Breast Cancer Screening Modalities

  • Kerry-Ann McDonald
  • Jessica YoungEmail author


Breast cancer is the most common malignancy in women and a leading cause of morbidity and mortality in them. Breast cancer survival varies by stage at diagnosis. According to Surveillance, Epidemiology, and End Results (SEER) data, the overall 5-year relative survival rate is 99% for localized disease, 85% for regional disease, and 27% for distant-stage disease [1]. Breast cancer screening is used to identify women with asymptomatic cancer so that cases are picked up and treated early leading to better outcomes. Presently, breast cancer detection relies on mammography as the main screening modality, but its role is now declining because of high false-positive rates and limited sensitivity for detection of lesions in dense breast tissues. Biomarkers that can predict early disease are a welcome addition to the imaging methods used for breast cancer screening. Imaging techniques for screening have been discussed in detail in Chap.  27, and the role of clinical examination and biomarkers will be dealt in this chapter.


  1. 1.
    American Cancer Society. Breast Cancer Facts & Figures 2017–2018. Atlanta: American Cancer Society, Inc.; 2017.Google Scholar
  2. 2.
    Gao DL, Thomas DB, Ray RM, Wang WW, Allison CJ, Chen FL, Porter P, Hu YW, Zhao GL, Pan LD, Li WJ, Wu CY, Coriaty Z, Evans I, Lin MG, Stalsberg H, Self SG. Randomized trial of breast self-examination in 266,064 women in Shanghai. Zhonghua Zhong Liu Za Zhi. 2005;27:350–4.PubMedGoogle Scholar
  3. 3.
    Baxter N, Canadian Task force on Preventive Health Care. Preventive health care, 2001 update: should women be routinely taught breast self-examination to screen for breast cancer? CMAJ. 2001;164(13):1837–46.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kosters JP, Gotzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003;(2):CD003373.
  5. 5.
    Thornton H, Pillarisetti R. Breast awareness and breast self examination are not the same. What do these terms mean? Why are they confused? What can we do? Eur J Cancer. 2008;44(15):2118–21.CrossRefGoogle Scholar
  6. 6.
    Grethelin SJ. Breast examination technique. Updated on 21 Jan 2016.
  7. 7.
    Boulos S, Gadallah M, Neguib S, et al. Breast screening in the emerging world: high prevalence of breast cancer in Cairo. Breast. 2005;14:340–6.CrossRefGoogle Scholar
  8. 8.
    Dinshaw K, Mishra G, Shastri S, et al. Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in Mumbai, India. 2. Compliance to referral and treatment. Oncology. 2007;73:154–61.CrossRefGoogle Scholar
  9. 9.
    Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L, On Behalf of the U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727–37, W237–42. Scholar
  10. 10.
    Tonelli M, Connor Gorber S, Joffres M, et al. On Behalf of the Canadian Task Force on Preventive Health Care Recommendations on screening for breast cancer in average-risk women aged 40–74 years. CMAJ. 2011;183:1991–2001. Scholar
  11. 11.
    U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716–26, W236.
  12. 12.
    Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314:1599–614. Scholar
  13. 13.
    National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis ver 1.2014. Fort Washington, PA: NCCN; 2014. Current version available online at: (free registration required). Cited 3 June 2016.
  14. 14.
    Gillman J, Toth HK, Moy L. The role of dynamic contrast-enhanced screening breast MRI in populations at increased risk for breast cancer. Womens Health (Lond). 2014;10(6):609–22.CrossRefGoogle Scholar
  15. 15.
    Chetlen A, Mack J, Chan T. Breast cancer screening controversies: who, when, why, and how? Clin Imaging. 2016;40(2):279–82.CrossRefGoogle Scholar
  16. 16.
    Moseley TW. Digital mammography and digital breast tomosynthesis. Clin Obstet Gynecol. 2016;59(2):362–79.CrossRefGoogle Scholar
  17. 17.
    Hendrick RE, Pisano ED, Averbukh A, Moran C, Berns EA, Yaffe MJ, et al. Comparison of acquisition parameters and breast dose in digital mammography and screen-film mammography in the American College of Radiology Imaging Network digital mammographic imaging screening trial. AJR Am J Roentgenol. 2010;194(2):362–9.CrossRefGoogle Scholar
  18. 18.
    Fiorica JV. Breast cancer screening, mammography, and other modalities. Clin Obstet Gynecol. 2016;59(4):688–709.CrossRefGoogle Scholar
  19. 19.
    Morris E, Feig SA, Drexler M, Lehman C. Implications of overdiagnosis: impact on screening mammography practices. Popul Health Manag. 2015;18(Suppl 1):S3–11.CrossRefGoogle Scholar
  20. 20.
    Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499–507.CrossRefGoogle Scholar
  21. 21.
    Ciatto S, Houssami N, Bernardi D, Caumo F, Pellegrini M, Brunelli S, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14(7):583–9.CrossRefGoogle Scholar
  22. 22.
    Spangler ML, Zuley ML, Sumkin JH, Abrams G, Ganott MA, Hakim C, et al. Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. AJR Am J Roentgenol. 2011;196(2):320–4.CrossRefGoogle Scholar
  23. 23.
    Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311(13):1327–35.CrossRefGoogle Scholar
  24. 24.
    Miller D, Livingstone V, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev. 2008;(1):CD002942.Google Scholar
  25. 25.
    Armstrong K, Moye E, Williams S, Berlin JA, Reynolds EE. Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians. Ann Intern Med. 2007;146(7):516–26.CrossRefGoogle Scholar
  26. 26.
    Loving VA, DeMartini WB, Eby PR, Gutierrez RL, Peacock S, Lehman CD. Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 2010;195(6):1472–7.CrossRefGoogle Scholar
  27. 27.
    Brem RF, Tabar L, Duffy SW, Inciardi MF, Guingrich JA, Hashimoto BE, et al. Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology. 2015;274(3):663–73.CrossRefGoogle Scholar
  28. 28.
    Kuhl CK, Schrading S, Leutner CC, Morakkabati-Spitz N, Wardelmann E, Fimmers R, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 2005;23(33):8469–76.CrossRefGoogle Scholar
  29. 29.
    Moore SG, Shenoy PJ, Fanucchi L, Tumeh JW, Flowers CR. Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Serv Res. 2009;9:9. Scholar
  30. 30.
    Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75–89.CrossRefGoogle Scholar
  31. 31.
    Fu SW, Chen L, Man Y. miRNA biomarkers in breast cancer detection and management. J Cancer. 2011;2:116–22. Scholar
  32. 32.
    Muralidharan-Chari V, Clancy JW, Sedgwick A, D’souza-schorey C. Microvesicles: mediators of extracellular communication during cancer progression. J Cell Sci. 2010;123:1603–11.CrossRefGoogle Scholar
  33. 33.
    van’t Veer LJ, Dai H, van de Vijver MJ, He YD, Hart AAM, Mao M, et al. Gene expression profiling predicts clinical outcome of breast cancer. Nature. 2002;415(6871):530–6.CrossRefGoogle Scholar
  34. 34.
    Melander O, Belting M, Manjer J, Maisel AS, Hedblad B, Engström G, Nilsson P, Struck J, Hartmann O, Bergmann A, Orho-Melander M. Validation of plasma proneurotensin as a novel biomarker for the prediction of incident breast cancer. Cancer Epidemiol Biomarkers Prev. 2014;23(8):1672–6. Scholar
  35. 35.
    Kazarian A, Blyuss O, Metodieva G, et al. Testing breast cancer serum biomarkers for early detection and prognosis in pre-diagnosis samples. Br J Cancer. 2017;116(4):501–8. Scholar
  36. 36.
    Menendez J, Lupu R, Colomer R. Targeting fatty acid synthase: potential for therapeutic intervention in Her-2/neu-overexpressing breast cancer. Drug News Perspect. 2005;18:375.CrossRefGoogle Scholar
  37. 37.
    Colleoni M, Viale G, Zahrieh D, Pruneri G, Gentilini O, Veronesi P, Gelber RD, Curigliano G, Torrisi R, Luini A, Intra M, Galimberti V, Renne G, Nolè F, Peruzzotti G, Goldhirsch A. Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res. 2004;10(19):6622–8.CrossRefGoogle Scholar
  38. 38.
    Dowsett M, Houghton J, Iden C, et al. Benefit from adjuvant tamoxifen therapy in primary breast cancer patients according estrogen receptor, progesterone receptor, EGF receptor and HER2 status. Ann Oncol. 2006;17:818–26.CrossRefGoogle Scholar
  39. 39.
    Slamon DJ, Leyland-Jones B, Shak S, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 2001;344:783–92.CrossRefGoogle Scholar
  40. 40.
    Chang J, Ormerod M, Powles TJ, Allred DC, Ashley SE, Dowsett M. Apoptosis and proliferation as predictors of chemotherapy response in patients with breast carcinoma. Cancer. 2000;89:2145–52.<2145::AID-CNCR1>3.0.CO;2-S.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Gillett C, Smith P, Gregory W, Richards M, Millis R, Peters G, Barnes D. Cyclin D1 and prognosis in human breast cancer. Int J Cancer. 1996;69:92–9.<92::AID-IJC4>3.0.CO;2-Q.CrossRefPubMedGoogle Scholar
  42. 42.
    Seshadri R, Lee CS, Hui R, McCaul K, Horsfall DJ, Sutherland RL. Cyclin DI amplification is not associated with reduced overall survival in primary breast cancer but may predict early relapse in patients with features of good prognosis. Clin Cancer Res. 1996;2:1177–84.PubMedGoogle Scholar
  43. 43.
    Keyomarsi K, Tucker SL, Buchholz TA, Callister M, Ding Y, Hortobagyi GN, Bedrosian I, Knickerbocker C, Toyofuku W, Lowe M, et al. Cyclin E and survival in patients with breast cancer. New Engl J Med. 2002;347:1566–75. Scholar
  44. 44.
    Skliris GP, Munot K, Bell SM, Carder PJ, Lane S, Horgan K, Lansdown MR, Parkes AT, Hanby AM, Markham AF, et al. Reduced expression of oestrogen receptor beta in invasive breast cancer and its re-expression using DNA methyl transferase inhibitors in a cell line model. J Pathol. 2003;201:213–20. Scholar
  45. 45.
    Hopp TA, Weiss HL, Parra IS, Cui Y, Osborne CK, Fuqua SA. Low levels of estrogen receptor beta protein predict resistance to tamoxifen therapy in breast cancer. Clin Cancer Res. 2004;10:7490–9. Scholar
  46. 46.
    Weigel MT, Dowsett M. Current and emerging biomarkers in breast cancer: prognosis and prediction. Endocr Relat Cancer. 2010;17(4):R245–62.CrossRefGoogle Scholar
  47. 47.
    Leon SA, Shapiro B, Sklaroff DM, Yaros MJ. Free DNA in the serum of cancer patients and the effect of therapy. Cancer Res. 1977;37:646–50.PubMedGoogle Scholar
  48. 48.
    Stoetzer OJ, Fersching DM, Salat C, Steinkohl O, Gabka CJ, Hamann U, et al. Prediction of response to neoadjuvant chemotherapy in breast cancer patients by circulating apoptotic biomarkers nucleosomes, DNAse, cytokeratin-18 fragments and survivin. Cancer Lett. 2013;336:140–8.CrossRefGoogle Scholar
  49. 49.
    Dos Anjos Pultz B, da Luz FA, de Faria PR, Oliveira AP, de Araújo RA, Silva MJ. Far beyond the usual biomarkers in breast cancer: a review. J Cancer. 2014;5(7):559–71.CrossRefGoogle Scholar
  50. 50.
    Siu AL, U.S. Preventive Services Task Force. Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2016;164(4):279–96.CrossRefGoogle Scholar
  51. 51.
    Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599–614.CrossRefGoogle Scholar
  52. 52.
    Committee on Practice Bulletins-Gynecology. Practice bulletin number 179: breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(1):e1–16.CrossRefGoogle Scholar
  53. 53.
    Wilt TJ, Harris RP, Qaseem A, High Value Care Task Force of the American College of Physicians. Screening for cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162(10):718–25.CrossRefGoogle Scholar
  54. 54.
    Canadian Task Force on Preventive Health Care, Tonelli M, Connor Gorber S, Joffres M, Dickinson J, Singh H, et al. Recommendations on screening for breast cancer in average-risk women aged 40-74 years. CMAJ. 2011;183(17):1991–2001.CrossRefGoogle Scholar
  55. 55.
    Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, et al. Recommendations for screening and early detection of common cancers in India. Lancet Oncol. 2015;16(7):e352–61.CrossRefGoogle Scholar
  56. 56.
    Yip CH, Smith RA, Anderson BO, Miller AB, et al. Guideline implementation for breast healthcare in low and middle income countries. Cancer. 2008;113:2244–56.CrossRefGoogle Scholar
  57. 57.
    Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med. 2009;151(10):738–47.CrossRefGoogle Scholar
  58. 58.
    Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.CrossRefGoogle Scholar
  59. 59.
    Smith RA, Saslow D, Sawyer KA, Burke W, Costanza ME, Evans WP 3rd, et al. American cancer society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53(3):141–69.CrossRefGoogle Scholar
  60. 60.
    Bhatia S, Robison LL, Oberlin O, Greenberg M, Bunin G, Fossati-Bellani F, et al. Breast cancer and other second neoplasms after childhood Hodgkin’s disease. N Engl J Med. 1996;334(12):745–51.CrossRefGoogle Scholar
  61. 61.
    Bhatia S, Yasui Y, Robison LL, Birch JM, Bogue MK, Diller L, et al. High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin’s disease: report from the Late Effects Study Group. J Clin Oncol. 2003;21(23):4386–94.CrossRefGoogle Scholar
  62. 62.
    Hancock SL, Tucker MA, Hoppe RT. Breast cancer after treatment of Hodgkin’s disease. J Natl Cancer Inst. 1993;85(1):25–31.CrossRefGoogle Scholar
  63. 63.
    Metayer C, Lynch CF, Clarke EA, Glimelius B, Storm H, Pukkala E, et al. Second cancers among long-term survivors of Hodgkin’s disease diagnosed in childhood and adolescence. J Clin Oncol. 2000;18(12):2435–43.CrossRefGoogle Scholar
  64. 64.
    van Leeuwen FE, Klokman WJ, Stovall M, Dahler EC, van’t Veer MB, Noordijk EM, et al. Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin’s disease. J Natl Cancer Inst. 2003;95(13):971–80.Google Scholar
  65. 65.
    Yahalom J, Petrek JA, Biddinger PW, Kessler S, Dershaw DD, McCormick B, et al. Breast cancer in patients irradiated for Hodgkin’s disease: a clinical and pathologic analysis of 45 events in 37 patients. J Clin Oncol. 1992;10(11):1674–81.CrossRefGoogle Scholar
  66. 66.
    McCormack VA, dos Santos Silva I. Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1159–69.CrossRefGoogle Scholar
  67. 67.
    Byrne C, Schairer C, Wolfe J, Parekh N, Salane M, Brinton LA, et al. Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst. 1995;87(21):1622–9.CrossRefGoogle Scholar
  68. 68.
    Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356(3):227–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Breast Surgery Division, Department of Surgical OncologyRoswell Park Comprehensive Cancer CenterBuffaloUSA

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