Breast Cancer Screening
Early Detection & Diagnosis
Breast Screening
Breast cancer is most often diagnosed in women over the age of 50, but it can occur at any age. The risk of developing breast cancer increases with age, family history, certain genetic mutations, and exposure to certain hormones.
Breast cancer screening aims to detect breast cancers early, when there are no symptoms or when they’re small and easier to treat. It is a high priority as early detection is key to successful treatment and improves your chances of survival.
Clinical breast examination
A clinical breast exam is often the first step in detecting breast cancer and you should have it done every year starting at age 40.
During the clinical exam, your doctor will look at your breasts for any changes in symmetry, shape, or size. They will examine your breasts for any skin changes including redness, rashes, or dimpling. They will also feel around your breasts to check for any lumps or other abnormalities.
Your doctor will gently press your nipples to check for any discharge. If there is discharge, a sample will be collected for examination under a microscope. A clinical breast exam is an important method for early breast cancer detection and should be performed along with mammography
Tests to diagnose breast cancer
There are different types of breast cancer tests available, and the best test for you depends on your age, breast density, personal history, and other factors. Your doctor will likely recommend a combination of these tests:
Mammogram (breast x-ray)
Your doctor may also recommend a mammogram, which is an X-ray of the breast. Mammograms are the most common breast cancer screening test and are recommended for all women starting at age 40. If you have a family history of breast cancer or other risk factors, you may need to start mammograms earlier.
Screening mammograms are used to check for breast cancer when there is no sign or symptom of the disease. They can be used to detect abnormalities in the breast that might be cancerous.
Diagnostic mammograms are very similar to screening mammograms but they are usually conducted after some symptoms of cancer are detected, or after a suspicious result on the screening mammogram. In addition to the standard two views of each breast, extra views may be needed. They are used when there are symptoms of the disease such as a breast lump, or when an abnormal area is already present. They may be done as a follow-up to an abnormal screening mammogram or clinical breast exam.
Mammograms may be used to diagnose breast cancer or for follow-up testing after a breast cancer diagnosis. If anything suspicious is found on the mammogram, your doctor may recommend a biopsy.
Ultrasound
Ultrasound is a type of imaging that uses sound waves to create pictures Ultrasounds are conducted using a handheld, wand-like instrument called a transducer. Your doctor will apply a gel onto your skin and/or the transducer, and will then move the transducer across the skin to conduct the test. The image of the inside of the breast can be seen on a computer screen.
An ultrasound is used to check for lumps or other abnormalities in the breast, especially those that cannot be seen on a mammogram. It may also help determine whether a suspicious area seen on a mammogram is solid (which is more likely to be cancer) or fluid-filled (more likely benign). Furthermore, ultrasounds can be used to guide a biopsy needle into an area where cells can be taken out and tested.
It is often used along with mammography to screen women who are at high risk for breast cancer, such as those who have dense breasts. Ultrasounds are also used as a follow-up test to check suspicious areas seen on a mammogram or felt during a breast exam. As ultrasounds do not involve radiation, it is safe for pregnant women to undergo ultrasounds.
Magnetic resonance imaging (MRI)
An MRI uses magnetic waves and radio waves, not X-rays, to create detailed images of the breast. Breast MRIs are used less often than mammograms or ultrasounds, and are usually not used as the sole screening test. This is because they are more likely to result in false positives, and may miss cancers that can be detected by mammography.
Usually, MRIs are used along with mammography in women who are at high risk for breast cancer, women with breast implants, and women with denser breast tissue. They may also be used as a follow-up test after an abnormal mammogram or ultrasound, or to determine the extent to which the cancer has spread
Biopsy
A biopsy is a procedure in which a small sample of tissue is removed from the body so it examined in a laboratory under a microscope. Biopsies are usually conducted to determine the presence or the extent of a disease, such as breast cancer. A biopsy is the only way to know for sure if you have breast cancer. There are different types of biopsies. The type of biopsy that is recommended will depend on the size, location, and appearance of the suspicious area
Fine-needle aspiration (FNA) biopsy
FNA biopsy is a quick and simple type of biopsy that uses a thin, hollow needle (about the thickness of a hair) to insert into the suspicious area of the breast to remove a small amount of breast tissue or fluid to be checked for cancer cells. It is the most common type of breast biopsy that can be done in the doctor’s office using ultrasound to guide the needle into the area of concern.
Core needle biopsy (CNB)
A core needle biopsy is a procedure similar to a fine-needle biopsy but it removes a larger sample of tissue. It uses a larger needle to remove a small cylinder of tissue from the breast.
In some cases, computer imaging may be used to guide the needle to the affected areas.
- Mammography: Most common form of computer imaging used, effective when checking for microcalifications that cannot be seen under an ultrasound.
- Ultrasound: May be used for pregnant women as an ultrasound does not involve radiation
- MRI: May be used when the abnormality can only be detected under an MRI. When conducting an MRI-guided CNB, you will be given contrast via IV
Surgical biopsy
A surgical biopsy is a more invasive procedure in which surgery is used to remove a sample of tissue from the breast. They are often used when the results of a needle biopsy are unclear. This procedure requires anaesthesia and is usually done in the hospital.
There are two types of surgical breast biopsies: Incisional biopsy, that only removes part of the lump or abnormal tissue, and a excisional biopsy, in which the entire tumor or suspicious area is removed.
In cases where the the abnormal area cannot be felt, computer imaging (ie. mammograp, ultrasound, or MRI) may be used.
As surgical biopsies are much more invasive, you may experience bruising, swelling, and bleeding following the biopsy. It may also cause scarring or a change in the shape of the breast.
What to expect after breast cancer screening
After breast cancer screening, you will be given a report of the findings. The report will tell you whether the breast cancer screening test was normal or abnormal.
If the breast cancer screening test is normal (no cancer is found), you will not need any more testing. You will be asked to return for another mammogram in one year.
However, if cancer is found, your doctor will order additional tests in order to determine the stage of cancer. These tests may include a mammogram, an MRI, PET scan, CT (CAT) scan, bone scan, and a biopsy Your doctor may also order blood tests to check for certain biomarkers that can help guide treatment decisions.
Then you will be referred to see a doctor, who specializes in treating breast cancer, to discuss treatment options and develop a treatment plan for you.
Who should go for breast cancer screening?
All women over the age of 40 should have a mammogram every year. Women who are at high risk for breast cancer may need to have more frequent mammograms. If you have a family history of breast cancer or other risk factors, you may need to start breast cancer screenings earlier.
Age Screening Mammogram Recommendation
The table below shows how often women should have breast cancer screening mammograms depending on their age according to the Singapore Cancer Society’s screening advisory. Women are recommended to go for mammogram screenings regardless of symptoms.
| Age | Recommedation |
|---|---|
|
≤40 years old
|
Mammogram screening not recommended |
|
40-49 years old |
Mammogram screening once a year |
|
≥50 years old
|
Mammogram screening once every two years, unless otherwise advised by your doctor |
Conclusion
Regular breast cancer screening can detect most breast cancers early, when they’re small and before they spread to other parts of the body. Early detection is critical to the successful treatment of breast cancer.
However, there are several reasons why some women do not receive regular screening mammograms. These include lack of access to quality care, fear or anxiety about the test, and misinformation.
If you are due for a screening mammogram, talk to your doctor about any concerns you may have. They can help you understand the risks and benefits of the test and determine which type of screening is appropriate for you.