Steps to Early Detection

The earlier breast cancer is found, the better the chance of cure with treatment. There are currently three methods of finding breast cancer: breast self-exam, clinical breast exam by a health care practitioner and screening mammography.

Screening guidelines

The earlier breast cancer is found, the better the chance of cure with treatment. There are currently three methods of finding breast cancer: breast self-exam, clinical breast exam by a health care practitioner and screening mammography. It is important that women take all three of these steps for proper breast cancer screening.

Breast Self-Exam: It is a common recommendation for women to perform a breast self-exam once a month. Yet, studies have not shown that doing these exams will decrease the risk of dying of breast cancer. While a breast self-exam may not reduce a woman’s chance of developing breast cancer, it is part of practicing good breast health and helps women become familiar with how their breasts normally feel, increasing the chance for early detection.

Clinical Breast Exam by a Health Care Practitioner: It is also commonly recommended that women have a clinical breast exam every three years between the ages of 20 and 39, and yearly starting at the age of 40.

Screening Mammography: The U.S. Preventive Health Services Task Force recommends annual screening mammograms in women over 40 years of age. There have been seven studies of the randomized controlled trial type that test the ability of mammography to decrease the risk of dying of breast cancer. These studies did show a benefit to annual mammography.

If you have a family history

Most young women are not encouraged to get regular mammograms. This is because the disease is unusual at that age and also because breast tissue is usually quite dense in younger women’s breasts, making the X-rays harder to interpret.

Women who have a family history of breast cancer or who have had non-cancerous breast lumps should check with their health care professional to find out at what age they should begin having mammograms and how often they should have clinical breast exams.

If you notice a change

If you notice a change, such as development of a lump or swelling, persistent skin redness or dimpling, nipple retraction (turning inward), scaliness of the nipple, or a discharge from the nipple other than milky, you should see your health care provider as soon as possible for evaluation. Most often these changes are not cancer, but it is important to check with your health care provider so that any problems can be diagnosed and treated as early as possible. Also, it may be a good idea to get a second opinion from a breast specialist.

An estimated 211,300 new invasive cases of breast cancer are expected to occur among women in the United States during 2003.

Some facts about mammograms

Mammograms are specialized x-rays of the breast. They show differences between water density (shows as white) and fat density (shows as black). Breast cancers contain lots of water and appear white on mammograms. When women are younger they have more dense glandular tissue. This tissue is also comprised largely of water and shows as white. As women age, the dense glandular tissue decreases and the breast becomes more fatty. It is difficult to see a white-appearing cancer against the white background of young breast tissue, easier against the black background of older tissue.

In order to perform a mammogram, the breast is compressed to flatten and spread out the breast tissue. This allows the use of less radiation and gives a better picture. The compression may be temporarily uncomfortable. Each compression only lasts a brief time and the entire procedure for a screening mammography takes about 20 minutes.

There are limitations to screening mammograms. A mammogram may miss some cancers that are present (false negative) or may detect something that turns out not to be cancer (false positive). Over a 10-year period, the chance that a woman will have a false positive mammogram resulting in a biopsy for benign disease is 50 percent. Because mammograms do not pick up all cancers, a normal mammogram does not mean that a lump being felt is not cancer.

For women of all ages, between 5 percent and 10 percent of mammograms indicate the need for additional testing, which may include a diagnostic mammogram, ultrasound, needle biopsy or open surgical biopsy. Most abnormalities turn out not to be cancer. About 97 percent of women ages 40-49 who undergo additional testing do not have cancer, as compared with about 86 percent of women age 50 and older. All women must have follow-up procedures when they have an abnormal mammogram.

How much do mammograms cost?

Most mammograms cost between $75 and $200. Most states now have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms. Check with your health plan to find out if mammograms are covered.

In addition, many AFSCME affiliates have negotiated coverage of mammograms in their health plans. Those who have not are encouraged to do so.

Medicare pays 80 percent of the cost of a screening mammogram each year for beneficiaries ages 40 or older. There is no deductible requirement for this benefit, but Medicare beneficiaries are responsible for a 20 percent co-payment of the Medicare-approved amount. Information on coverage is available through the Medicare Hotline at 1-800-MEDICARE.

If you do not have health insurance, the National Alliance of Breast Cancer Organizations suggests the following options:

Call your local chapter of the American Cancer Society (ACS) — the number is in your phone book — or the national toll-free number, 1-800-ACS-2345. The ACS will be able to tell you about any low-cost or free mammography programs that offer screening to women unable to pay for it themselves.

Call your state Department of Health. Every state now has a Breast and Cervical Cancer Early Detection Program, funded by the U.S. Centers for Disease Control and Prevention, planned or in operation (see the "Resources" section of this booklet). This program offers screening to qualifying women unable to pay for it themselves.

Call the YWCA’s ENCOREplus Program for access to low-cost or free mammograms. To find out which YWCA facilities offer this service and if you are eligible, call 1-800-95EPLUS or your local YWCA.

Call the National Cancer Institute (NCI) at 1-800-4-CANCER for the names of FDA-certified, accredited mammography facilities in your area. If you explain your financial situation, some mammogram facilities are willing to work out a lower fee or payment schedule that will make the test more affordable. Ask the facility if they are willing to discuss these options with you.

Call one of the many mammogram facilities that offer special fees and extended hours during October, National Breast Cancer Awareness Month. If you are unable to schedule a mammography another time of year, you may wish to call in September to reserve an appointment.

How do I know I am getting a quality mammogram?

The effectiveness of mammography as a breast cancer detection technique is directly related to the quality of mammography procedures. As a result of lobbying by breast cancer advocates and activists, Congress enacted the Mammography Quality Standards Act of 1992 (MQSA). The act established requirements for the accreditation, certification and inspection of facilities designed to ensure that all women have access to high-quality mammography services. The MQSA gives the Food and Drug Administration the responsibility for implementing and regulating its requirements.

The certification status of facilities may change, so you may want to check your facility’s current status and look for their certificate. Most facilities will display this certificate prominently.

Information about local FDA-certified mammography facilities is available through NCI’s Cancer Information Service at 1-800-4-CANCER. Also, you may want to order the free booklet "Things to Know About Quality Mammograms" in English or Spanish from the U.S. government’s Agency for Health Care Policy and Research at 1-800-358-9295.

Once you have chosen a certified mammography facility, it is a good idea to use the same facility for future mammograms. Your previous films can then be compared with the current ones, making a detailed analysis easier. If you change facilities, ask for your previous films to be sent to the new facility.

How to be part of the solution

Follow the three-part screening steps outline — regular mammograms, yearly clinical breast exam and monthly self-examination.

Encourage your female friends and relatives to do proper breast cancer screening.

Through collective bargaining or legislation, make sure that mammography is fully covered under your health insurance plan.

Disseminate information about breast cancer through the union. For example, have speakers at union meetings, post literature on the bulletin board or sponsor health fairs.

Get regular exercise; watch your weight if you are post-menopausal; and consume less than one alcoholic drink a day.