Risks of Breast Cancer Screening
Key Points for This Section
- Screening tests have risks.
- The risks of breast cancer screening tests include the following:
- Finding breast cancer may not improve health or help a woman live longer.
- False-negative test results can occur.
- False-positive test results can occur.
- Anxiety from additional testing may result from false positive results.
- Mammograms expose the breast to radiation.
- There may be pain or discomfort during a mammogram.
- The risks and benefits of screening for breast cancer may be different in different age groups.
Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.
Screening may not help you if you have fast-growing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become life-threatening. Finding these cancers is called overdiagnosis. When such cancers are found, treatment would not help you live longer and may instead cause serious side effects. At this time, it is not possible to be sure which breast cancers found by screening will cause problems and which ones will not.
Screening test results may appear to be normal even though breast cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms.
One in 5 cancers may be missed by mammography. False-negative results occur more often in younger women than in older women because the breast tissue of younger women is more dense. The chance of a false-negative result is also affected by the following:
- The size of the tumor.
- The rate of tumor growth.
- The level of hormones, such as estrogen and progesterone, in the woman’s body.
- The skill of the radiologist.
Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) is usually followed by more tests (such as biopsy), which also have risks.
Most abnormal test results turn out not to be cancer. False-positive results are more common in the following:
- Younger women.
- Women who have had previous breast biopsies.
- Women with a family history of breast cancer.
- Women who take hormones, such as estrogen and progestin.
The skill of the radiologist also can affect the chance of a false-positive result.
False-positive results from screening mammograms are usually followed by more testing that can lead to anxiety. In one study, women who had a false-positive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after false-positive test results are more likely to schedule regular breast screening exams in the future.
Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure.
During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better x-ray of the breast. Some women have pain or discomfort during a mammogram.
The benefits of breast cancer screening may vary among age groups:
- In women who are expected to live 5 years or fewer, finding and treating early stage breast cancer may reduce their quality of life without helping them live longer.
- As with other women, in women older than 65 years, the results of a screening test may lead to more diagnostic tests and anxiety while waiting for the test results. Also, the breast cancers found are usually not life-threatening.
- In women in their 80s and 90s, decisions about screening should depend on the patient's health and the possible effect on quality of life.
- It has not been shown that women with an average risk of developing breast cancer benefit from starting screening mammography before age 40.
Women who have had radiation treatment to the chest, especially at a young age, are advised to have routine breast cancer screening. Yearly MRI screening may begin 8 years after treatment or by age 25 years, whichever is later. The benefits and risks of mammograms and MRIs for these women have not been studied.
There is no information on the benefits or risks of breast cancer screening in men.
No matter how old you are, if you have risk factors for breast cancer you should ask for medical advice about when to begin having breast cancer screening tests and how often to have them.