Breast Cancer Screening

Fred Hutch physicians recommend women 40 or older have a screening mammogram every year if they are at average risk for breast cancer. This matches guidelines from the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers, including Fred Hutch.

This recommendation is not right for everyone. If you are at higher-than-average risk, you may need screenings earlier and more often. Some people may choose to start screening later or to be screened less often.

Organizations like the American Cancer Society and the United States Preventive Services Task Force have different recommendations on the age to start screening and how often to have screenings (every year or every two years).

Here is what is important: Have screenings regularly on a schedule that matches your risk and preferences. Your health care provider or an Fred Hutch expert can assess and explain your risk. We can help you decide on the screening schedule that is right for you.

3D mammography is a way to take many pictures of your breast at once so physicians can see your breast tissue in detail. This improves the odds of finding true cancers early. It also leads to fewer false alarms (suspecting cancer in tissue that is healthy).

Getting a 3D mammogram is much like getting a 2D (conventional) mammogram. A specially trained technologist positions your breast on a platform. They compress your breast under a paddle. Then an X-ray arm sweeps over your breast, taking multiple images. 

2D mammography takes one image of your breast from above and one from the side. 3D mammography takes many images from both angles. It uses high-powered computing to convert the images into a stack of layers, or “slices.” Each layer is only 1 millimeter thick.

With these layers, your radiologist can see breast cancers more clearly and provide a more confident assessment. 3D mammography might reduce your need for follow-up tests of tissue that is normal but could seem abnormal on a 2D image.

For most patients, the benefits of getting a mammogram outweigh the risks. But, like all tests, mammograms are not completely risk-free.

Most breast cancers can be seen on mammograms, but some cannot. If you have breast concerns, talk with your physician or breast health specialist. This is important even if you just had a mammogram that did not show any problems.

A mammogram can also result in a false alarm, showing a possible problem that turns out not to be cancer after you have more tests, like other scans or a biopsy.

At Fred Hutch and UW Medical Center, false alarms happen for fewer than 10 in 100 patients. This is better than the average rate for health care facilities in the United States.

Mammograms should not be painful. If you feel any pain, let your technologist know so they can reposition your breast. 

Mammograms require the use of a small amount of radiation. This level of radiation is very safe. It is smaller than the amount you would get in your daily life over two months. 

When you have a mammogram, you may learn you have dense breasts. Breast density refers to the amount of normal, non-fatty tissue seen in a mammogram. There are four levels, from almost all fatty tissue to extremely dense tissue with very little fat. If your breasts are in the two higher levels, they are considered dense. 

Keep in mind that there is no “normal” amount of breast density. About half of patients who get a screening mammogram have dense breasts, and half do not.
There are two main reasons that breast density matters:

• Cancer can be harder to see in mammograms of dense breasts.
• Density has been linked to a higher risk of getting breast cancer. (But density alone has only a small impact on breast cancer risk.)

If you have dense breasts, Fred Hutch breast health specialists will talk with you about your breast density and what it means for you. 

MRI is a powerful tool to detect breast cancer early. But it is not right for everyone. This is because an MRI can raise suspicions, which lead to more tests and procedures, about spots that turn out not to be cancer.

Like the National Comprehensive Cancer Network, we recommend you have an annual screening breast MRI, along with a mammogram, if any of these are true:

• You have a lifetime risk for breast cancer of at least 20 to 25 percent. (Physicians have tools to calculate your risk.)
• You had radiation therapy to your chest between the ages of 10 and 30.
• You have a genetic predisposition to (meaning, a family history of,) breast cancer.

Fred Hutch radiologists are experts at knowing which patients can benefit the most from breast MRIs and at getting high-quality breast MRI images.

If you are not sure of your breast cancer risk and wonder if you need breast MRI, ask your health care provider or an expert at the Fred Hutch or UW Breast Health Clinics.

• Call 206.606.6487 to request an appointment at the Fred Hutch South Lake Union Breast Health Clinic.
• Call 206.668.6746 to request an appointment at the UW Medical Center – Northwest Breast Health Clinic.

A clinical breast exam is a physical exam of the breast and underarm lymph nodes that is done by a physician, physician assistant or nurse practitioner (such as your primary care provider or OBGYN). This is typically recommended on a yearly basis.

You can help detect breast cancer by being aware of how your breasts normally feel and look. Some breast cancers are self-detected, meaning people feel or see something unusual in their own breast.

There is no one right way to examine your breasts. We encourage you to regularly inspect and feel your breasts so you know what is normal for you and what is new or different. 

You should seek attention from a medical provider if:

• You feel a new or different lump or thickening in your breast, especially if it lasts more than a month in the same spot.
• You notice changes in the appearance of your breasts, such as dimpling of the skin, redness of the skin or nipple discharge.

If you or your provider have concerns about a breast lump or other breast abnormality, request an appointment for a consultation and examination with a breast specialist. Call the Breast Health Clinic at South Lake Union at 206.606.6487 or UW Medical Center – Northwest at 206.668.6746.