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Breast
Exams
Causes
of Breast Cancer
Early
Detection of Breast Cancer
Mammogram
Information
Paying
for Breast Exam Screening
Signs
and Symptoms of Breast Cancer
Recommendations
for People Who Do Not Have Breast Cancer
Breast Cancer prevention recommendations for people without symptoms
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Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.
Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. Starting at age 40, women should have a CBE by a health professional every year.
Breast self-examination (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%. Women at high risk include those who:
Women at moderately increased risk include those who:
If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is a more sensitive test (it's more likely to detect cancer than a mammogram), it may still miss some cancers that a mammogram would detect. For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. But because the evidence is limited regarding the best age at which to start screening, this decision should be based on shared decision-making between patients and their health care providers, taking into account personal circumstances and preferences. Several risk assessment tools, with names such as the Gail model, the Claus model, and the Tyrer-Cuzick model, are available to help health professionals estimate a woman's breast cancer risk. These tools give approximate, rather than precise, estimates of breast cancer risk based on different combinations of risk factors and different data sets. As a result, they may give different risk estimates for the same woman. Their results should be discussed by a woman and her doctor when being used to decide whether to start MRI screening. It is recommended that women who get a screening MRI do so at a facility that can do an MRI-guided breast biopsy at the same time if needed. Otherwise, the woman will have to have a second MRI exam at another facility when she has the biopsy. There is no evidence right now that MRI will be an effective screening tool for women at average risk. While MRI is more sensitive than mammograms, it also has a higher false-positive rate (it is more likely to find something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of the women screened. The American Cancer Society believes the use of mammograms, MRI (in women at high risk), clinical breast exams, and finding and reporting breast changes early, according to the recommendations outlined above, offers women the best chance to reduce their risk of dying from breast cancer. This approach is clearly better than any one exam or test alone. Without question, a physical exam of the breast without a mammogram would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms. Mammograms are a sensitive screening method, but a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors. For women at high risk of breast cancer, such as those with BRCA gene mutations or a strong family history, both MRI and mammogram exams of the breast are recommended.
State Mammography Screening Coverage Laws
Sources: Health Policy Tracking Service, " Mandated
Benefits: Breast Cancer Screening Coverage Requirements,"
4/01/04; CDC Division of Cancer Prevention and Control "State
Laws Relating to Breast Cancer: Legislative Summary, January 1949 to
May 2000." Updated 9/14/06, ACS National Government Relations Department Other state efforts and self-insured plans Other types of health coverage also provide screening mammograms. Public employee health plans are governed by state regulation and legislation, and many cover screening mammograms. Self-insured plans are not regulated at the state level, which means women in these plans do not necessarily get screening mammogram benefits, even if there are laws in the state to cover such benefits. Self-insured plans are typically large employers. Women who have self-insured-based health insurance should check with their health plans to see what breast cancer early detection services are covered. Medicaid All state Medicaid programs plus the District of Columbia cover screening mammograms. This coverage may or may not conform to American Cancer Society guidelines. State Medicaid offices should be able to provide screening coverage information to interested individuals. The Medicaid programs are governed by state legislation and regulation, so assured coverage is not always apparent in legislative bills. In addition, all 50 states plus the District of Columbia have opted to provide Medicaid coverage for all women diagnosed with breast cancer through the Centers for Disease Control and Prevention's (CDC's) National Breast and Cervical Cancer Early Detection Program (see the next section), so that they may receive cancer treatment. This option allows states to receive significant matching funds from the federal government. States vary in the age, income and other requirements that women must meet in order to qualify for treatment through the Medicaid program. (All 50 states, 4 U.S. territories, the District of Columbia, and 13 American Indian/Alaska Native organizations participate in the National Breast and Cervical Cancer Early Detection Program.) National Breast and Cervical Cancer Early Detection Program States are making breast cancer screening more available to medically underserved women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This program provides breast and cervical cancer screening to low-income, uninsured, and underserved women for free or at very low cost. The NBCCEDP attempts to reach as many women in medically underserved communities as possible, including older women, women without health insurance, and women who are members of racial and ethnic minorities. Age and income requirements vary by state. The program provides both screening and diagnostic services, including:
Though the program is administered within each state, tribe, or territory, the Centers for Disease Control and Prevention (CDC) provides matching funds and support to each program. Since 1991 when the program began, it has provided more than 7.8 million screening exams to underserved women and diagnosed more than 35,000 breast cancers, more than 114,000 pre-cancerous cervical lesions, and more than 2,100 cervical cancers. Now that the program is firmly established, doctors are detecting new cancers at their earliest stages, leading to longer-term survival. These accomplishments demonstrate a truly nationwide effort. Unfortunately, however, due to limited resources, only about 1 in 5 eligible women aged 40 to 64 is served nationwide. As noted above, all 50 states plus the District of Columbia have opted to provide Medicaid coverage for women diagnosed with breast cancer through the NBCCEDP, so that they may receive cancer treatment. Each state's Department of Health will have information on how to contact the nearest CDC screening and early detection program in your area. For more information, please contact the CDC at 1-800-CDC-INFO ( 1-800-232-4636) or through their web site at www.cdc.gov/cancer. Medicare Since 1998, Medicare has covered mammograms once every 12 months for all women with Medicare aged 40 and over. (Women are eligible for Medicare if they are age 65 and older, are disabled, or have end-stage renal disease.) Medicare also pays for a clinical breast exam once every 24 months along with a pelvic exam. These benefits are not subject to the usual Medicare Part B deductible, but the standard 20% co-pay applies. Medicare also covers an initial preventive physical exam for all new Medicare beneficiaries within 6 months of enrolling in Medicare. The "Welcome to Medicare" exam includes measurements of height, weight, and blood pressure, in addition to referrals for prevention and early detection services already covered under Medicare, such as mammograms. Additional resources More information from your American Cancer Society The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-227-2345, or found on our Web site, www.cancer.org.
National organizations and web sites* In addition to the American Cancer Society, other sources of patient information and support include: Centers for Disease Control and
Prevention (CDC) National Cancer Institute (NCI) *Inclusion on this list does not imply endorsement by the American Cancer Society. No matter who you are, we can help. Contact us any time, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org. References American Cancer Society. Detailed Guide: Breast Cancer. 2009. Available at: www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=5. Accessed September 22, 2009. Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program. Available at: www.cdc.gov/cancer/nbccedp/about.htm. Accessed September 22, 2009. Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773�1783. Saslow D, Boetes C, Burke W, et al for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75�89. Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: Update 2003. CA Cancer J Clin. 2003;53:141�169. |
Source: American Cancer Society
Note: Some statements in this article may not be
approved by the FDA. This article is for informational purposes only and
should not be taken as professional medical advice.
