind first, they are far from the only option.

“Breast cancer screening methods include mammography, which is a low dose X-ray often with 3D imaging, along with ultrasound and MRI (magnetic resonance imaging),” Waer said.

These three different types of diagnostic imaging can be used separately or together to provide a comprehensive screening. A mammogram compresses the breast into a flatter shape to collect either 2D or 3D images using a special kind of X-ray. An ultrasound is collected via a small, handheld device used to scan tissue and typically functions as a secondary examination. While breast MRIs typically are the most expensive option, they create clearer images of the breast tissue using magnet and radio waves without using radiation. A provider usually will recommend a breast MRI to patients with prior abnormal results or patients determined to be at a higher risk for cancer.

Density of breast tissue, breast implants, hormonal fluctuations, benign calcifications, cysts and fibroadenomas are just some conditions that can make identifying abnormal breast tissue on a traditional mammogram more challenging. Additionally, age, body weight and hormone replacement therapy all play a role in breast tissue density and can impact the modality and timing of screening, Waer said.

When a woman presents with dense breast tissue or other conditions that could make a mammogram less effective, a provider might recommend alternate screening options. Usually, dense breasts are initially diagnosed through a mammogram. However, if you already know you have dense breast tissue or another condition—in yourself or your family history—that may impact screening effectiveness, it is best to have a conversation with your provider ahead of screening to determine the best path forward.

Waer emphasized the importance of having these conversations with your provider and being aware of factors that might make screening look different for you.

She also noted that while clinical breast exams by health care providers and self-breast exams can sometimes assist in screening for breast cancer, there is currently no evidence to suggest that it reduces the risk of mortality (risk of dying) from breast cancer. If you find a lump during a self-exam—regardless of gender—it should be evaluated by a health care provider as soon as possible. Most masses are benign, Waer said, but it’s important to have them checked.

“I cannot emphasize enough how important it is for women to get their recommended breast screening examinations done as recommended by their health care providers,” Waer said. “Breast cancer that is detected early is typically curable. Any breast abnormality that is detected, regardless of the woman’s age, should be evaluated by a medical professional.”