Precautionary checking of a woman’s breasts for cancer even before there are signs or symptoms of the disease is known as breast cancer screening. Various screening options are available for the same and some guidelines mention the recommended age-wise checking. 

Signs and Symptoms of Breast Cancer

Women should be familiar with how their breasts normally look and feel and should report any changes to a healthcare provider right away.

The most common symptom is a new lump or mass (although most breast lumps are not cancer). Having a painless, hard mass with irregular edges is more likely to be cancer, but breast cancers can also be soft, round, tender, and even painful.

Other possible symptoms include:

• Swelling of all or part of a breast (even if no lump is felt)
• Skin dimpling (sometimes looking like an orange peel)
• Breast or nipple pain
• Nipple retraction (turning inward)
• Nipple or breast skin that is red, dry, flaking, or thickened
• Nipple discharge (other than breast milk)
• Swollen lymph nodes under the arm or near the collarbone (Sometimes this can be a sign of breast cancer spread even before the original tumour in the breast is large enough to be felt.)

Breast cancer screening helps to detect breast cancer early when it is easier to treat. 

Why is screening important?

The two most important strategies for preventing deaths from breast cancer are early diagnosis and getting appropriate treatment. Getting regular screening tests is the most reliable way to find breast cancer early.

Tests and exams help find signs of breast cancer even in people who don’t have any symptoms. The goal of screening tests for breast cancer is to find it early before it causes symptoms (like a lump in the breast that can be felt). 

Breast cancers that are detected during screening exams are more likely to be smaller and less likely to have spread outside the breast. The size of breast cancer and how far it has spread are some of the most important factors in predicting the prognosis (outlook) of a woman with this disease.

Imaging Tests to Find Breast Cancer

Different tests help to look for and diagnose breast cancer. If your doctor finds an area of concern on a screening test (a mammogram), or if you have symptoms that could mean breast cancer, you will need more tests to know for sure if it’s cancer, such as: 

Mammogram

A mammogram is an X-ray of the breast. It is the best way to find breast cancer early, making it easier to treat before it is big enough to feel or cause symptoms. Having regular mammograms lowers the risk of mortality from breast cancer and hence is the best way to find breast cancer for most women of screening age. 

Doctors use a mammogram to look for early signs of breast cancer, sometimes up to three years before it can be felt. It is always advisable to continue to get mammograms at recommended time intervals. Mammograms work best when they are compared with your previous ones’ results, allowing the radiologist to compare and look for changes in your breasts. 

If your mammogram results shows do not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. 

Breast Ultrasound

These generate computer pictures of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that can be harder to see on mammograms.

Ultrasound can:

• Look through dense breast tissue, which can make it hard to see abnormal areas on mammograms
• Provide a better look at a suspicious area that was seen on a mammogram
• Tell the difference between fluid-filled masses like cysts and solid masses

Breast MRI

For certain women at high risk for breast cancer, a screening breast MRI is recommended along with a yearly mammogram. MRI might be done if it is needed to further clarify the results from the other tests. A breast MRI might sometimes be done if breast cancer is suspected based on symptoms or exam findings, such as suspicious nipple discharge.

In women whom breast cancer has already been diagnosed, a breast MRI is sometimes done to help determine the exact size and location of cancer. It also looks for other tumours in the breast, and checks for tumours in the other breast.

In women with silicone breast implants, breast MRI can be used to check for implant leaks.

Newer and Experimental Breast Imaging Tests

Newer types of tests are now being developed for breast imaging. Some of these, such as breast tomosynthesis (3D mammography), are already being used. Other tests are still being studied, and are expected to come into implementation soon.

Some of the tests are:

• Abbreviated breast MRI (fast breast MRI)
• Nuclear medicine tests (radionuclide imaging)
• Contrast-enhanced mammography (CEM)
• Elastography
• Optical imaging tests
• Electrical impedance tomography (EIT)

Breast Cancer Screening Guidelines

American Cancer Society Recommendations for the Early Detection of Breast Cancer.

The American Cancer Society suggests screening guidelines for women at average risk of breast cancer, and for those at high risk for breast cancer.

Guidelines for women at average risk

For screening purposes, a woman is considered to be at average risk even if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase the risk of breast cancer, and has not had chest radiation therapy before the age of 30. 

• Women between 40 and 44 – recommended to start screening with a mammogram every year.
• Women 45 to 54 – are advised to have mammograms every year.
• Women 55 and older - can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

Guidelines for women at high risk

Women who might be at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. 

This includes women who:

• Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history
• Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)
• Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
• Had radiation therapy to the chest when they were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes

To Conclude

Breast cancer is sometimes found after symptoms appear, but many women with breast cancer have no symptoms. This is why regular breast cancer screening is so important. Screening can often help find breast cancer early before any symptoms appear. Finding breast cancer early gives you a better chance of successful treatment.