Breast Cancer Screening Tests: What Every Woman Should Know !

Author : Dr. Vidya.M.N, Lead Consultant and HOD Histopathology, Aster Labs

India

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New Delhi, October 28, 2020 :

Dr. Vidya.M.N, Lead Consultant

A few years back, cervical cancer was the leading cause of cancer in Indian women. However, the recent trends and statistics show that breast cancer is now the leading cause of cancer among both the Urban and rural Indian women. Breast Cancer currently accounts for 25-32% of overall cancers in women.

Over the last decade, we have seen a drastic surge in the number of cancer cases in India. Due to an increase in awareness in the general population and facilities of screening tests, we have seen a rising trend in breast cancer in men as well, which was unheard of a few decades back.

Sedentary lifestyle, obesity, Nulliparous, not breastfeeding, long term OCP usage, family history of breast cancer, and overindulgence in several illicit habits like alcoholism and smoking are some of the leading causes which have now led to a higher number of breast cancer cases among young women.

As the prevalence rate of breast cancer is increasing, breast cancer screening is currently known to be a highly effective way to diagnose the disease. However, while opting for a test, individuals often have several questions such as what are the signs and symptoms of breast cancer, how can one detect breast cancer at home, when should one start breast cancer screening, and so on.

Therefore, before opting for a test, people can first understand the detection practices and can understand when they should opt. for a screening –

What are the signs and symptoms of breast cancer and how can one detect breast cancer at home?

 One should be aware of the symptoms of breast cancer which will help in early diagnosis. These include lumps or bumps in the breast, skin changes like itching and redness, nipple discharge, or lumps in the armpit.

The above can be detected by a monthly self-examination in the comfort of your home.

Step 1: Start by looking at your breasts in the mirror while keeping your shoulders straight and your arms on your hips. You need to examine for the following –

• Breasts are normal in size, shape, and colour. Generally, one of the breasts may be slightly larger than the other
• Check for any dimpling, puckering, or bulging of the skin
• If a nipple has changed position or if there is an inverted nipple
• Redness or soreness or presence of any discharge

Step 2: Raise both your arms and again look for the above. Also, notice both your arm pits for any visible swellings

Step 3: Lie down on the bed, raise one arm over your head, and examine this side of the breast with the fingers of the opposite hand. The fingers have to be placed close together and gently examine the breast in a circular motion starting from the nipple and moving outwards. Move the fingers to the armpit and check for any lumps and bumps. Repeat the same on the opposite side.

Step 4: Repeat the above-mentioned step now in a standing position.

When should one start breast cancer screening? 

Screening for breast cancer is a must for every woman even though the recommended age and frequency may vary. As the incidences of breast cancer are now creeping up among young women, hence, self-examination can be started as early as above 15 years of age, especially for women who have a family history of breast cancer.

Regular health checks these days in hospitals and laboratories now include a screening mammogram for women over the age of 40 years. But, if someone is at risk of breast cancer and also has a strong family history of breast cancer then they should ideally undergo a health checkup once every 6 months.

What to do when there is a lump?

 In such a scenario, one should undergo the triple test as follows:

1. Clinical Examination by an experienced clinician, preferably by a breast surgeon.
2. Breast Imaging: Bilateral Mammogram and or Ultrasound or MRI as appropriate.
3. Histopathology: FNAC / Core biopsy (Ideal). Excision Biopsy/Incision biopsy if indicated.

 What is FNAC and Core biopsy?

FNAC and core biopsies are performed in the laboratories. These are procedures that do not require any hospitalization and will give quick results.

Core biopsy is preferred over FNAC as hormonal markers which are essential in the treatment of breast cancer can be done at the same time of biopsy diagnosis.

What should we know about the screening mammogram ?

This is a test similar to the regular x-ray. The ideal time for mammograms would be 1 week following the period. You need to also inform the staff whether there is any possibility that you may be pregnant, as it is a contra-indication.

Who are eligible for a mammography test? 

Women who are on an average risk of breast cancer are advised to undergo regular screening mammography starting at age 45 years. (Strong Recommendation) as per the American Cancer Society.

Women of the age group 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.

Women of the age group 45 to 54 should get mammograms every year.

Women 55 and older should switch to mammograms every 2 years or can continue yearly screening.

What should one do in case of a positive or negative test? 

Breast cancer screening can help in early diagnosis and can aid doctors in analyzing any structural abnormalities in the breast tissue. Even though a positive report can create panic and anxiety among one, but, one must remember that a positive test result does not indicate that they have cancer.

The report only provides information on any abnormalities which have been detected in the screening tests and the woman might be advised to undergo further tests such as biopsy which will help to diagnose the condition.

Furthermore, in case of negative screening, one should remember that it does not mean that they are at no risk of breast cancer, and in case they notice any changes in the breast even after a few months after the screening, they should ideally undergo another screening test. There is a high chance that a woman might have some internal symptoms, which can be detected between two different screening tests or mammograms.

Many women undergo breast cancer screening tests with a lot of anxiety and avoid these tests due to the fear of a cancer diagnosis. These women should understand that these tests can help in lump detection that is already present or any changes in the breast which are unnoticed. Although breast cancer screening tests do not prevent cancer, it can help you to find breast cancer early which in turn makes it easier to treat cancer. Hence, one should consider talking to one’s doctor about breast cancer screening tests that are right for you, and the right time to undergo a screening test.

To prevent themselves from breast cancer, women must consider making certain lifestyle modifications like regular exercise, yoga and having a good and healthy diet to keep the fear of breast cancer at bay.

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