Breast Cancer Screening in Younger Women

with Patrick McWey, M.D., diagnostic radiologist with Columbia St. Mary's

Last Updated: Oct. 1, 2003

The current recommendations of the American Cancer Society call for women to begin monthly breast self-exams at age 20, and annual mammograms at age 40. However, certain circumstances lower the age at which women should begin receiving mammograms.

Patrick McWey, M.D., diagnostic radiologist with Columbia St. Mary's "Some studies say that breast self-exams are not effective, but I can tell you that I have diagnosed a number of women in their late twenties or early thirties who found a lump themselves. If they hadn't been doing those self-exams their survival chances would be severely reduced." Dr. McWey presents: Breast Cancer Occurrence in Young Women October 16, 2003 7-8 p.m. Columbia St. Mary’s Milwaukee Campus, Brady Hall Search for additional events

Genetic risks
Genetic risk factors may lower the age of the first mammograms. The most important risk factor is a family history of breast cancer, particularly breast cancer occurring prior to menopause in a first-degree relation (mother or sister).

“Let’s say a young woman has a mother who was diagnosed with breast cancer at age 45. That young woman should begin receiving annual screenings at age 35,” said Dr. Patrick McWey, a diagnostic radiologist with Columbia St. Mary’s.

The doctor added that a woman with a strong family history of early occurring breast cancer might want to consider genetic testing. This would determine if she carries the BRCA1 or BRCA2 genetic mutations. These greatly increase the likelihood of a woman developing breast cancer.

Dr. McWey stressed that this is a personal decision, and not something that every woman wants to know. “The important factor is, what will you do once you know this information? How will it affect the rest your life,” the doctor said.

Exams and self-checks
Younger women are also directed to get a breast exam by a physician every three years, though most women get the exam done yearly as part of their annual physicals. “If, for some reason, a physician does not routinely do a breast exam, a woman should request it. It gives them a little extra peace of mind,” Dr. McWey said.

Most self-check guides suggest a woman do her monthly exam mid-cycle, not just before menstruation. That is because some women’s breasts do develop tender spots and lumps that come and go as her hormonal cycle changes.

“If a woman feels something around the time of her period, it’s most often benign. But if it is still there two weeks later, she needs to have it evaluated,” the doctor said.

Younger women also need to be aware that pre-menopausal breast cancer spreads far more rapidly than breast cancer in older women. Women should not put off seeing a physician if they suspect a problem, including pregnant women.

Diagnosis
Dr. McWey stressed that a normal mammogram is not adequate to exclude breast cancer in a young woman with a palpable lump. This is because younger women have denser breasts that may make it difficult to locate a problem on a mammogram.

It is recommended that women younger than 30 who find a lump start diagnosis with an ultrasound, then get a mammogram if there is any question. For most women over 30 with a palpable lump, both a mammogram and an ultrasound are recommended.

A woman who discovers a lump may have a normal mammogram and feel relieved, providing a false sense of security. A mammogram alone is not adequate in all cases. In women with dense breasts on mammography, a cancer may not be detected. However, in many of these cases, an ultrasound will detect the abnormality.

Other means of detection
One new development that shows great promise for diagnosis in younger women is breast MRI (magnetic resonance imaging). While Dr. McWey stressed that this is not a replacement for mammograms or ultrasound, MRI’s are quite sensitive at detecting breast cancers and are not affected by the density of a younger woman’s breasts.

In addition, Columbia St. Mary’s offers digital mammography and computer-aided detection. This gives radiologists an extra tool for pinpointing potential problems.

Finally, there are breast biopsies, often far less invasive than in years past. Ultrasound guided cyst aspiration can be performed for symptomatic cysts. Ultrasound guided core needle or mammotome biopsies can be used to diagnose breast masses. Stereotactic mammotome biopsies are used to diagnose calcifications.

Stereotactic mammotome biopsy is a method in which a probe is guided to the site of the abnormality. The probe has a small vacuum tube which draws in the suspicious tissue, cuts and stores it. Like needle biopsies, the probe can take multiple samples, and has been found to be highly accurate. These procedures are performed through a tiny incision that does not require stitches.

But the most important advice to women of any age is not to ignore a problem. “The ostrich approach does not work with breast cancer. We need to find the cancer and remove it as early as possible,” Dr. McWey said.

“I had a twenty-eight year-old patient, a very bright lady who had been doing breast exams since she was twenty. She found a lump and came in. We didn’t see it on the mammogram but did on the ultrasound. That lady had surgery and her nodes were negative and her prognosis is excellent. If she hadn’t been doing those breast exams and had just stumbled across the problem later, she would not have had the success she did,” the doctor concluded.

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.