Early detection of breast cancer depends on a sensible awareness, physical exam, and technology. Breast imaging "mainstays" are mammography, sonography, and more recently breast MRI.
Mammography, or mammogram, is still the gold standard and the first mammogram should be obtained by age 40, and yearly after that. Often the earliest sign of breast cancer is an abnormality found on a mammogram, however, it can miss 10-15% of all breast cancers. Therefore, this test should be considered in light of physical exam and history. Mammography can be uncomfortable because of the intense compression required to flatten the breast tissue so that the anatomy can be seen with the least amount of radiation. Radiation exposure from mammography is extremely low. Adverse experiences can include pain, bruising, and chest wall discomfort; but most of these are temporary. Younger breasts are more difficult to evaluate with mammography, and are more likely to encounter false positive mammographic findings and require additional imaging. However, this imaging has resulted in fewer biopsies overall for women of every age. Increased breast density and previous breast surgeries can make the interpretation of the breast imaging more challenging. Mammography, done for "screening" (when a patient is completely without symptoms) is the most common use of this test.
A "diagnostic" mammogram is done when an abnormality has been found through screening, or the patient has a symptom, such as a lump. For patients with a first degree relative with a BRCA1 or BRCA2 genetic mutation, mammography can start as early as age 23. There has been some controversy over when a woman should stop obtaining yearly screening mammography. There was a recommendation that mammography stop at age 74, but these guidelines are in clear opposition to all existing breast cancer guidelines. The American Cancer Society, American College of Radiologists, American College of Surgeons, and American College of Breast Surgeons all agreed that there should be no specific age at which a woman should stop "caring for herself" and this would include breast mammography.
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