Frequently Asked Questions - Screening

1. What is breast screening ?
2. Is breast screening necessary only for women with family history of breast cancer ?
3. What exactly does screening include ?
4. At what age should a woman start screening tests and how often should she undergo them?
5. When is screening considered complete ?
6. How can I self examine my breasts ?
7. How often should a woman examine herself and when is the best time to do it?
8. Why is breast self-examination important?
9. At what age does screening end?
10. Is the screening program the same for women who have suffered from cancer or have a heavy family history?
 
1. What is breast screening ?

Breast screening is the testing of asymptomatic women using mammography and clinical examination in order to detect tumors at a very early stage (of very small size or even at a precancerous stage). Detection of tumors at early stage increases by far the possibilities of successful treatment of the disease. Breast screening has reduced the number of deaths caused by breast cancer by approximately 30%.

 
2. Is breast screening necessary only for women with family history of breast cancer ?

No. Breast screening is necessary for all women, regardless of their history. Women with family history of breast or ovarian cancer might face much higher risk but general population women also face a high risk, since breast cancer is the most common malignancy in the female population (approximately 1 in 8 women will develop some type of breast cancer).

 
3. What exactly does screening include ?
Breast screening includes:
 
  • Regular periodic imaging testing (the basic examination is mammography and the supplementary test is ultrasonography)
  • Visit to a physician (second reading of the mammography and clinical examination)
  • Regular periodic self-examination on a monthly basis
 
4. At what age should a woman start screening tests and how often should she undergo them?
Screening starts at the age of 25. According to the international guidelines, the screening program is the following:
 
Age 25-40 years
  • Clinical examination every 1-3 years (the clinical examination might include ultrasonography, especially at ages over 35)
  • Monthly self-examination
 
Age 40+
  • Annual clinical examination
  • Annual screening with mammography (the ultrasonography being a supplementary test)
  • Monthly self-examination
 
In standard clinical practice, despite the controversies, most of the time, physicians suggest that women have their reference mammography around the age of 35. This mammography is not so much used for diagnosis; instead it will be used as reference for the next screening.
 
 
5. When is screening considered complete ?

Examination of the breasts as part of the breast screening is considered complete after palpation of the breasts by a specialized physician and after imaging by means of mammography and ultrasonography.

Mammography can diagnose up to 86% of breast cancers. However, there are tumors which are "invisible" to the mammography or particularly dense breasts that make diagnosis especially difficult. 

Ultrasonography is used as a supplement, to provide more information on the breast. But ultrasonography also has an up to 10% possibility of not diagnosing a neoplastic lesion.

During clinical examination it is possible to diagnose tumors that were not found in imaging, because:

  • The composition of the breasts does not allow for it (very dense breasts)
  • Their position is not visible by mammography (subclavian areas, lateral thoracic wall)
  • The nature of the disease is special (Paget's, lobular cancer, non calcified ductal carcinoma in situ etc.)
  • They simply escaped the first evaluation (the second reading of the mammography reveals at least 4% more cancers)
 
6. How can I self examine my breasts ?

Self-examination of the breasts is an easy process during which you are asked the following simple question: "Is there anything new and foreign to my breasts?". In order to be able to answer this question, you must have familiarized yourselves with the normal look and feel of your breasts. This is easy to do, if you examine your breasts for quite a long time under your doctor's assurances that they are normal and healthy. There are several self-examination techniques, all of them are equally effective (See the related video). We describe one of them below.

In the bathtub/shower:

Examine your breast while you are taking a bath or a shower: hands slide more easily on wet skin. Keeping your fingers flat, gently move them on the entire breast. Use your right arm to examine the left breast and the left arm to examine the right one. Look for nodules, indurations or thickness.

In front of the mirror:

Look at your breasts with your arms to your side. Next, raise your arms over your head. Look for any changes in the shape of the breast, for swelling, for skin deformations or changes in the nipple.  Then place your hands on your hips and press downwards, so that the muscles of the thorax contract. Usually the two breasts are not the same, except in a few women.

Regular monitoring shows what is normal for you and will provide you with self-confidence for your self-examination.

Lying down:

In order to examine the right breast, place a pillow or a folded towel under your right shoulder. Put your right arm over your head. This way, the breast tissue will be distributed more evenly on the thorax. With the fingers of the left hand flat, gently push with small, circular motions around an imaginary clock. Start at the highest outer part of the right breast, as if it is 12 o' clock, and then move towards 1 and forward until you are back at 12. A part of hard tissue at the lowest fold of each breast is normal. Then move 1 cm towards the nipple and continue the cyclical examination of every part of the breast, including the nipple. This requires at least 3 extra circles. Now repeat the process for the left breast by placing a pillow under your left shoulder and the left arm behind the head. Feel the composition of the breast.

Last, gently press the nipple of each breast between the thumb and the forefinger. Any nipple discharge, whether clear or bloody, most probably means that there is some problem.

If you discover a nodule, an induration, a skin retraction or a nipple discharge during self-examination, it is important to see your doctor as soon as possible. Do not be afraid. Most nodules and indurations are not cancer, but only the doctor can perform the diagnosis.

 
7. How often should a woman examine herself and when is the best time to do it?

Self-examination of the breasts should be done once a month. Always follow the same steps, approximately a week after your period, when the breasts are not sensitive or swelled. After menopause, examine your breasts on a fixed date each month (e.g. the 1st day of each month, the 1st Saturday of the month etc.). After a hysterectomy, consult with your physician for the suitable day of the month. By examining yourselves once a month you will feel calm and your doctor, during your annual visit, will assure you that there is no problem.

 
8. Why is breast self-examination important?

In many cases, breast cancer is discovered by the women themselves. If breast cancer is discovered in time and treated correctly, it can be cured completely; learning how to examine your breasts correctly might help you save your life.

 
9. At what age does screening end?

A woman who has screening tests regularly until the age of 70 faces a very low risk of presenting with cancer later. However, the risk is not completely eliminated. The predominant opinion is that a woman over 70 years should continue having screening tests according to her doctor's instructions.

 
10. Is the screening program the same for women who have suffered from cancer or have a heavy family history?

No. The screening program is different for women who have suffered from cancer or have a heavy family history or belong to the high-risk groups altogether. For certain groups, the imaging tests used are also different. In these cases, the physician proposes the appropriate screening program for the specific case.

 
 
 
 
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