Today, breast cancer is the most common cancer among women globally. In this challenge, breast cancer screening helps detect problems quickly, before any signs appear and when the treatment is simple.
Getting recommended screenings is one of the most important things one can do for their health. The efficacy of screening lies in minimizing human risk, human cost and economic cost.
Mammography has passed the acid test in this endeavour.
As per the American College of Radiology (ACR) and the Society of Breast Imaging (SBI), the recommendation of screening mammogram starts from age 40. Screened women in 40s are more likely to have smaller tumors, negative lymph nodes and early-stage disease. Mammograms are recommended annually because they help detect tumors of smaller sizes, facilitate more screened detected tumors and there are fewer interval cancers.
Regarding breast cancer screening recommendations inclusive of all women at average risk, the ACR and SBI affirm that weighing the benefits and risks of mammogram should be done by women and not for women. It is recommended that women have a risk assessment done at 30 years. Yearly mammogram screening has to commence at 40 years of age and can go on as there is no upper age limit until severe comorbidities limit life expectancy.
The benefits of screening have to be balanced alongside the possibility of call back for extra imaging, benign biopsy, risks of anxiety and over diagnosis.
Breast cancer screening from age 40 is done because below this age risk of breast cancer is generally very low. Mammograms are not done for younger women as the breast tissue is thick and patterns are not clear. Evidence is also limited when it comes to proving that mammograms in younger women help.
According to studies, the average size of lump found on the first mammogram is far smaller than the average size of lump found by women practising regular breast self-examination, and the average size of lump found on regular repeat mammogram is the smallest. Over the past 25 years, in both the US and Europe, there has been a dramatic decrease in the size of breast cancers reported by women to their health practitioners. (David B. Thomas, Dao Li Gao, Roberta M. Ray, Wen Wan Wang, Charlene J. Allison, Fan Liang Chen, Peggy Porter, Yong Wei Hu, Guan Lin Zhao, Lei Da Pan, Wenjin Li, Chunyuan Wu, Zakia Coriaty, Ilonka Evans, Ming Gang Lin, Helge Stalsberg, Steven G. Self, Randomized Trial of Breast Self-Examination in Shanghai: Final Results, JNCI: Journal of the National Cancer Institute, Volume 94, Issue 19, 2 October 2002, Pages 1445–1457, https://doi.org/10.1093/jnci/94.19.1445).
As per European guidelines, screening should happen as per below recommendations:
https://doi.org/10.1093/jnci/94.19.1445
| 40-49 years | Every 2-3 years |
| 50-69 years | Every 2 years |
| 70-74 years | Every 3 years |
As per Canadian guidelines:
| 50-74 years | Every 2 years |
| 40-49 years and > 75 years | GP consultation |
As per Australian guidelines – 40-75 years (once in 2 years).
The consensus is that screening mammograms is definitely useful in women in the age group 50-75 years.
Guidelines in India
(Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part-1 – 2022;58:60-68. Suma Chakrabarthi, Shikha Panwar, Tulika Singh, Shilpa Lad, Jwala Srikala, Niranjan Khandelwal, Sanjeev Misra, Sanjay Thulkar)
Recommendation is to get an annual screening mammogram between 40-70 years of age together with a self-breast examination and clinical breast examination. Clinical breast examination is done by a qualified medical practitioner once in 3 years from the age of 30 as they are trained to pick up even small lumps. Breast self-examination is important to know what is normal for oneself and should be done every month from 25 years onwards after periods.
Breast cancer deduction rate is 7.6 per 1000 women screened.
Screening for Breast Cancer:
- Clinical Breast Examination – Inferior to screening mammography but may be used for organized screening and camps in a lower-middle income country like India.
- Mammography – In India – opportunistic screening on an individual basis – all women with means.
- Others – Not indicated for opportunistic screening – ultrasound and MRI in very specific circumstances.
Breast Cancer Is Curable!
| Stage | 5 Years Survival |
| 0,1 | 100% |
| 2 | 98% |
| 3 | 72% |
| 4 | 22% |
Mammography saves lives… one of them may be yours. (To learn more about mammography benefits and risks, visit mammographysaveslives.org.)
Out of every 100 women who get a screening mammogram:
- 90 will be assured that there is nothing to worry about.
- 10 will be advised on additional mammogram or investigations.
- 6 will be told that their mammograms are normal.
- 2 will be advised for a follow-up after 6 months.
- 2 will have to undergo a needle biopsy.
Indian Scenario:
- Encourage opportunistic screening – yearly mammograms 40-75 years age group.
- Clinical breast examination – yearly after 30 years; promote widespread use.
- Promote self-breast examination/breast awareness.
- Ultrasound – often in health checks – is used as a clinical breast examination in below 40.
- MRI – promoted as opportunistic high-risk screening.
Dr. Gayatri Iyer
Senior Consultant – Radio Diagnosis & Clinical Lead – Breast Imaging,
Kauvery Hospital, Chennai
