Methods of breast cancer screening.

Methods of breast cancer screening.

Assoc. Prof. Yaowanuch Kongdan, M.D.

Breast cancer is one of the most common cancers in women worldwide. Breast cancer screening is a crucial method for detecting breast cancer in its early stages, which can significantly increase the chances of successful treatment and reduce mortality rates. This article presents international standard breast cancer screening guidelines and guidelines from the Breast Cancer Society of Thailand, including the rationale, benefits, limitations of screening, the screening methods used, and the guidelines recommended by Numarak Hospital.

The advantages of breast cancer screening.

• Increased chances of recovery: Detecting cancer in its early stages improves treatment effectiveness. Regular screening significantly reduces mortality rates from breast cancer.

• Avoid complex, expensive, and highly side-effective treatments if detected early, such as mastectomy, chemotherapy, targeted therapy, and immunotherapy.

• This allows doctors to choose less impactful treatment options if breast cancer is detected early, such as breast-conserving surgery or lower doses of chemotherapy, which helps reduce side effects and maintain a better quality of life for patients.

• Cost-effective treatment: Treating early-stage cancer is often less expensive than treating advanced-stage cancer.

Limitations of breast cancer screening.

• False positive : Sometimes a test may incorrectly show cancer when there is no actual cancer, leading to unnecessary anxiety and the need for additional testing and wasted time.

• False negative results : Screening may fail to detect existing cancer in some cases, causing patients to miss out on early treatment.

• Discomfort and Pain : Certain medical examinations, particularly mammography, may cause slight discomfort, unease, or pain during the procedure.

• Stress and anxiety : The testing process and waiting for results can cause stress and anxiety in those being tested.

• Over-treatment : In some cases, detecting cancer in its early stages, when it may not be invasive or dangerous, can lead to unnecessary treatment.

Methods of breast cancer screening.

There are several methods for breast cancer screening, each playing a crucial role in detecting breast abnormalities in their early stages. The main screening methods fall into three categories: self-examination, examination by healthcare professionals, and the use of advanced medical technology. Each method has its own strengths and limitations. Using these methods appropriately can significantly increase the chances of detecting breast cancer in its early stages, leading to effective treatment and a higher chance of a cure.

Breast self-examination (BSE)

The test should be taken approximately 3-10 days after the first day of your menstrual period. The procedure is as follows:

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 and observe any abnormalities again, such as indentations in the skin.

3. Press or squeeze around the nipple to check for blood or abnormal discharge.

4. Palpate each breast one at a time, raising the arm on the same side as the breast being examined. Feel across the entire breast (you may palpate in circles, in a spiral, or from the inside out).

5. Palpate the area under the armpits to check for lumps or enlarged lymph nodes.

6. Repeat the procedure in the supine position, lying on your back with a cloth or sheet supporting the shoulder to be examined.

Any abnormalities such as a palpable lump in the breast or armpit, blood or fluid discharge from the nipple, an abnormally pointing nipple, skin or nipple sores, dimpling or retraction of the skin, uneven breast size, thicker-than-normal breast tissue, or a swollen, grapefruit-like appearance of the breast skin, should prompt you to seek medical attention for diagnosis.

Clinical Breast Examination (CBE)

Breast examinations performed by a physician, combined with medical imaging, significantly improve the effectiveness of breast cancer screening. Breast examinations by a physician remain necessary even after mammograms and ultrasounds because:

• Mammograms and ultrasounds can only detect abnormalities in 85-90% of cases.

• Doctors can detect abnormalities that may not appear in photographs, such as bleeding from the nipple or sores on the nipple.

• Medical examinations confirm and expand screening coverage, helping to detect more breast abnormalities.

Medical imaging

Breast imaging is a technologically advanced method that creates images of breast tissue, allowing doctors to detect abnormalities that might not be visible or palpable with other methods. Common imaging techniques used for breast cancer screening include mammography, ultrasound, and magnetic resonance imaging (MRI). Each imaging technique has its own advantages and limitations. Doctors will choose the most appropriate method for each individual, considering factors such as age, family history, breast tissue density, and risk factors for breast cancer.

1. Mammogram

   Procedure: A low-dose X-ray is used to image the breast by compressing the breast between two plastic sheets.

   Advantages: Highly effective in detecting early-stage breast cancer. Can detect small lumps that may not yet be palpable, and 3D mammography technology increases examination accuracy.

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

2. Ultrasound

   Method: High-frequency sound waves are used to create images of breast tissue.

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

   Limitations: It may not detect some types of cancer as well as a mammogram, and the results depend on the skill of the examiner.

3. Magnetic resonance imaging (MRI)

   Method: Magnetic fields and radio waves are used to create detailed images of breast tissue.

   Advantages: High accuracy in cancer detection, especially in dense breast tissue; does not use radiation; and can detect cancer in its early stages effectively.

   Limitations: It is expensive and may frequently produce false positives, leading to unnecessary further testing. It is not suitable for individuals with metal in their bodies or those with claustrophobia.

Selection guidelines

• Mammograms: Recommended as a basic screening for women aged 40 and older.

• Ultrasound: Used in conjunction with mammography, especially in women with dense breast tissue.

• MRI: Recommended for high-risk individuals, such as those with a family history of breast cancer or BRCA1 or BRCA2 gene mutations.

Note: Treatment results depend on the nature of the disease and the individual patient's condition. A guaranteed outcome cannot be guaranteed. Please consult a doctor for a personalized treatment plan.