Is This Test Necessary? Six Breast Cancer Procedures You May Not Need
PJ Hamel | May 29, 2017
Reviewed by Todd Gersten, MD
Women experiencing suspected breast cancer symptoms are often scheduled for a variety of tests to rule in or rule out cancer. And women who’ve been diagnosed with breast cancer face still more tests, both to check on the potential spread of cancer, or to assess how well any particular treatment is working. The number of tests can be daunting — as can their expense, even if you have health insurance. What expensive tests can you consider skipping?
Genetic testing: look for other breast cancer risk factors first
Genetic testing for certain mutated genes is an option for women wanting to know for sure if breast cancer “runs in the family.” But according to the National Cancer Institute (NCI), this test should only be considered for women meeting a number of specific criteria, including having a relative diagnosed with breast cancer before age 50, being of Ashkenazi Jewish descent, or having a male relative with breast cancer. For more, see the NCI’s full list of criteria.
Mammogram: breast cancer screening tool no longer recommended starting at age 40
Prior to 2009, women were typically told to begin annual mammogram screening for breast cancer at age 40. Then the USPSTF launched new guidelines calling for biennial screening beginning at age 50. And in 2015, the American Cancer Society issued its own guidelines, suggesting women begin annual screening at age 45, and progress to biennial screening at age 55. So, the annual mammogram? Unless you have other breast cancer risk factors, you only need it between the ages of 45 and 55.
Tumor marker test: unreliable and often unnecessary for most breast cancer survivors
A tumor marker is a protein produced by the body as a result of cancer. These proteins can be tracked via a blood test; when the number rises, it’s a potential sign of cancer recurrence. But proteins identified as tumor markers may also be the result of other diseases, or pregnancy, or hormonal fluctuations. Unless a woman has stage 4 breast cancer, or a particularly aggressive type (such as IBC), tumor marker tests to identify cancer recurrence are simply too unreliable to be worth their cost.
Pet scan/CT scan: other tests for breast cancer metastasis are more reliable
If you’ve been diagnosed with breast cancer, one of your first questions will be, “Has it spread?” Metastatic breast cancer — cancer that’s spread to a distant part of the body, beyond the breast area — is almost invariably fatal. But before you proceed, determine if your particular circumstances warrant a full-body scan. If other, simpler tests have determined that cancer hasn’t spread beyond the breast and nearby lymph nodes, there’s no need to check for it elsewhere.
Axillary dissection: once a critical breast cancer diagnostic tool, no longer necessary
Twenty years ago, women diagnosed with breast cancer routinely had all of the underarm lymph nodes on their affected side removed and examined, to determine if cancer had spread beyond the breast to the lymph nodes — and thence potentially to more distant parts of the body. These days, removing and examining just the first several lymph nodes (sentinel node biopsy) is a less invasive, less dangerous, just as effective way to determine potential cancer spread.
MRI: simpler breast cancer screening tests are often more appropriate
A PCP ordering testing for suspected breast cancer may typically progress from mammogram to ultrasound to MRI to biopsy. But if previous tests have failed to identify a suspicious mass as cancer, will an MRI do the job? Probably not. MRIs are notorious for producing false positives, readings identifying cancer that upon biopsy turn out to be benign. While an MRI can offer solid information about your already-identified tumor prior to surgery, it’s best left out of the screening process.