Catching breast cancer early gives you the highest chance of survival. Regular screening is the key to early detection.

Mammograms and clinical breast exams are two ways to check for breast changes that could be cancerous. Both methods have their own benefits and limitations.

A mammogram creates images of breast tissue. It may find tumors that are too small to feel or cause symptoms.

A clinical breast exam (CBE) is a hands-on exam. A healthcare provider feels and looks at the breasts to check for any suspicious changes.

Here’s what you should know about these two screening methods.

What Is a Mammogram?

A mammogram is an imaging test of the breast. Mammograms use a low level of radiation (X-rays) to take pictures of the breast tissue.

During a standard mammogram, each breast is placed between two plates and compressed or squeezed. The machine takes images from different angles. Then, a specialist doctor called a radiologist reviews them.

Radiologists scan mammogram images for abnormal tissue. If they have any concerns, they may recommend further testing, whether through a diagnostic mammogram (supplementary projections) or other imaging tests such as an ultrasound or an MRI.

Key Mammogram Benefits

Mammograms are 85 percent to 90 percent accurate at detecting abnormalities in the breast. That’s why they’re such an essential step in breast cancer screening.

Mammograms are a routine part of preventive care. They’re recommended at certain ages, even when you don’t have breast symptoms. This is known as a screening mammogram.

If you have symptoms, mammograms can help figure out why. These are known as diagnostic mammograms.

An abnormal mammogram doesn’t automatically mean cancer. But mammograms are a good first step to detect potential breast cancer.

To diagnose cancer, you’ll need to have a biopsy. A biopsy involves collecting tissue samples from suspicious areas and analyzing them in the lab.

What Is a Clinical Breast Exam?

A clinical breast exam is a physical exam. A healthcare provider uses their hands to feel the breasts and surrounding areas, like the underarms.

During the exam, the healthcare professional will also look at the breasts for changes in appearance. They’ll also gently press different areas of the breasts and nipples.

Your provider may look for:

• Lumps
• Nipple discharge
• Swelling, discoloration, or dimpling of the skin

These changes are signs of a potential problem. However, clinical breast exams aren’t an effective way to detect breast cancer.

You can also do breast exams at home to detect any abnormal changes that you can report to your doctor (breast self-examination).

Differences Between Breast Exams and Mammograms

These are the biggest differences between these two screening methods:

• How they’re done
• How useful they are

A mammogram creates an image of the breast using low-dose X-rays. A clinical breast exam uses touch and visual inspection.

Clinical breast exams are quicker. Your doctor can do it at a regular doctor’s appointment, even if you haven’t reached the age when mammograms are usually recommended.

Mammograms require certain equipment and staff. You may have to travel to a special facility to get one. In addition, the actual exam can feel more uncomfortable, since clear images require compression.

When Should You Get a Clinical Breast Exam?

Major medical organizations don’t fully agree on the benefits of routine clinical breast exams in people at average risk of breast cancer. Unlike mammograms, some organizations don’t recommend clinical breast exams at all.

The American Cancer Society (ACS) doesn’t recommend clinical breast exams as a routine breast cancer screening method for women at average risk.

However, the American College of Obstetricians and Gynecologists (ACOG) recommends clinical breast exams starting at age 25. After this, follow-ups may happen every one to three years.

A CBE can be helpful if there’s limited access to mammograms. Before giving the results, providers should let people know that the findings aren’t highly accurate or specific. It’s not unusual to get a false positive result, where something seems suspicious but isn’t actually cancer.

When Should You Get a Mammogram?

The age you start mammograms varies depending on your personal risk for developing breast cancer. Your healthcare provider can make a specific recommendation for you depending on your history and risk factors.

People at Average Risk

For people at average risk, mammograms should become routine in midlife. However, the guidelines vary by organization.

For example, here are the ACS recommendations for those at average risk:

• 40 to 44 years old — You can begin screening for breast cancer.
• 45 to 54 years old — It’s recommended you receive annual screenings.
• 55 and older — You can continue yearly screening or switch to every other year.

The U.S. Preventive Services Task Force (USPSTF) recommends mammograms every other year from age 40 through age 74.

This guideline is stricter than their previous stance. The USPSTF used to recommend starting anytime between 40 and 50. Now, they emphasize the importance of starting as soon as you turn 40.

People Who Are High Risk

People with a higher risk of breast cancer may need to begin screening earlier or receive additional tests.

Your provider may recommend a different screening plan if you have risk factors such as:

• A strong family history of breast cancer (having multiple close blood relatives diagnosed with breast cancer at a young age )
• A gene mutation associated with breast cancer
• A personal history of breast cancer
• Dense breast tissue
• Previous chest radiation treatment at a young age
• Obesity
• Smoking history

Some people who are high risk may need mammography along with other screening methods, such as breast magnetic resonance imaging (MRI).

A clinical breast exam may also be part of care for high-risk cases, especially if you notice symptoms and are too young for standard mammograms. But it shouldn’t be considered a substitute for imaging.

If you have a serious concern, your healthcare provider can help you pursue more effective screening options.

Do You Need Both Screenings?

Whether you need both screenings depends on your risk and the screening guidelines your healthcare provider follows.

What To Do if You Feel a Lump

Screening recommendations are meant for people without symptoms. If you notice a new breast lump or another unusual change, tell your healthcare provider.

Even if your last mammogram was normal, they may want to look at issues like:

• A new lump or area of thickening
• Changes in breast size or shape
• Skin dimpling or puckering
• New nipple inversion
• Nipple discharge
• Persistent changes in one area of the breast
• A change in the appearance of the breast or nipple

A healthcare provider may perform a clinical breast exam and recommend diagnostic imaging, such as mammograms and other tests.

How To Choose the Right Screening Plan

Mammograms and clinical breast exams serve different purposes, but both are used to find out if more investigation is needed. Neither test can diagnose breast cancer, but they’re often one of the first tests to screen for it.

A clinical breast exam can’t replace a mammogram. At the same time, a mammogram doesn’t mean that you should ignore a new breast change that you can see or feel.

Because screening guidelines differ, there’s no single schedule that’s right for everyone. Talk with your healthcare provider about when to start mammograms and how often to have them. Ask whether a clinical breast exam or additional breast imaging (like a breast MRI or breast ultrasound) makes sense for you.