Screening is a strategy to detect early stage cancer in an asymptomatic individual. Screening has the potential advantage to detect cancer in early stage and hence making them curable. Screening is undertaken by healthy individuals and they are likely to follow healthy life style as advice by primary care physician.
Breast cancer is a global health problem. It is most common cancer to occur in women. Regular screening has been shown to decrease the odd of dying from breast cancer by around 20%. This reduction is found among women in all age groups who have undergone screening.
Screening has been divided according to women risk assessment of developing breast cancer. On one extent are the women with average risk and on other extent are the women with high risk.
#Screening in average risk women: All women who do not have mutation in cancer susceptibility gene are average risk. Screening in these women is undertaken by doing “Mammography”. Mammography is specialized X-ray of the breast done in two views cranio-caudal and medio-lateral. Mammography is reported according to BIRADS category. BIRADS category gives us idea for planning the approach towards patient. It can be either biopsy or just follow-up.
Mammography is done between age group of 40 to 74 years. It is done once in every two years, unless any abnormality detected which suggest close follow-up.
Ultrasound of breast is adjunct to Mammography. Ultrasound alone is not used for screening purpose. It is helpful especially in age group of 40 to 49 years where Mammography may not be very sensitive in lieu of dense breast. Ultrasound may help to further characterize the lesion as solid or cystic.
#Screening in high risk women: Women who carries genetic mutation in breast cancer susceptibility genes like BRCA1 and BRCA2, P53, PTEN have very high risk for breast cancer.
High risk women are screened with MRI breast which is more sensitive than Mammography. MRI breast is done with a dedicated breast coil and it can detect a small lesion even in dense breast which is missed by Mammography. MRI screening is typically started from the age of 40 unless an indexed in the family had breast cancer at very early age.
Centers where MRI is performed for screening in high risk should have the facility for MRI guided biopsy of the breast lesion.
Screening is the only way to detect cancer at an early stage and Mammography has been shown to effectively reduce death caused by breast cancer. All women should be encouraged for screening starting from the age of 40 and repeating it every two yearly tll the age of 74.