Breast Cancer Screening: How and When to Begin

What Is Breast Screening?

In today’s world, breast screening is one of the most crucial aspects of gynecological screening procedures. It is the most common female cancer worldwide. Every one out of eight women in the world is suffering from breast cancer. Among women, breast cancer is responsible for 15.5 percent of cancer deaths. However, regular breast cancer screening has shown a 20 percent reduction in mortality related to it. Genetic screening for breast cancer may also be beneficial to prevent if one has a family history of breast cancer.

The cause of breast cancer is unknown but related to the BRCA1 (BReast CAncer gene) and BRCA2 gene mutation and hormonal imbalance. As it is not directly related to any carcinogenic agency or external tissue changes like ulcers, it is difficult to diagnose in the early stage. Self-screening in this condition can be very useful.

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 find undetectable cancerous growths within the breast 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 factors 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 (breast self-examination) 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 helps identify and characterize breast lesions such as cysts, solid masses, and others to help diagnose and manage conditions in the breasts. It is painless and non-invasive with no 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.

• The information obtained from breast MRI can help in the size, location, and characteristics of breast lesions, guide treatment decisions, and monitor response to therapy.

• It is a non-invasive procedure, but an injection with a contrast agent may be needed to improve the quality of the image.

5. Biopsy:

• A biopsy is a procedure for obtaining tissue samples from the breast to be looked at under a microscope to establish whether cancer or other abnormalities exist.

• 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).

• The biopsy results will assist in diagnosing breast cancer and guide treatment decisions.

6. Thermography:

• Thermography uses infrared technology as a non-invasive imaging technique to measure and map temperature distributions on the skin surface.

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

When Is Breast Cancer Screening Recommended?

There is no specific age for breast cancer screening. The optimalage to start screening for breast cancer depends on various factors, including individual risk factors and recommendations from medical organizations. However, screening for breast cancertypically recommends starting 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.

• The United States 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 breast cancer screening may begin earlier for women with specific risk factors, such as a family history of breast cancer.

What Could be the Benefits of Breast Cancer Screening?

Breast cancer screening offers several benefits. While screening, the healthcare professionals will follow proper screening guidelines for breast cancer.

• 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.

• Improves Prognosis: Early treatment initiation may begin with less intensive treatments and ensure the better retention of breast tissue.

• Reduces Mortality: Screening has helped in reducing deaths due to breast cancer as detected cases are caught when they can be treated well.

• Increases More Treatment Options: Early detection may allow for many treatment options with fewer surgical incisions and the potential for successfully having breast-conserving therapy.

• Quality of Life: Early detection and treatment help reduce the physical and emotional toll of breast cancer, thus enhancing the 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.

What Are the Initiatives for Individualized Screening for Breast Cancer?

The Breast Cancer Surveillance Consortium (BCSC) is the most widely used risk-estimation model. It was developed by Tice et al. in 2008. For estimating the risk, factors like age, ethnicity, breast density, race, family history of breast cancer, and history of biopsy are taken into consideration. The previous biopsy factor was replaced by benign breast disease type in 2015. Including the polygenic risk score (PRS) has helped improve the accuracy of the model, as found by Yanes et al. The Breast Cancer Surveillance Consortium risk model is also used for personalized screening and includes age, ethnicity or race, history of benign breast disease, first-degree relatives with breast cancer, and mammographic breast density. This is combined with the Catalan (people of Spain) breast cancer incidence and mortality based on the cause of death and the distribution of risk factors in the BCSC dataset. These were implemented for the estimation of a preliminary five-year absolute risk of breast cancer. After the risk score is obtained, the same healthcare professional who conducted the first visit will schedule a second visit for screening recommendations and will communicate the risk.

Conclusion:

Breast cancer screening includes routine examinations and tests to detect breast cancer soon, 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. Women need to discuss their screening plan with their healthcare provider based on their personal risk factors and preferences.