Breast health: Your questions answered

Screening

IS MAMMOGRAPHY WORTHWHILE IF I'M IN MY 40S?
While annual screening for women over age 50 clearly saves lives, the benefits for younger women are less clear. Young women are much less likely than older ones to develop the cancer.

And the greater density of their breasts makes it harder to spot tumors. As a result, mammography for them may produce less benefit. And that can make the test's risks-mainly false alarms and the anxiety and biopsies they trigger-more disturbing. On the other hand, breast cancer in younger women tends to be especially aggressive. The more breast-cancer risk factors you have the more sensible testing in your 40s becomes.

But most cancers occur in women with no known risk factors. If you're in that group, the decision boils down to how worried you are about breast cancer and how prepared you are for the possibility of a false-positive result.

ARE MANUAL EXAMS WORTHWHILE?
A July 2008 review found that breast self-exams have no overall benefit and make needless biopsies more likely. But that's probably because women don't perform the tests properly. Our consultants still say that women should be familiar with the terrain of their breasts and report any lumps or changes to their physician. Talk with your doctor about the proper timing and technique for the exams. Similarly, while there's little evidence backing up manual exams by doctors or nurses, a careful clinical exam by a skilled practitioner might catch some tumors missed by mammography.

Consider having it done before your mammogram so that the radiologist will be aware of suspicious areas.

DO I NEED OTHER SCREENING TESTS IF I'M AT HIGH RISK?
People at high risk of breast cancer should consider a breast MRI. Ultrasound screening, as it becomes increasingly available, might be the answer for women who are at somewhat lower risk as well as for those who can't undergo MRIs because they're too claustrophobic or too large to enter the machines, or because they can't have the test for medical reasons. Breast ultrasounds, combined with standard mammography, find 3 to 4 additional cancers per 1,000 women at intermediate risk, according to a recent study. But neither ultrasound nor MRI is appropriate for average-risk women, since they both increase the risk of a false-positive result.