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Early Detection of Breast Cancer

• Introduction to the early detection of breast cancer
• Advantages and risks associated with early detection of breast cancer
• Mammography in the early detection of breast cancer
• Clinical breast examination in the early detection of breast cancer
• The role of breast awareness in the early detection of breast cancer

Introduction to the early detection of breast cancer

The early detection of breast cancer in women is important for the effective management of the disease. Although there is no current treatment to prevent breast cancer, early detection of the disease can lead to an excellent outcome.

Early detection methods for breast cancer include screening mammography, clinical breast examination (carried out by a trained health professional) and breast awareness. Breast self-examination, a technique taught to women in the past, is no longer recommended as it has not been shown to improve outcomes.  

Advantages and risks associated with the early detection of breast cancer

Early detection of breast cancer is important as it is associated with an increased number of available treatment options, increased survival, and improved quality of life. While there is no definitive method of preventing breast cancer, early detection provides the best chance of effective treatment. However, while early detection of breast cancer can help improve outcomes, there are also risks involved with any screening program. These include the chance that a false positive or false negative diagnosis can be made. When undergoing any screening test, the risks and benefits of that test should be considered.

Mammography in the early detection of breast cancer

Screening mammography is the best early detection method for reducing the number of deaths associated with breast cancer (as outlined by current evidence). Mammography is generally not undertaken in patients under 40 years of age (as age is the largest risk factor for breast cancer), however women older than 40 should have mammograms every two years. Women with other risk factors such as a strong family history, gene anomalies or previous breast cancer may have mammograms at an earlier age or be monitored more closely.

Screening mammography is the best early detection method for reducing the number of deaths associated with breast cancer. For every 10,000 women aged 50-69 years screened over a 10 year period, mammograms would be expected to prevent between 10 and 20 deaths from breast cancer.

The benefits of screening mammography are different depending on the age of the woman. Younger women have denser breast tissue, which make breast changes harder to detect. In addition, as the occurrence of breast cancer increases with age, older women are more likely than younger women to have developed breast cancer - so more cancers are detected with mammography in older women.

In Australia, the National Breast Cancer Centre recommendations regarding screening mammograms are as follows:

• Women aged under 40 years: mammographic screening is not recommended.
• Women aged 40-49 years: women in this age group are eligible for free two-yearly screening mammograms through the BreastScreen Australia program, but they are not targeted by the program. This is because the benefits of screening are not clear. Women should consider the risks and benefits before deciding whether to access mammograms.
• Women aged 50-69 years: these women are encouraged to have free two-yearly screening mammograms through BreastScreen Australia.
• Women aged 70 years and over: women in this age group are eligible for free two-yearly screening mammograms, but they are not targeted by the BreastScreen Australia program. Women should consider the risks and benefits of mammography, including factors such as their general health or other medical conditions.

Women who are at increased risk of developing breast cancer, such as those with a strong family history, should have an individualised surveillance program established in consultation with their doctor.

Clinical breast examination in the early detection of breast cancer

Clinical breast examination refers to examination by a trained health professional of a woman's breasts. The woman will not normally have noticed any breast changes before the examination. The examination is focused on detecting changes to the breasts, such as skin changes, nipple discharge, lumpiness, or changes in size or shape.

There is no clear evidence to suggest that clinical breast examination is an effective method of early detection of breast cancer in women who are already undergoing regular screening mammograms. In women who do not have regular mammograms, clinical breast examination may be useful.

The role of breast awareness in the early detection of breast cancer

More than 50% of breast cancers in Australia are diagnosed as a result of investigation of a breast change noted by a woman or her doctor. The importance of a woman's awareness of the normal appearance and feel of her breasts is therefore clear.

While breast awareness is now recommended to all women, breast self-examination as taught in the past is now considered obsolete. Under this system, women were taught a specific technique for examining their breasts, and encouraged to perform this examination on a monthly basis. However, there is no evidence that breast self-examination reduces mortality from breast cancer, or even leads to earlier detection of breast cancer.

Instead, the National Breast Cancer Centre of Australia recommends that a woman be aware of the normal look and feel of her breasts, and that she note and report any of the following changes to her doctor:

• A new lump or lumpiness, particularly if one-sided;
• Nipple discharge;
• Change in size or shape of the nipple or breast;
• Change in the skin over the breast;
• Unusual, persistent pain, particularly if one-sided.

More information

For more information on breast cancer, types of breast cancer and its investigations and treatments, as well as some useful videos, see Breast Cancer.

Reference

1. Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001877. DOI: 10.1002/14651858.CD001877.pub2
2. Humphrey LL, Helfand M, Chan BK, Woolf SH. 'Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force,' Annals of Internal Medicine. 2002;137(5 Part 1):347-60.
3. Kosters JP, Gotzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews 2003, Issue 2, Art. No.: CD003373. DOI: 10.1002/14651858.CD003373.
4. National Breast Cancer Centre. Position statement: Early Detection of Breast Cancer [online]. 2004 [cited 2006 December 22]. Available from: http://www.nbcc.org.au/resources/documents/EDP_earlydetectionposition0804.pdf

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Article Dates:

Created: 28/12/2005

Modified: 12/4/2010