Breast cancer stands as the most prevalent type of cancer in the world. Not only do screenings detect over 2 million new cases each year, but 600,000 women are estimated to die because of breast cancer and its complications.
The point many health care systems across the world miss is that early detection can drastically reduce mortality rates and make possible breast-conserving surgery (BCS) instead of complete mastectomies. Furthermore, if the cancer is diagnosed before it has spread to other parts of the body and remains constrained to the breast only, life expectancy for five years skyrockets to over 90%.
Considering these statistics, starting screening practices at an early age has never been more crucial. All the different guidelines and approaches may feel overwhelming, but experts converge on one point: it's always best to err on the side of early.
Here's what you should be doing each decade and in between, with advice from radiology specialist professor Füsun Taşkın.
In your 20s
Although self-examination is technically not breast cancer screening, most cases are diagnosed thanks to women noticing newly developing masses or visual irregularities while self-examining. Therefore, Taşkın recommends women to check their breasts for anything that looks out of the ordinary once a month, the week after their period ends. These regular self-checks should start in your teens or at the latest at age 20, and continue over a lifetime.
Taşkın warns that, however, self-checks cannot replace mammographies and do not reduce breast cancer-related deaths.
“Even if you do not detect a palpable mass in your monthly breast examination, regular mammographies after the age of 40 should never be neglected,” she says as a mass might mean things are already too late in some cases.
HOW TO DO A BREAST SELF-EXAM
1. Start by visually examining your breasts. Sit in front of a mirror, without a bra or shirt, and inspect your breasts with your eyes. Keep your arms relaxed, at your sides.
Facing forward, look for any dimpling, puckering or changes in size, shape or symmetry. Turn your gaze to your nipples and check to see if you can notice anything new or if they are inverted.
Repeat these steps with your hands pressed on your hips, arms at sides but torso slightly tilted forward, and your arms raised overhead and palms pressed together. Lastly, don't forget to check underneath for changes in symmetry.
2. Now, move on to the tactile portion of the examination. Use your hands to examine your breasts.
Lie down on your back on a flat surface to help make your breast tissue spread out in an even layer, making it easier to feel any lumps and bumps. Using the pads of your fingers, not the very tips, start feeling all breast tissue. Most doctors recommend using your three middle fingers to do this.
Exert different levels of pressure to feel different depths of tissue. With your firmest touch, you should be able to feel the tissue closest to your chest wall and ribs. If you are not sure of how hard you should press, consult your nurse or doctor.
Follow a pattern: some recommend going in circles from the outside in; some prefer to follow a sectional approach and divide the breast into sections like a pie chart. Start with a light touch and then press to feel deeper layers.
3. Don't forget to examine your armpits and collarbones. Start from your collarbone and make your way toward your nipple. Don't rush and take your time. Make sure you spend a few minutes examining.
If you find:
You should immediately contact your doctor who may recommend additional tests to investigate.
Age 25 onward
Whether you have health complaints about your breasts or not, and regardless of medical history, Taşkın recommends women to start visiting specialized policlinics and their gynecologists for a professional examination starting at age 25.
Under 30s or no matter what age
Breast ultrasonography is the first step of action and choice of screening for women under the age of 30, as well as teenagers, with any complaint about their breasts.
Taşkın adds that ultrasound is also a reliable method that is used in conjunction with or as complementary to mammographies from the age of 40 onward.
“Ultrasonography is a method with high sensitivity that detects and evaluates both mass and non-mass-forming breast cancer. It helps doctors understand the structure and characteristics of the tumor in the breast. "
Emphasizing that a significant portion of breast biopsies are performed under the guidance of ultrasonography, Taşkın says that as ultrasonography does not use ionizing radiation, it can be used safely at any age and even during pregnancy. (Did you know these myths about breast cancer?)
Age 35 and up
While magnetic resonance imaging (MRI) is the most sensitive method in detecting breast cancer, it is not often used in cancer screening as the first step in the general population; however, it is the most widely preferred screening method in women deemed high risk.
If you are considered high risk for breast cancer, doctors will likely recommend you start MRIs at a younger age and MRIs coupled with annual mammographies from age 35 onward.
Taşkın says MRIs greatly contribute to early detection and effective treatment of breast cancer, especially in young women who do not benefit from mammographic screening.
Age 40 and onward
Mammography, whose reliability has been scientifically proven, is the "gold standard" in breast cancer screening. Therefore, it is vital that women have an annual mammography starting from the age of 40, even if they have no breast-related complaints. If you have a family history of breast cancer, your doctor may advise you to start it sooner.
Taşkın says that mammographic screenings reduce the rates of death by cancer by 30% on average thanks to providing early diagnosis.
“Early diagnosis means more effective and timely treatment. Thus, as death rates decrease, treatments with fewer side effects and breast-conserving surgeries become possible."
Taşkın also underlines that if a mammogram is performed for "diagnostic purposes," i.e., in women with health complaints or a history of cancer, there is no age limit to start and can even be performed on pregnant or breastfeeding women. (For more information about mammograms, check out this link.)