October is observed as Breast Cancer Awareness Month
Breast cancer is the leading cause of death due to cancer in Indian women. According to the National Cancer Registry Programme, One in 22 women in urban areas and one in 60 women in rural areas is likely to develop breast cancer during her lifetime. It is due to the high prevalence rate, breast cancer screening is known to be a highly effective way to diagnose breast cancer. However, there are many questions on what are the right breast cancer screening tests, who should go for a screening, how often should one get a screening done, and so on.
So to help you understand different breast cancer screening tests, we have asked Dr. Snehal Patil, Breast Cancer Surgeon, Onco-Life Cancer Centre, Maharashtra to explain and clear some of the common doubts on breast cancer.
What is the best way to test breast cancer?
The best way to test breast cancer is through early screening. The different types of breast cancer screening tests include:
-Monthly breast self-examination (BSE)
-Clinical breast examination (CBE)
-Mammography
-Magnetic Resonance Imaging (MRI)
1. Monthly breast self-examination (BSE)
Breast self-examination, as the name suggests, is a breast cancer screening test that can be done by oneself and at home. It usually takes 5 -10 mins and should be done every month by all females above 15 yrs of age. Here is how to do a self-breast examination at home.
-Stand topless in front of a mirror with your hands on your sides and shoulders straight.
-Look at your breasts in the mirror for any visual changes in the breasts such as dimpling, inverted nipple, puckering, and changes in the size, shape or symmetry.
-Lift your hands and place the palms on the back of the head to look for changes in the breast. Repeat this by lifting one breast at a time.
– Feel your breasts by using the pads of your fingers (not the tips). Apply pressure and move your fingers over the breasts in a circular motion just like massaging the area. As you do this, make your way to the collarbone, center of the breastbone and near the armpits.
-Inspect your breasts when lying down and again in the shower. The use of water and soap while taking a shower makes it easier for your fingers to glide over the skin and make it easy to feel the breasts.
– Repeat the procedure by placing one hand over the back the head and massaging the breast with the other hand. Lastly, gently squeeze the nipple to check for any discharge.
The principle behind BSE is that if you know what is normal for your body, only then will you be able to figure out even the smallest abnormality, if any, in the breast. BSE is proven to aid in the early diagnosis of lumps and other changes (signs and symptoms) that happen in the breast, which could indicate breast cancer.
Women in the menstruating age should do the self-examination on any day from day 5 to day 10 of the menstrual cycle (day one being the first day of periods). Postmenopausal women can do it on any day but they also must do the self-breast examination without fail. Hence, it is advised to have a fixed day for BSE such as the first day of every month or the first Sunday of every month.
2. Clinical Breast Examination (CBE)
A clinical breast exam is done by a doctor or a nurse. During this exam, the clinician uses his/her hands to feel any lumps, hardness, nipple discharge or any other changes in the breast. It should be done once in six months in women who are at a high risk of breast cancer or at the earliest sign of any abnormality or symptoms of breast cancer. If you observe any abnormality during BSE, it’s advised to get a CBE done immediately to investigate further.
3. Mammography
Mammography is basically an X-ray of the breast tissue. It should be done by all women once a year after the age of 40 years or as advised by your doctor.
It is reported that breast density and age are important predictors of the accuracy of this test. This could be the reason why the results are more accurate in older women and less sensitive in young women and those with dense breast tissue. Moreover, women in their 40s have a lower incidence of breast cancer and faster-growing cancers. Mammography alone is not useful in women with dense breasts. In these women, it has to be done in conjunction with ultrasonography or as advised by your doctor.
4. Magnetic Resonance Imaging (MRI)
This method uses magnetic and radio waves to take pictures of the breast and check for abnormalities. It is considered to be better than mammograms and CBE for screening women with a high risk of breast cancer such as those with BRCA gene mutation. For women in high-risk groups, MRI along with mammography and CBE is used as a screening tool. As breast MRIs may appear abnormal even if there is no cancer, they are not advised for women who have an average risk of cancer.
When should you start breast cancer screening?
Every woman should be screened for breast cancer although the recommended age and frequency to start screening for breast cancer might differ. The incidence of breast cancer in India begins to rise in the early thirties and peaks during 50-64 years of age.
Breast self-examination can be started as early as above 15 years of age, especially for a woman who has a family history of breast cancer. Clinical breast examination (CBE) is usually part of routine annual care for women above 40 years. However, if you are at risk of breast cancer or have a strong family history of breast cancer, you may be recommended to undergo CBE every six months.
Generally, mammography screening should start at the age of 40 and must be repeated every year or two until 75 years of age. However, according to the US Centre for Disease Prevention and Control and the United States Preventive Service Task Force (USPSTF), women in the age group 50 – 74 years and at average risk of breast cancer should get a mammogram every two years. Women who are 40 – 49 years old should consult their doctor to know the pros and cons of the testing and when to start and how often to get a mammogram.
MRI should be conducted only as per your doctor’s advice.
Are there any precautions to be followed before undergoing these tests?
No, there are no specific precautions a woman has to follow before undergoing a breast cancer screening test. However, it is always better to get a clinical breast exam done before a mammogram or MRI so that the investigation can be targeted around the symptoms, if any, experienced by a woman.
Breast cancer screening test result: What do positive results indicate?
The breast cancer screening test can help us to know about any structural abnormalities in the breast tissue and aid in self-care. However, a positive report might not always indicate cancer. So there is no need to be scared of the tests or the test results.
In case of any abnormality being detected in the screening tests, the woman might be directed to take further tests such as a biopsy which will help to diagnose the condition.
Do negative screening test results indicate no risk of cancer?
No. A negative screening test may indicate that there is no structural abnormality at present and that one should continue with routine screening to be safe. However, if a woman notices any changes in the breast even a few months after the screening tests, it is wise to get a screening test done again. There is a high chance that a woman might have some internal symptoms, which can be detected between two different screening tests or mammograms.
Bottom line:
A lot of women undergo breast cancer screening tests with a lot of anxiety and quite a few avoid these tests due to the fear of a cancer diagnosis. But what many women fail to understand is that these tests can help in lump detection that is already present or any changes in the breast which are unnoticed.
Although breast cancer screening tests do not prevent cancer, it can help you to find breast cancer early which in turn makes it easier to treat cancer. Hence, talk to your doctor about breast cancer screening tests that are right for you, and the right time to undergo a screening test.
(The article is reviewed by Dr. Lalit Kanodia, General Physician)
Recommended Reads:
8 Ways To Detect And Prevent Breast Cancer At An Early Stage
Breast Lumps and Breast Cancer: Facts and Fictions
References:
1. India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Oncol. 2018 Oct;19(10):1289-1306.
2. Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for breast cancer. JAMA. 2005 Mar 9;293(10):1245-56.
3. What Is Breast Cancer Screening? Breast Cancer. Centre for Disease Control and Prevention (CDC).