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EARLY DETECTION SAVES LIVES
- What is the aim of early detection or breast screening?
The aim of breast screening is to detect breast cancer early so that treatment will be more effective. With early detection, the prognosis of the patient is much better, with an increased chance of survival and statistically higher life expectancy.
- How does it work?
When a breast cancer grows, it goes through a stage in which its cancer cells are confined within the milk ducts. This is known as the noninvasive stage. If we can detect the cancer at this stage we know that the cancer cells have most likely not spread to the lymph glands in the armpit or elsewhere in the body.
- What are the advantages of early detection?
When a breast cancer is detected and treated at an early stage, there are several advantages:
1) The most important advantage is the fact that such women can live longer.
2) These tumours are often small (<1 cm diameter) and are suitable for less mutilating surgery e.g. lumpectomy as compared to mastectomy, which ultimately yield better cosmetic results.
3) There is a higher chance of avoiding chemotherapy after surgery.
4) If no cancer is detected by breast screening, a woman will be reassured.
- What are the methods of early detection?
The most effective and proven method to detect breast cancer early is an xray of the breast called a Mammogram. The Mammogram is able to detect microcalcifications (calcium deposits), which can be a sign of non-invasive breast cancer. It can also detect breast cancers that are too small to be detected by clinical examination (<1 cm). Other methods e.g. Breast self examination, Clinical examination, Ultrasound and MRI scan have not been proven to be as effective.
- Is Mammogram painful?
A certain amount of compression of the breast is required to obtain a clear image on the mammogram. This may be discomforting and painful. In a survey conducted in England, only 10% of women said the procedure was painful. To avoid pain, a woman should choose a xray centre with trained radiographers and have the mammogram 7 to10 days after the onset of her menses.
- Is mammogram harmful?
A common belief holds that since a mammogram involves xray radiation, it is harmful to the body. However the radiation dose from a mammogram is very low and the risk to the patient's health is minimal. This risk is so small that statistically, it is comparable to the risk of a 30-mile car journey!
- Is there any proof that Breast Screening works?
Yes. Studies in the USA and Europe have shown that regular breast screening in women aged 40 years and above can reduce the risk of mortality from breast cancer by up to 50 %. This effectively translates into many lives saved.
- Is Breast screening effective for all women?
Studies have shown that Breast screening is most effective in women 50 to 75 years. For women in their forties, Breast screening is more difficult as their breasts are more dense. Dense breasts imply that there is a greater proportion of glandular and ductal tissue as compared to the fat tissue making mammogram performance low and interpretation of mammogram difficult.
However, more recent studies however have shown that breast screening is also effective for women in their forties. For these women, the recommended screening interval is yearly. For women above 50, the interval is once in two years.
This is because breast cancer in younger woman is more aggressive and grows faster; If one screens younger women once in two years, there is a significant chance that any breast cancer that develops will not be detected early, simply because the checks are too infrequent.
Where can I go for Breast Screening?
Breast Screening is available in Singapore under the Breast Screen Program run by the Health Promotion Board. Breast screening involves a Clinical examination of the breast followed by a mammogram. Facilities for mammogram xrays are available in most hospitals and xray centers.
- What happens if a woman's mammogram is abnormal?
This does not mean that the woman has breast cancer. A large proportion of the abnormalities found in the mammograms are not due to cancer. The patient will be recalled by the doctor for further tests such as magnification views of the mammogram and ultrasound scans. Only in a small proportion of women does an abnormality suspected of being cancerous become confirmed by further tests. These women are then offered a Biopsy to definitively rule out cancer.
- What is a Biopsy?
This is a small procedure to sample (remove) the abnormality in the breast for laboratory examination to rule out a cancer. There are many different biopsy procedures: needle aspiration (FNA), core needle biopsy, mammotome biopsy and finally an open biopsy.
- What are the disadvantages of breast screening?
1) I have mentioned earlier that mammogram is painful to some women and there is a small risk from radiation exposure.
2) Unfortunately, no diagnostic tests (including the mammogram) are 100 percent accurate. Some women who don't have breast cancer may have mammograms showing an abnormal result. They have to undergo further tests and surgical biopsy to rule out a cancer. This can be costly and inconvenient to these women. Such women may also be subjected to unnecessary mental stress. On the other hand, some women with breast cancer may have a normal mammogram i.e. the cancer was missed by the tests. Such women may be falsely assured.
| What are the government's guidelines for Breast Screening? |
| 40 years and below |
Monthly Breast Self Examination
Clinical Breast examination every 3 years
Baseline Mammogram |
| 40 to 49 years |
Monthly Breast Self Examination
Clinical Breast Examination yearly
Mammogram yearly |
| 50 years and above |
Monthly Breast Self Examination
Clinical Breast Examination yearly
Mammogram once in two years |
- What about ultrasound?
Ultrasound technology has improved over the years and now we can generate a good image of the breast. For younger women (<35 years) with dense breasts, mammogram is ineffective, and thus ultrasound is especially useful for detecting small lumps in this age group. Ultrasound may also be used in conjunction with mammograms during breast screening.
- What about MRI?
MRI (Magnetic Resonance Imaging) is a dynamic scan of the breast which studies the blood flow to breast cancers. MRI is much more sensitive than mammogram or ultrasound in detecting abnormalities in the breast. However, this sensitivity can also be a weakness. Because the MRI scan can detect a large range of abnormalities, it is often hard to tell the precise nature of what has been detected on the MRI scan, leading to a higher rate of false positives. Thus MRI scans are not used during routine breast screenings.
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