Breast Screening Methods

Assoc. Prof. Youwanush Kongdan, MD.

Breast cancer is one of the most common cancers in women worldwide. Breast cancer screening is an important way to detect breast cancer at an early stage, which can increase the chance of cure and reduce the mortality rate. This article will present the guidelines for breast cancer screening according to international standards and guidelines from the Breast Society of Thailand, including the reasons, benefits, limitations of screening, screening methods used, and guidelines recommended by Namarak Hospital.

Advantages of breast cancer screening

1. Increased chances of cure: Early detection of cancer increases the efficiency of treatment. Regular screening significantly reduces the mortality rate from breast cancer.

2. Avoid complicated, expensive, and side-effect-prone treatments if detected early, such as mastectomy, chemotherapy, targeted therapy, and immunotherapy.

3. Give the opportunity to choose treatments with less impact if breast cancer is detected, such as breast-conserving surgery or lower doses of chemotherapy, which can reduce side effects and maintain the patient's quality of life better.

4. Save on treatment costs: Early cancer treatment is usually less expensive than treating advanced cancer.

Limitations of breast cancer screening

1. False positive results: Sometimes the test may falsely show cancer when there is no cancer, causing unnecessary anxiety and wasting time and money on additional tests.

2. False negative results: In some cases, the screening test may not detect actual cancer. Missing the Opportunity for Early Treatment

3. Discomfort and Pain: Some screening methods, particularly mammography, can cause discomfort, discomfort, or minor pain during the exam.

4. Stress and Anxiety: The exam process and waiting for the results can cause stress and anxiety for the person undergoing the exam.

5. Overtreatment: In some cases, detecting a cancer that is not invasive or dangerous early on can lead to unnecessary treatment.

Breast Cancer Screening Methods

There are several methods of breast cancer screening, each of which plays an important role in detecting breast abnormalities at an early stage. There are three main types of screening methods: self-examination, medical professional examination, and advanced medical technology. Each method has its own strengths and limitations. Using these methods together can increase the chances of detecting breast cancer early, leading to effective treatment and a higher chance of a cure.

1. Breast Self-Examination (BSE)

The exam should be performed approximately 3 to 10 days after the first day of your period. Here are the steps:

1. Stand in front of a mirror and observe the size, skin color, and texture of your breasts, as well as the direction of your nipples.

2. Raise your hand above your head. Observe any abnormalities again, such as dimples on the skin.

3. Press or squeeze around the nipples to check for blood or abnormal secretions.

4. Use your hand to feel each breast one at a time, by raising the arm on the same side as the breast being examined, and feel the entire breast (you may feel in a circle, a spiral, or from the inside out).

5. Feel the area under the armpit to find lumps or enlarged lymph nodes.

6. Repeat in a lying position, lying on your back and using a cloth under the shoulder of the side being examined.

Abnormal characteristics, such as a lump in the breast or armpit, blood or fluid coming out of the nipple, the nipple pointing in the wrong direction, a wound on the skin or nipple, dimples or pulling skin, uneven breasts, thicker than normal breast tissue, or a swollen breast skin resembling the skin of a grapefruit, etc., should be seen by a doctor immediately for diagnosis.

2. Clinical Breast Examination (CBE)

A breast examination by a doctor in conjunction with a medical imaging examination will significantly increase the efficiency of breast cancer screening. A breast examination by a doctor is still necessary. Even with mammography and ultrasound, because:

• Mammography and ultrasound can detect only 85-90% of abnormalities.

• A doctor can detect abnormalities that may not be seen in the image, such as nipple bleeding or nipple sores.

• A doctor's examination confirms and increases the comprehensiveness of the screening, allowing for more detection of breast abnormalities.

3. Medical Imaging

Medical imaging is a high-tech method of creating images of breast tissue, allowing doctors to detect abnormalities that may not be seen or felt with other methods. Common medical imaging methods used for breast cancer screening include mammography, ultrasound, and magnetic resonance imaging (MRI). Each method of medical imaging has different advantages and limitations. Your doctor will consider the most appropriate method for each individual, taking into account factors such as age, family history, breast tissue density, and risk of breast cancer.

Mammogram

How it works: Uses low-dose X-rays to take a picture of the breast by pressing the breast between two plastic sheets.

Advantages: Highly effective in detecting early-stage breast cancer. It can detect small, non-palpable lumps and 3D mammography technology increases the accuracy of the examination.

Limitations: It may cause discomfort during the examination, there is a chance of false positives, especially in women with dense breast tissue, and radiation is used, even at low doses.

Ultrasound

How it is done: It uses high-frequency sound waves to create an image of the breast tissue.

Advantages: It does not use radiation, it is safe for repeat examinations, it is suitable for women with dense breast tissue, and it can differentiate fluid-filled lumps (such as cysts) from solid masses well.

Limitations: May not detect some cancers as well as mammograms and the results depend on the skill of the examiner.

Magnetic resonance imaging (MRI)

How it works: Uses a magnetic field and radio waves to create detailed images of breast tissue.

Advantages: Highly accurate in detecting cancer, especially in dense breast tissue. Does not use radiation and can detect cancer in the early stages.

Limitations: Expensive, can often give false positives, leading to unnecessary additional tests. Not suitable for people with metal in their body or claustrophobia.

Screening Recommendation

1. Mammogram: Recommended as a basic screening test for women aged 40 and over.

2. Ultrasound: Used in conjunction with mammograms, especially for people with dense breast tissue.

3. MRI: Recommended for people at high risk, such as those with a family history of breast cancer or BRCA1 or BRCA2 gene mutations.