Breast Cancer Screening: How and When to Begin

Introduction:

Every woman needs to know how and when she should get screened for breast cancer. The incidence of breast cancer is gradually increasing in developing as well as developed countries. it is important to look for cancer before there are any obvious symptoms. The screening process helps in detecting cancers even at an early stage when there are no obvious manifestations. Thus screening helps in early detection, which further enhances the prognosis and survival rate. Only if the screening test results are in favor of cancer, other diagnostic interventions are advised. Individuals who are more likely to develop breast cancer should strictly undergo periodic screening tests to rule out the presence of cancer.

When Is Breast Cancer Screening Recommended?

The optimal age to start screening for breast cancer depends on various factors, including individual risk factors and recommendations from medical organizations. However, general guidelines typically recommend starting breast cancer screening between the ages of 40 and 50 for average-risk women. Here are some common recommendations:

• American Cancer Society (ACS): The ACS recommends that women with an average risk of breast cancer should have the opportunity to start screening with mammography annually at age 40 to 44. Women aged 45 to 54 should undergo annual mammograms, and women aged 55 and older can do screening twice a year.

• U.S. Preventive Services Task Force (USPSTF): The USPSTF recommends twice-a-year screening mammography for women aged 50 to 74 years. They suggest that the decision to start screening before age 50 should be an individual one, taking into account patient values, preferences, and risk factors.

• National Comprehensive Cancer Network (NCCN): The NCCN recommends annual screening mammography for women aged 40 and older with average risk. They suggest that screening may begin earlier for women with specific risk factors, such as a family history of breast cancer.

What Are the Methods of Breast Cancer Screening?

The various methods for screening include

1. Mammography:

• It is the best method for screening as it is painless, safe, and most accurate.

• Mammography provides an interior view of the breast, which helps in finding cancerous growths within the breast that are undetectable with palpatory examination.

• However, mammography is less fruitful in dense breast tissue, as it cannot distinguish dense breast tissues and dense cancerous nodules. It is better to go for a mammography checkup from the age of 40 years.

• However, even a younger woman can go for it. If the person has a familial history of breast cancer, or other known risk factor that can enhance the risk of developing breast cancer, mammography is advised even in the early adulthood stage.

• For women aged 40 to 44 years, it is recommended to do mammography once in two years. Women aged 45 and above, should get screened every year. The screening should be continued till the age of 75 years. Women with risk factors like certain gene mutations should undergo annual screening mammography to keep track of the cancerous changes in the breast.

• The procedure is safe and non-invasive. There is a very small amount of radiation exposure. But the benefits outweigh the small risks every single time.

2. Self-Examination of Breast:

• Though studies have shown no real benefit, breast self-examination along with regular checkups by the doctor can be beneficial to detect any changes.

• Even if initially BSE is confusing, it is good to start the practice and familiarize yourself with what is normal. It must ideally be performed one week after the menstrual period so that there is no tenderness or swelling of the breasts.

• So that any form of palpable abnormalities can be easily identified. It is better to note down the findings of each examination in a notepad or diary so that a comparative analysis can be made out of it.

• After the age of 20, it is a good habit to start BSE once a month and record the findings in a diary. It helps in identifying even the slightest change in the breast.

3. Breast Ultrasound:

• Breast ultrasound is a non-invasive imaging technique that uses sound waves to produce detailed images of the breast tissue.

• It is often used as a supplementary tool to mammography in breast cancer screening, particularly in women with dense breast tissue or those at high risk for breast cancer.

• Breast ultrasound can help identify and characterize breast lesions, including cysts, solid masses, and other abnormalities, aiding in the diagnosis and management of breast conditions. It is safe, painless, and does not involve exposure to ionizing radiation.

4. Breast MRI:

• Breast MRI (Magnetic Resonance Imaging) is a non-invasive imaging technique that uses powerful magnets and radio waves to create detailed images of the breast tissue.

• It is often used as a supplementary tool to mammography and ultrasound in breast cancer screening, particularly in women at high risk for breast cancer or those with dense breast tissue.

• Breast MRI can provide information about the size, location, and characteristics of breast lesions, helping to guide treatment decisions and monitor response to therapy.

• It is a safe procedure but may require an injection of a contrast agent to enhance image quality.

5. Biopsy:

• A biopsy is a procedure used to collect tissue samples from the breast for examination under a microscope to determine if cancer or other abnormalities are present.

• In screening for breast cancer, biopsy is typically performed when imaging tests such as mammography, ultrasound, or MRI detect suspicious areas or abnormalities in the breast tissue.

• There are different types of biopsy procedures, including needle biopsy (such as core needle biopsy or fine needle aspiration) and surgical biopsy (such as excisional biopsy or incisional biopsy).

• Biopsy results help to diagnose breast cancer and guide treatment decisions.

6. Thermography:

• Thermography is a non-invasive imaging technique that uses infrared technology to measure and map the temperature distribution on the surface of the skin.

• Thermography is not recommended as a standalone screening method for breast cancer by major medical organizations, including the American Cancer Society and the U.S. Food and Drug Administration.

What Could be the Benefits of Breast Cancer Screening?

Breast cancer screening offers several benefits:

• Early Detection: Screening can detect breast cancer at an early stage, often before symptoms develop, leading to more successful treatment outcomes and higher survival rates.

• Improved Prognosis: Early detection allows for prompt initiation of treatment, which may include less aggressive interventions and better preservation of breast tissue.

• Reduced Mortality: Screening has been shown to reduce breast cancer mortality by detecting cancers at a stage when they are more treatable.

• Increased Treatment Options: Early detection provides more treatment options, including less invasive surgical procedures and a higher likelihood of successful breast-conserving therapy.

• Quality of Life: Early detection and treatment can help minimize the physical and emotional impact of breast cancer, leading to improved quality of life for patients and their families.

• Awareness and Education: Screening programs promote breast health awareness and education, encouraging women to become proactive in their health and participate in regular screening activities.

Conclusion:

Breast cancer screening involves regular examinations and tests to detect breast cancer early, often before symptoms appear. Mammography is the primary screening tool, typically starting at age 40 for average-risk women, but recommendations may vary based on individual risk factors and guidelines. Early detection through screening increases treatment options and improves survival rates. It is important for women to discuss their screening plan with their healthcare provider based on their personal risk factors and preferences