Guidelines for breast cancer screening

In 2019, 26,900 women in Canada were diagnosed with breast cancer. It’s an illness that’s hard on your body and can be fatal. That’s why breast cancer screening is so important. 

Screening is when you periodically check for an illness in someone who seems otherwise healthy. When it comes to breast cancer, it’s a life-saving practice. Screening helps you understand how likely you are to develop breast cancer by weighing risks like lifestyle habits and genetics. That way, you can hopefully discover cancer in early stages when it’s most treatable.

If breast cancer is caught early, doctors can intervene before it’s had a chance to spread. Even if you’re young and don’t have any health problems, it’s still a good idea to go for routine breast cancer screenings.

Who needs to get breast cancer screening?

Factors like life stage and family history are considerations when deciding if breast cancer screening is right for you. Your doctor will look at the following when making a decision:

• Your age. Chances of breast cancer increase as you get older. For women over 50, guidelines advise screening by mammography every 2-3 years. 
• Personal and family history of cancer. Women who’ve had breast cancer before are more likely to develop cancer again. If a close relative has had breast cancer, you’re at higher risk.
• Lifestyle factors. Drinking alcohol, smoking, and being overweight may contribute to cancer development.
• Genetics. Some women carry genes called BRCA1 and BRCA2. Both are mutations that cause ovarian and breast cancer.

Breast cancer screening tests

Once your doctor has considered your risk factors, you should jointly decide whether to go ahead with screening. If you choose to proceed with screening, these tests are typically recommended:

Clinical examinations

During a clinical examination a doctor conducts a manual and visual exam of the breast. They’ll check for lumps and look for abnormalities.

Mammogram

A mammogram is a low energy x-ray that takes a picture of the breast. They’re especially helpful in catching breast cancer early. They’re often able to detect lumps in the breast that are still too small for doctors to feel through palpation. 

Breast MRI

A breast MRI (magnetic resonance imaging) is a test where multiple images of your breast are taken at different angles. Then they’re put together to show a complete picture of your breast. Doctors usually recommend MRIs after it’s been confirmed that breast cancer is present through a biopsy. The full-circle picture helps them get a better idea of how advanced the cancer is so they can recommend proper treatment.

Self-examination

If you’re familiar with the look and feel of your breasts when you’re healthy, it’s easier to tell when something is off. 

You can do a self exam in three easy steps:

1. Look

Stand in front of a mirror with your arms at your sides. Then, raise your arms above your head while paying close attention to each breast. Turn so that you can see your profile in the mirror and repeat the same motions. Last, stand facing the mirror with hands on hips. Tighten your chest muscles and move your shoulders forward slowly.

2. Feel

Remove your shirt and lay down. Then, raise your right arm over your head and slide a pillow under the right shoulder. With the pads of your three middle fingers on your other hand, start at the outer edge of your breast and move in circles with varying pressure. Start out light, and progress to medium and firm pressure. Check around your collarbone, and in the area between your breast and underarm. Do the same on the other side. 

3. Compress

Gently feel around your nipples, squeezing lightly to check for any discharge. Keep an eye out for:

• • Lumps
  • Skin dimpling
  • Hardened tissue
  • Nipple retraction
  • Unusual shape
  • Swelling
  • Nipple retraction  

Should you examine your own breasts?

There’s controversy around whether breast self-examination is really a good idea. On one hand, it’s free and convenient to examine your own breasts at home. Breast self-examinations can help some women feel more empowered about their health, particularly if they have hereditary risk factors. On the other hand, breast self-examinations haven’t been shown to lower breast cancer mortality rates. Plus, they can encourage over-vigilance, unnecessary doctor’s visits, and over-treatment. Cancer treatment is very physically and mentally taxing, and going through the oncology system for a false positive can be scarring. 

The Canadian Task Force recommends against breast self-examinations, but at the end of the day it’s your choice when it comes to your own body. The key is to make an informed decision, weighing all the pros and cons as they relate to your health. 

The downside to breast cancer screening

While screening can be a useful way to catch cancer early, it comes with its own set of risks:

• False positives. This is when a doctor thinks cancer is present when it isn’t. It’s scary for the person who is misdiagnosed, and can lead to unnecessary treatment. 
• False negatives. When this happens, a negative test result is produced even though cancer is present. For example, x-rays can sometimes miss lumps in the breast that turn out to be cancerous.
• Over-diagnosis. This is when early treatment is given for cancer that would never have become severe. In this scenario, the benefits of being screened outweigh the risks. 10% of breast cancer treatment is a result of overdiagnosis. But, women who don’t get screening are 60% more likely to die from breast cancer.

What to do if you find a lump in your breast

Finding a lump in your breast is understandably scary. It’s important to see your doctor, but try not to worry too much. Benign lumps are common too, so finding a lump doesn’t automatically mean you have breast cancer. 

Screening and self examinations are two excellent ways to catch breast cancer early. With your doctor’s help you can identify the best tests for you, and how often you’ll need to do them. Making breast cancer screening a priority is a life-saving decision.

Whether you’ve been diagnosed with breast cancer, or you want to better understand your personal risk factors, an oncology navigator can help. Best of all, you can speak to an oncology navigator online, from the comfort of your home.