Breast Screening

What is Breast Screening?

Breast screening is a method used to detect breast cancer at an early stage before any symptoms appear. This proactive approach aims to identify breast cancer early when treatment is more likely to be successful. The screening typically involves a mammogram, which is an X-ray of the breasts.


Who is Suitable for Breast Screening?

Breast screening is generally recommended for women who are at average risk for breast cancer. The suitability and guidelines for breast screening can vary, but here are some common criteria:

  • Age Factor:
  • Most guidelines recommend that women start regular breast screening from the age of 40 to 50.
  • For women between the ages of 50 to 74, screening is often recommended every two years.
  • The guidelines may vary for women over 75, with some suggesting continued screening based on individual health status and life expectancy.
  • Risk Factors:
  • Women with a family history of breast cancer or genetic factors that increase their risk (like mutations in the BRCA1 or BRCA2 genes) might need to start screening earlier. They may undergo additional types of tests, such as MRI alongside mammography.
  • Personal Health History:
  • Women who have had breast cancer before are usually advised to have more frequent screenings.
  • Those who have dense breasts may also need more frequent screenings because dense breast tissue can make it harder to detect abnormalities with standard mammograms alone.
  • Recommendations by Health Authorities:
  • In Australia, for instance, the National Breast Cancer Screening Program invites women aged 50 to 74 to undergo free mammograms every two years.
  • Health professionals might advise screenings outside these recommendations based on a woman’s risk factors.


Benefits of Breast Screening

  • Early Detection: Early detection through screening can identify breast cancer before symptoms develop. Cancers detected at an early stage are often smaller and confined to the breast, which can make them easier to treat compared to cancers that have spread.
  • Improved Survival Rates: When breast cancer is detected early and localised, the 5-year survival rate is significantly high. Early detection and treatment can prevent the cancer from spreading to other body parts, thus improving survival rates.
  • Less Aggressive Treatments: Early-stage cancers may require less aggressive treatment than more advanced cancers. For example, smaller, localised breast cancers might be treatable with lumpectomy (removing the tumour and a small margin of surrounding tissue) instead of mastectomy (removal of the whole breast).
  • Reduction in Overall Mortality: Regular breast screening has been shown to reduce the mortality rate from breast cancer among the populations screened. This reduction is primarily due to the early detection and treatment of high-risk lesions before they develop into more aggressive, harder-to-treat cancers.


Types of Breast Screening

  • Mammography: The most common and widely recommended type of breast screening is mammography. It involves taking X-rays of the breast from different angles to detect abnormalities. There are two main types:
  • Screening Mammography: Used routinely to check for breast cancer in women who have no symptoms.
  • Diagnostic Mammography: Used when there is a suspected problem based on the results of a screening mammogram or symptoms presented by the patient.
  • Contrast Enhanced Mammogram (CEM): A CEM is a diagnostic imaging technique used to detect breast cancer and other abnormalities. It combines the traditional mammogram with the use of contrast material (typically iodine-based) injected into the bloodstream to highlight areas of increased blood flow, which are often associated with tumors or other significant changes in breast tissue.
  • Breast Magnetic Resonance Imaging (MRI): Breast MRI is a more sensitive method than mammography and is used primarily for screening women at high risk for breast cancer, such as those with a genetic predisposition.
  • Ultrasound: Ultrasound uses sound waves to produce images of structures inside the body. It is often used to evaluate breast changes found during a mammogram or physical exam, particularly in women with dense breast tissue where mammograms are less effective.
  • Clinical Breast Exam (CBE): A care provider performs a CBE using their hands to feel for lumps or other changes in the breast and underarm area. It is less common as a screening tool but can complement mammography.
  • Self-examination: Although not a substitute for mammograms or clinical exams, being familiar with the normal look and feel of one’s breasts can help individuals notice changes more readily and seek professional evaluation sooner.


Preparation Before a Breast Screening

  • Try to schedule the screening when your breasts are least likely to be tender, which is usually a week after your menstrual period.
  • On the screening day, avoid using deodorants, antiperspirants, powders, lotions, or perfumes under your arms or breasts, as these can appear as white spots on the x-ray.
  • Dress comfortably, preferably in a two-piece outfit, as you must undress from the waist up for the procedure.
  • If you have had mammograms at another facility, bring these images to help the radiologist compare past and current images for any changes.
  • If you have breast implants or any medical history that could affect the screening, inform the technician before the procedure begins.


Breast Screening Procedure

  • Mammogram Procedure: You stand in front of the mammogram machine, and the technician places your breast on a clear plastic plate. Another plate firmly presses your breast from above. The pressure lasts only a few seconds, though it might be uncomfortable; it's necessary to spread out the breast tissue for clear images.
  • MRI or Ultrasound: If undergoing an MRI, you will lie face down on a table with openings that allow your breasts to hang freely without compression. The table slides into the MRI machine. For an ultrasound, a gel is applied to your breast, and a technician moves a handheld probe over the area to create images.


What to Expect After a Breast Screening?

  • You can usually resume normal activities immediately after a mammogram. If you had an MRI with contrast, you might be asked to drink water to help flush the contrast from your body.
  • Results are typically available within a few weeks. You will receive a letter or a call. Additional imaging or a biopsy may be recommended if there are any concerns.
  • It’s normal to feel anxious while waiting for results. If needed, contact friends, family, or a counselor for support.


Potential Limitations of Breast Screening

A mammogram is the most effective test for finding breast cancer early in women over the age of 50, but like other screening tests, it is not 100% accurate. Not all cancers will be detected through screening. Some cancers cannot be seen on a mammogram or can develop between mammograms. There is also a small chance that cancer could be missed on a mammogram.


A screening mammogram may detect abnormalities in the breast, which require further tests but may not turn out to be cancer.


Most breast cancers found through BreastScreen NSW would grow and become life-threatening if not treated. However, some breast cancers that are found and treated may not have become life-threatening (known as overdiagnosis). At this time, it is not possible to tell exactly which breast cancers may become life-threatening.


Having a screening mammogram means your breasts are exposed to a very small amount of radiation. Research shows the benefits of having regular breast screening outweigh any possible risks from radiation.


Can I have a screening mammogram if I have breast implants? 

Yes. Women with breast implants can have regular screening mammograms. Special techniques are used to push the implant aside to obtain clear images of the breast tissue and to minimise the amount of compression placed on the implants. Implants can cover some of the breast tissue, which may make it more difficult to find small breast cancers. There is an extremely small chance that the pressure placed on the implant during the mammogram may cause the implant to rupture. In women with ruptured implants, having a mammogram may increase the amount of silicone or saline spreading into the breast tissue.


Implications of Delayed Breast Screening

  • Advanced Disease at Diagnosis: Delaying breast screening can result in cancers being detected at a more advanced stage, which can be harder to treat effectively. Cancers found at later stages might require more extensive treatment and have a lower chance of survival compared to those detected early.
  • Increased Mortality: Studies have shown that regular screening can reduce breast cancer mortality by detecting the disease at an earlier, more treatable stage. Delaying or skipping screening increases the risk of dying from breast cancer due to late detection.
  • Limited Treatment Options: Early-stage breast cancer often has more treatment options available that can be less aggressive and more likely to preserve breast tissue. With delayed diagnosis, options may be more limited and involve more extensive treatment plans, including higher doses of chemotherapy, more extensive surgery, and more comprehensive radiation therapy.
  • Impact on Health Systems: Detecting cancer at more advanced stages can also lead to higher treatment costs and longer treatment durations, which can strain healthcare resources.
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