By Kari Danziger, MS, CGC

Reviewed by Beth Crawford, MS, CGC and Miriam Komaromy, MD
Last updated September 11, 2000

Doctors use a standard set of procedures for detecting early signs of breast and ovarian cancer. The age at which you should begin screening and the interval between examinations will vary depending on your level of risk for either disease.

More on Screening for the General Population)

More on Screening Recommendations for Women with A Familial History of Breast and Ovarian Cancer

More on Screening Recommendations for Women at High Risk

BREAST CANCER SCREENING PROCEDURES

Physical breast examination and mammograms are the best tools currently available for breast cancer screening. The goal of any of these screening procedures is to detect breast cancers at an early stage when they are easier to treat. If a procedure detects a lump that could be cancerous, the doctor performs a biopsy to analyze the lump. (For more information about upcoming breast cancer screening procedures, see Related News below.)

Breast Self Examination

During a self-examination, you feel your breasts for any changes that may indicate a tumor. The benefit is that it allows you to detect changes in your breasts, often before a physician would notice them during a periodic check-up and clinical breast examination or mammogram. When you detect a breast lump or thickening, you can report it to a physician for prompt follow-up and analysis.

Although breast self-exam has not been definitively shown to improve the likelihood of detecting breast cancer at a stage where it is more curable, many women feel greatly reassured by thoroughly examining their own breasts, and having the ability to detect changes in their breast as soon as they occur rather than waiting for a physician.

Education and instruction programs use several methods to teach the self-exam process. For example, some use models that familiarize participants with they types of lumps that could be found. Some programs now instruct high school and college women in the procedure in order to establish a life-long patterns of self-examination.

Key factors in a successful breast self-exam are knowing what to feel for, and having familiarity with your own breast tissue.

The key factors in success include knowing what to feel for, and having familiarity with your own breast tissue. Training in breast exam methods can increase your confidence if you find yourself hesitating to perform monthly exams. Training has also been associated with an increase in accuracy. You may want to learn one of the following methods for breast self-examination:

top

Clinical Breast Examination

During a clinical breast examination, a physician or another trained health care professional examines your breasts for changes in size, shape, and appearance. The doctor also feels the breasts for any masses or changes in texture, and the area under the arms for lumps in the outer portion of the breast tissue and lymph nodes.

A clinical breast exam is the same as a self-exam, except that it is performed by a healthcare provider who has received training in the procedure.

The clinical breast examination is actually the same procedure as the breast self-exam. However, it is performed by a healthcare provider who has received training in the procedure. Studies have shown that without any other screening techniques, this type of exam can detect approximately 63 percent of breast cancers. Although the success of such exams depends on the stage and size of the cancer and the experience of the examiner, physicians and researchers believe they are especially important for women at risk of early breast cancer.

top

Mammogram

On a mammogram, tumor tissue typically appears more dense than normal breast tissue.

A mammogram uses low levels of radiation to provide a black-and-white X-ray image of your breast. This image varies according to breast density, with tumors typically appearing denser than normal breast tissue. However, the tissue tends to more dense in young women, which makes it difficult to distinguish between normal breast tissue and potentially cancerous tumors on the mammograms in this group. Therefore, physicians do not typically recommend this screening method for women under age 40 — unless they are at increased hereditary risk for breast cancer. For these high-risk women, because the risk of early breast cancer is so much greater, physicians believe that the chance of a confusing or false positive mammogram result is outweighed by the possibility that early cancer will be detected. For this reason they do recommend screening at a younger age, although this remains somewhat controversial.

Mammograms detect potentially dangerous masses that cannot be felt or seen with the naked eye, which makes them an important screening tool for older women. However, mammograms can also identify benign or precancerous areas as suspicious. Three of the most common such conditions are cysts, fibroadenomas, and microcalcifications.

More on Benign Conditions of the Breast

Although mammograms can identify potential problems, they cannot be used alone to diagnose cancer.

Although mammograms can identify potential problems, they cannot be used alone to diagnose cancer. In order to confirm the presence of a cancer, a small amount of tissue must be removed and examined under a microscope in a procedure called a biopsy.

The value of mammograms is greatly enhanced by annual or repeat screening because when compared with previous mammograms, changes in breast density or the presence of new microcalcifications can be observed. For this reason it is important to follow the screening schedule you and your doctor have discussed. ( For news about how mammograms increase breast cancer detections, see Related News below.)

top

OVARIAN CANCER SCREENING PROCEDURES

The ability to accurately detect or rule-out ovarian cancer is believed to be improved when the two tests described below, CA-125 testing and transvaginal ultrasound, are combined rather than given alone.

Transvaginal Ultrasound With Color Doppler

top

CA-125 Testing

In this procedure, doctors look for a chemical, or tumor marker called CA-125 in a woman's bloodstream. Because ovarian cancers usually produce CA-125, an above-average level can be an indicator of ovarian cancer. However, CA-125 testing is far from the perfect screening method because:

• More than 50 percent of early-stage tumors fail to produce elevated CA-125 levels, meaning that CA-125 levels can remain low even when cancer is present.
• Some benign conditions can lead to elevated CA-125 levels, including pregnancy, pelvic inflammatory disease, tuberculosis, and cirrhosis of the liver.

It is more accurate to establish a baseline CA-125 test and then compare future tests with the woman's own previous test results. However, in women age 50 or older, it appears to be better for distinguishing between benign and malignant conditions.

References

Barton M.B. et al. (1999). Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 282(13):1270-80.

Fletcher, S.W. et al. (1990). How best to teach women breast self-examination. A randomized controlled trial. Ann Intern Med. 112(10):772-9.

Gargano, G. et al. (1990). The role of tumour markers in ovarian cancer. Clin Exp Obstet Gynecol. 17(1):23-9.

Higgins, R.V. et al. (1989). Transvaginal sonography as a screening method for ovarian cancer. Gynecol Oncol. 34(3):402-6.

Kerlikowske K. et al. (1995). Efficacy of screening mammography. A meta-analysis. JAMA. 273(2):149-54.

van Nagell, Jr. et al. (1990). Transvaginal sonography as a screening method for ovarian cancer. A report of the first 1000 cases screened. Cancer. 65(3):573-7.