EARLY DETECTION AND SCREENING
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The three most common forms of screening tests used to detect breast cancer are Mammography, Clinical Breast Exam, and Breast Self Exam. Below is a brief description of each as well as recommended guidelines of when and how often these tests should be performed.

Mammography
Mammography is a technique that uses X-rays to provide an image of the breast. These images, called mammograms, are used to find potential signs of breast cancer including tumors, small clusters of calcium (microcalcifications) and abnormal changes in the skin. Overall, mammography is the best screening tool available today for breast cancer. It can find cancers at an early stage, when they are small and most responsive to treatment. However, young women have denser breasts and it is sometimes more difficult to find breast tissue abnormalities.

Clinical Breast Exam
Clinical breast exams are physical examinations done by physicians, nurse practitioners and other trained medical staff. The exams involve checking the look and feel of the breasts and underarm for any changes. The breasts are checked while a woman is sitting up and lying down.

Breast Self Exam
Breast Self Exam (BSE) is a screening technique that is intended to find tumors, particularly those that develop in between one’s yearly mammogram or clinical breast exams. By doing BSE’s once a month, a woman becomes familiar with how her breasts look and feel normally, and be better equipped to recognize any changes such as thickening, puckering, lumps, dimpling or spontaneous nipple discharge. The best time for a woman to perform a BSE is at the end of her period, when her breasts are least tender. If a woman no longer has a period, she should do it at the same time each month. To learn the correct way to perform this test, Bright Pink suggests viewing the Susan G. Komen for the Cure online BSE tool and downloading a free card by clicking here (http://cms.komen.org/komen/AboutBreastCancer/EarlyDetectionScreening/BreastSelf-Exam/index.htm)
Getting tested regularly for breast cancer is the best way for a woman to lower her risk of dying from the disease. The tests highlighted above can find breast cancer early and when it is most treatable. Getting regular screening tests is especially important for women who are at a higher risk of developing breast cancer. In general, a woman can be placed in a high risk category if she possesses either a single factor that greatly increases her risk or a combination of lesser factors that together increase her risk.

Factor’s that can single-handedly increase a woman’s risk a great deal include:

• Mutation in BRCA 1 or BRCA2 genes
  
• Very strong family history of breast cancer, such as a mother or sister diagnosed before age 40.
  
• Personal history of breast cancer
  
• Radiation treatment in chest area during childhood or young adulthood.

It is recommended that women at high risk for breast cancer begin getting tested at earlier ages and perhaps more frequently than women at average risk. In addition to clinical breast exams, mammograms and breast self exams, other screening tests, such as MRI and ultrasound, may also be effective tools for detecting cancer in women at higher risk. While the following are guidelines for screening provided by the National Comprehensive Cancer Network, Bright Pink advises any decisions about screening should only be made after consulting with a health care professional.

MRI

Magnetic Resonance Imaging (MRI) is a test that uses magnetic fields to create an image of the breast that can be meticulously examined for abnormalities. Thus, the test is considered to be more invasive. MRI is a promising tool because it can find tumors even in very dense breasts, and can find very small tumors. Although typically used to determine the progression of cancer, the test is beneficial to particular groups of women who are at high risk. A mammography and MRI combination has been shown to increase the detection rate of breast cancer in women who are at high risk due to the BRCA1 or BRCA2 gene mutation or a family history of breast cancer. While mammograms are thought to be less effective in younger women because their breast tissue is denser and making the images harder to read, there is no conclusive data to suggest that young women should get MRI's in place of mammograms, but rather, in addition to them. The American Cancer Society recommends young women at very high risk due to family history or a BRCA mutation consider MRI, in addition to mammogram, as part of their screening program.

Surveillance Options for Women of General Population

Breast Cancer Surveillance
Mammography	Every year beginning at age 40.
Clinical Breast Exam	At least every three years from age 20-39. Every year beginning at age 40.
Breast Self Exam	Monthly beginning by age 20.
MRI	Not Recommended

Ovarian Cancer Surveillance
Pelvic Exam	Annual vaginal exam beginning by age 18
Rectovaginal exam	Annual exam beginning by age 35.

Surveillance Options for Women of Higher Risk

Breast Cancer Surveillance

	Under Age 25		Age 25 and over
	Strong family history of breast or ovarian cancer	Carrier of BRCA1 or BRCA2	Strong family history of breast or ovarian cancer	Carrier of BRCA1 or BRCA2
Mammography	Not recommended	Not recommended	Every year	Every year
Clinical Breast Exam	Every year	Every year	Every 6-12 months	Every 6-12 months
Breast Self Exam	Encouraged	Encouraged	Encouraged	Encouraged
MRI in Combination with Mammography	Not Recommended	Yearly beginning at age 20	Every year	Every year

Ovarian Cancer Surveillance

Pelvic Exam	Annual vaginal exam beginning by age 18
Rectovaginal exam	Annual exam beginning by age 35.
Concurrent transvaginal ultrasound & CA-125 blood test	Every 6 months starting at age 35, or 5-10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family, and preferably days 1-10 of cycle for premenopausal woman

• Note: Risk reducing salpingo oophorectomy (surgical removal of fallopian tubes and ovaries) recommended between ages 35 and 40 years or upon conclusion of child bearing, after discussing the woman’s reproductive desires, her family history, cancer risk and other factors with medical professional

Sources: National Cancer Institute, 2007; Susan G. Komen for the Cure, 2007; American Cancer Society, 2007, National Comprehensive Cancer Network, 2007.