Courtesy Roswell Park Cancer Talk Blog

Finding a lump during a self-exam or annual physical might be how most women think breast cancer is found. However, screening mammography is able to find cancer even when it is too small to feel, according to Ermelinda Bonaccio, MD, Chair of Diagnostic Radiology at Roswell Park Comprehensive Cancer Center.

Dr. Bonaccio encourages women to be familiar with their breasts and report any changes to their physicians promptly. She explains that women often find a lump outside of a monthly self-directed exam. She adds that while most lumps are not cancer, it is important to have any lump evaluated with mammography and/or ultrasound. This is because you cannot tell if a lump is cancer by how it feels. Dr. Bonaccio says that when a mammogram does reveal a problem, women often tell her that they feel fine, and do not feel anything. Dr. Bonaccio says the goal of mammograms is to find cancer before it can be felt, and why women should have a yearly mammogram.

Roswell Park follows National Comprehensive Cancer Network guidelines for breast cancer screening, which includes annual screening mammography beginning at age 40 for average risk women. Women at increased risk for breast cancer may need to start sooner. Women who may be at increased risk of breast cancer can be evaluated in Roswell Park’s High Risk Breast Cancer Program.

Screening mammography is the only test shown in multiple trials to lower the risk of dying from breast cancer. Also, detecting breast cancer at a very early stage often requires less aggressive treatment, such as a lumpectomy rather than a mastectomy. Early discovery may also eliminate the need for chemotherapy treatment.

It is also important to remember that most woman who develop breast cancer do not have a family history of breast cancer. “I always tell women that you need to have a screening mammogram yearly if you are over age 40, even if no one in your family has had breast cancer,” Dr. Bonaccio says.

Pain is not a sign of breast cancer, according to Dr. Bonaccio. She says, “Most women know that the bilateral pain that waxes and wanes with your menstrual cycle is normal and related to hormones. Some women will get areas of focal pain and come in with concerns that they have developed breast cancer. For breast cancer to cause pain, it is typically large enough that there is no question as to the diagnosis.” She says that women have been taught that if they feel pain, there is something wrong, but this is not quite true for breast cancer. “If a woman is over 30 and is concerned about pain, we could potentially do a mammogram for evaluation. If the pain is focal, we can also evaluate the breast tissue with ultrasound. However, there is no data to suggest we find breast cancers when pain is the only symptom.”

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