Breast Cancer Screening, Prevention & Diagnosis

Our Breast Cancer Screening Options

Early detection of breast cancer is crucial. Mammography is the gold standard of breast cancer screening, but depending on individual factors like breast density and breast cancer risk, additional types of imaging also may be used. Understanding your screening options can help you make more informed decisions about your health.

Mammography

A mammogram is a specialized low-dose X-ray of the breast that can show small, early-stage breast cancers. It’s a key component in breast cancer screening that plays a vital role in early diagnosis. At Houston Methodist, we offer 3D mammograms (digital breast tomosynthesis), a more advanced form of breast imaging that offers improved detection, better visualization and fewer false positives than its 2D counterpart.

Screening mammography is recommended annually starting at age 40 for women with average risk of breast cancer. Those who are at higher risk may need earlier screening and additional types of imaging. If a screening mammogram shows an abnormal result, a diagnostic mammogram will be needed. During a diagnostic mammogram, additional views of the breast are taken as the radiologist reads the mammogram in real-time.

Breast Ultrasound

A breast ultrasound creates detailed pictures of the breast using sound waves instead of radiation. It may be used in addition to a screening mammogram for women who have dense breast tissue or are at higher risk of developing breast cancer. A breast ultrasound also might be used during follow-up imaging to more closely examine unusual findings uncovered on a screening mammogram, as it can help distinguish between fluid-filled cysts and solid masses.

Breast Magnetic Resonance Imaging

Breast magnetic resonance imaging (breast MRI) is a minimally invasive technique that uses magnetic fields and radio waves to create detailed images of breast tissue without radiation exposure. It is often recommended in addition to a screening mammogram for high-risk individuals, such as those with a known genetic mutation or strong family history.

Contrast-Enhanced Mammogram

A contrast-enhanced mammogram (CEM) is similar to a traditional mammogram but incorporates the use of iodinated contrast dye to help identify breast cancer. CEM may be used to screen for breast cancer in people who are at higher risk or those who have dense breast tissue.

Molecular Breast Imaging

Molecular breast imaging (MBI) is a specialized imaging technique that uses a small amount of radioactive tracer dye to detect cancer cells. MBI may be used in combination with a screening mammogram for women who have dense breast tissue, since the denser the breast tissue can make a standard mammogram more difficult to read. MBI also may be used if a screening mammogram and breast ultrasound show abnormal results, and more detailed images of breast cells are needed.

Clinical Breast Exam

A clinical breast exam is a physical examination of the breasts performed by a health care professional, such as a doctor or nurse. This exam can help to identify lumps or other abnormalities that require further investigation. Women over age 25 should have a clinical breast exam annually as part of their well-woman visit. During the exam, the doctor or nurse will check both breasts and the underarm areas for any changes in size, shape, skin texture or the presence of lumps. Houston Methodist also encourages regular breast self-awareness, including monthly breast self-exams, so patients notice changes between screenings.

Schedule your screening >

Risk Factors for Breast Cancer

About 1 in 8 women will develop breast cancer in her lifetime. Lowering your risk of breast cancer starts with knowing the factors that can increase it. Having one or more risk factors does not guarantee a breast cancer diagnosis, just as having none does not rule one out. It’s important to be aware of both the factors that can be changed and the ones that can’t so you can understand your modifiable and non-modifiable risk.

Factors that can raise someone's risk of developing breast cancer include:

• Being female
• Increasing age
• An inherited mutation in the BRCA1 or BRCA2 genes, or other genes linked to breast cancer
• A family history of breast cancer or related cancers, including ovarian, uterine, prostate or pancreatic cancer
• A personal history of breast or ovarian cancer
• A personal history of benign breast tumors or tissue removal
• Prior radiation therapy to the chest, often related to earlier cancer treatment before age 30
• Dense breast tissue, which can also make mammograms harder to interpret
• Menopause after age 55, or starting menstruation before age 12
• Giving birth to a first child after age 30, or never giving birth
• Long-term use of birth control pills before a first full-term pregnancy
• Postmenopausal hormone therapy
• Being overweight or obese, particularly after menopause
• Consuming more than one alcoholic drink daily
• Ashkenazi Jewish ancestry
• Occupational radiation exposure

• Maintaining a healthy weight
• Eating a well-balanced diet
• Exercising regularly
• Limiting alcohol consumption
• Not smoking
• Understanding your personal risk of breast cancer and following recommended screening and prevention guidelines

How often someone should be screened, and starting at what age, depends on whether they fall into an average-risk or high-risk category.

Average Risk Guidelines

Houston Methodist recommends screening mammograms annually starting at age 40 for women with an average risk of breast cancer. Average risk generally means:

• No personal or strong family history of breast cancer
• No known genetic mutation
• No prior chest radiation therapy

High-Risk Guidelines

Some of the risk factors above, when present at a certain level, move someone into a high-risk category with a different screening timeline. Someone is generally considered high risk and should start annual screening earlier than age 40 if they have any of the following:

• A known BRCA1 or BRCA2 mutation (or another gene mutation linked to breast cancer)
• A first-degree relative with a BRCA mutation
• A strong family history of breast or ovarian cancer
• A calculated lifetime risk of around 20% or higher
• Prior chest radiation therapy before age 30
• An inherited syndrome such as Li-Fraumeni or Cowden syndrome

For these patients, an annual breast MRI in addition to an annual mammogram, typically starting around age 30, sometimes earlier depending on the specific risk factor. Patients with a lifetime risk above 20% may need diagnostic imaging, such as alternating diagnostic mammograms and MRIs, as often as every six months.

Houston Methodist's High Risk Program brings together cancer doctors, nurses, genetic counselors and nutritionists to offer personalized risk assessment, genetic counseling and nutrition and lifestyle guidance to help determine the right starting age and screening combination for you.

What to Expect During Your Mammogram

During a screening mammogram, a technologist positions the breast between two plates for a brief compression lasting just a few seconds, repeated two to three times per breast. The entire appointment typically takes about five minutes. There's no need to prepare beyond avoiding deodorant or lotion near the chest and skipping jewelry that could interfere with imaging. A radiologist reviews the images, and most patients receive results within a few days.

Mammogram results are reported using the Breast Imaging Reporting and Data System (BI-RADS), a standard scale radiologists use to categorize findings from 0 to 6, ranging from incomplete studies that need more imaging to a confirmed cancer diagnosis.

If a screening mammogram shows an area that needs a closer look, whether it's a mass, calcifications or another finding, patients are called back for a diagnostic mammogram, which takes additional, more detailed views of that specific area. A callback does not mean a cancer diagnosis. According to our breast radiologists, a callback means our experts want to look at something more closely. In actuality, the majority of patients who are called back do not have cancer, with fewer than 1 in 10 women who are called back are found to have breast cancer.

Understanding Breast Density

Breast tissue density is reported on every mammogram and falls into one of four categories:

• Almost entirely fatty tissue
• Scattered areas of fibroglandular tissue
• Heterogeneously dense tissue
• Extremely dense tissue

How Breast Cancer Is Diagnosed

A screening result, a symptom or a finding during a clinical exam can all lead to further testing. Here's what that process typically looks like:

First Steps: Initial Consultation

Your first meeting with a breast specialist includes a conversation about your diagnosis and the treatment options available to you. An oncology nurse navigator will be there to support you, help you understand your next steps and coordinate upcoming appointments. Since this initial visit can be a lot to take in, your nurse navigator will also give you a packet with information about your diagnosis, treatment plan and additional resources to review later, on your own time.

Biopsy

A breast biopsy removes a small sample of tissue for testing, to confirm whether cancer or abnormal cells are present. It's usually recommended after a mammogram, ultrasound or MRI shows an area of concern, and may be guided by one of those imaging tools to reach the correct spot. A breast cancer biopsy may include: 

• Core needle biopsy: Uses a hollow needle to remove a sample of breast tissue.
• Vacuum-assisted (minimally invasive) biopsy: Uses a needle paired with a suction-style instrument to remove several small tissue samples, typically more than a core needle biopsy alone.

Genetic Testing for Breast Cancer

Some breast cancers are linked to an inherited mutation on genes such as BRCA1, BRCA2, PALB2, ATM, PTEN, TP53 or CHEK2. Genetic testing isn't right for everyone, since these mutations are rare, but your doctor may recommend it if you have a strong family history of breast cancer, a known mutation in your family, are of Ashkenazi Jewish descent, were diagnosed before age 50, have cancer in both breasts, are a man with breast cancer or have triple-negative breast cancer.

Testing is simple, usually just a blood, saliva or cheek swab sample sent to a lab. Results typically come back as:

• Positive: The tested mutation is present.
• Negative: The tested mutation is not present.
• Inconclusive: The test could not determine whether the mutation is present.
• Variant of unknown significance (VUS): A gene variation was found, but it's not yet known whether it affects your risk.

Over-the-counter genetic tests are available, but they typically screen for only a small number of the more than 1,000 known BRCA mutations, so a negative result from one of these tests doesn't rule out an elevated risk from a different mutation. If you're concerned about your genetic risk, talk to your care team about comprehensive testing through our genetic counseling program.

Understanding Your Pathology Report

After a biopsy, a pathologist examines the tissue sample and prepares a report describing what they found. This report typically includes:

• Non-invasive or invasive: Whether the cancer is confined to its original location or has spread into surrounding tissue.
• Hormone receptor status: Whether the cancer cells have estrogen or progesterone receptors that can fuel their growth.
• HER2 status: Whether the cells produce HER2, a protein that can also drive growth and that certain targeted therapies are built to block.
• Tumor size and margins: How large the tumor is, and whether the tissue surrounding it is free of cancer cells.
• Nuclear and cancer grade: How closely the cancer cells resemble healthy cells, an indicator of how aggressive the cancer may be.
• Lymph node involvement: Whether cancer is present in nearby lymph nodes, if any were removed and tested.

Your care team will walk you through what your specific report means and how it shapes your treatment plan.

Breast Cancer Staging

Staging determines how much cancer is present and whether it has spread, and it plays a central role in treatment planning. It's based on tumor size, lymph node involvement, whether the cancer has spread to distant parts of the body, and receptor status (ER, PR and HER2).

Breast cancer is staged from 0 to 4. Stage 0 refers to non-invasive cancer, such as DCIS, that hasn't spread beyond its original location. Higher stages reflect more extensive spread, with stage 4 meaning the cancer has spread beyond the breast to other parts of the body.

Learn more about the different types of breast cancer >

Why Choose Houston Methodist for Breast Cancer Screening

• Board-certified radiologists with specialized expertise in early cancer detection
• Advanced 3D mammography and a full range of supplemental imaging, including breast MRI, ultrasound, CEM and molecular breast imaging
• Fast follow-up and clear next steps if a screening result comes back abnormal
• Personalized breast cancer risk assessment and genetic testing through our High Risk Program, so patients understand their individual risk before a screening path is recommended
• Breast Care Centers and Breast Imaging locations throughout the Greater Houston area, including Texas Medical Center, West Hospital, Willowbrook, Sugar Land, Baytown, Clear Lake, The Woodlands, Cypress, Pearland, Kirby and Towne Lake, with a full list of locations to find the one nearest you

Wherever you are in your screening journey, our team is here to help you feel informed and cared for at every step.