Breast Cancer Screening

At NYU Langone, the goal of breast cancer screening is to identify cancer early, when it can be most effectively treated. The most important benefit of early detection is the improved chance of recovery associated with early breast cancer.

Early detection may also mean that you require less extensive treatment and experience fewer side effects. 

NYU Langone doctors recommend that women perform a breast self-exam once a month starting in their 20s. They also recommend that women have a clinical breast exam, which is given by a doctor, every three years during their 20s and 30s and annually after age 40.

They also advise having a mammogram—the X-ray test that’s considered the gold standard for breast cancer screening—every year starting at age 40. Mammograms are the primary test used to screen for breast cancer, but they may not be the only one our doctors use.

Our doctors can recommend a more personalized screening plan based on your individual risk of developing breast cancer, taking into account factors such as family history and whether you have a genetic mutation associated with breast cancer. If your doctor determines you are at increased risk, he or she may recommended having additional screening tests starting before age 40.

NYU Langone offers a full range of imaging tests at several locations, including the Laura and Isaac Perlmutter Cancer Center, the NYU Langone Joan H. Tisch Center for Women's Health, and the Laura Perlmutter Center for Women's Imaging.

Screening Tests

Results of imaging tests are available immediately after your appointment. This helps to ensure that any further testing and treatment can begin quickly. 

Breast Self-Exam

A breast self-exam allows women to become familiar with their breasts and to detect any unusual changes in the breasts’ appearance and how they feel from month to month.

The exam involves looking at your breasts in a mirror to see if you notice any skin puckering, dimples, or changes in the outline. It also involves lying down and examining your breasts with your fingers for any lumps and squeezing the nipples to see if there is any discharge. Usually, nipple discharge is a sign of a small, benign growth called an intraductal papilloma. Although it’s usually benign, nipple discharge should be evaluated by a health professional.

Women can perform a monthly breast self-exam at home, several days after the menstrual cycle starts. This is the time of month when the breasts are not as tender or lumpy due to hormonal changes. In women who have gone through menopause, the exam can be performed on the same day every month.

NYU Langone doctors can explain how to perform a breast self-exam correctly.

Clinical Breast Exam

Gynecologists and general practitioners perform clinical breast exams during routine checkups. They examine the breasts visually and feel them with their hands for any unusual lumps or changes since the last exam.

Mammogram

A mammogram, which is an X-ray of the breasts, is the gold standard for breast cancer screening.

During this procedure, your breasts are gently compressed between two plates that are attached to a mammography unit, an X-ray machine designed specifically for mammograms. The unit flattens breast tissue, making any tumors easier to see. The technician takes multiple two-dimensional images of the breasts.

Technologist Teisha David-Blanchette Administers Mammogram

At NYU Langone, mammographic images are digitized and stored on a computer. This enables doctors to enhance and magnify the images while reviewing them. They look for suspicious growths or calcium deposits, which can be a sign of cancer. 

Three-Dimensional Mammogram

During this procedure, which is known as breast tomosynthesis, X-ray images are taken from multiple angles to create three-dimensional pictures of the breast instead of the two-dimensional images taken during a traditional mammogram.

The benefits of breast tomosynthesis are currently being investigated. This approach may help doctors to detect any suspicious growths, especially in women who have “dense” breasts, which contain more fibrous and glandular tissue than fatty tissue. While this is normal, it can make breast cancer difficult to detect on traditional mammograms. 

Ultrasound

In ultrasound, sound waves create images of the breasts. Ultrasound can be very helpful in determining if a breast mass is solid or filled with liquid (cystic). This test is often used in combination with a mammogram in women who have dense breast tissue. 

MRI 

NYU Langone doctors may recommend a breast MRI if mammogram images are unclear or for women who are at high risk of developing breast cancer. An MRI uses a magnetic field and radio waves to produce computerized, three-dimensional images of the breasts.

Your doctor may give you a contrast agent before the scan to highlight any abnormalities in the breast tissue. It’s usually given through a vein with intravenous (IV) injection. 

High Risk Screening Program 

NYU Langone offers a screening and prevention program for women at high risk of developing breast cancer. Our team of medical oncologists, surgical oncologists, and staff members works with each woman to help her gain a clear understanding of her breast cancer risk factors, how her risk of developing the condition evolves as her life changes, and what she can do to manage her risk.

Through this program, each woman receives a thorough physical examination, a review of her medical history by an oncologist, and routine and advanced screening examinations that may consist of clinical breast exams, mammograms, ultrasounds, and MRIs. 

Surveillance for associated cancer risk, including ovarian, colon, prostate, uterine, pancreatic and other gastrointestinal cancers, thyroid, and melanoma, is also included.

Women who are found to be at high risk for breast cancer receive individualized preventive care to help minimize and manage their risk. This may include nutritional, psychological, and genetic counseling, preventive treatments—for example, tamoxifen or access to clinical trials that evaluate various approaches to cancer prevention—and risk-reducing surgery. 

NYU Langone researchers collect information about the health of high-risk women in a longitudinal registry, meaning medical information is repeatedly evaluated over a long period of time to help investigators discover which screening and preventive measures are most effective.

Risk Factors

Women are considered to be at high risk for breast cancer if they have a family history of the disease or genetic mutations, such as in BRCA1 or BRCA2, which are also called the “breast cancer genes.”

Normal versions of the BRCA1 and BRCA2 genes produce proteins that help prevent cancer growth. Abnormal, or mutated, versions of these genes raise the risk that breast cancer may develop.

These genetic mutations are rare in the general population; they occur more often in people of Ashkenazi Jewish descent. BRCA1 and BRCA2 testing, which usually involves a blood test, is available at NYU Langone. 

Genetic mutations linked to cancers of the colon, uterus, and thyroid, as well as melanoma, may also increase the risk of breast cancer. These genetic mutations can also be tested for and identified at NYU Langone. Women with high-risk mutations can choose to have prophylactic mastectomy before any cancer develops through our Breast in a Day surgery.

Our genetic counseling services can help women with these mutations to better understand their risk of developing cancer. NYU Langone counselors can recommend support services that help you to manage the psychological effects of testing positive for these mutations. 

In addition to your family history and the results of genetic testing, doctors take other risk factors into account when developing a breast cancer screening plan for you. Certain conditions can increase your risk of developing cancer, including lobular carcinoma in situ and atypical hyperplasia, an overgrowth of cells in the milk ducts or milk-producing glands. 

Prior radiation therapy—the use of high energy beams to destroy cancer cells—for conditions such as Hodgkin lymphoma and thyroid cancer can also increase your risk of breast cancer. 

Some lifestyle factors may increase your risk of developing breast cancer. For example, studies show that smoking and other forms of tobacco consumption may raise the risk. NYU Langone doctors strongly urge people to quit smoking. Our specialists offer effective Tobacco Cessation Programs to help you quit for good.

Drinking alcohol may also increase the risk of breast cancer. Additionally, being overweight—having a body mass index (BMI) of 25 to 29.9—or obese, meaning a BMI of 30 or higher—after menopause has also been linked to breast cancer. 

Additionally, using combination hormone therapy after menopause—which includes estrogen and progesterone—can raise breast cancer risk. These hormones can fuel breast cancer growth. 

One of the strongest risk factors for developing breast cancer is age. A woman’s risk increases as she gets older.

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