Breast Cancer Screening: Types and Prevention Methods

Breast cancer may not appear until it reaches advanced stages, making it difficult to treat. Therefore, knowing how to examine the breast is crucial for early cancer detection and receiving treatment to prevent its progression. But what tests help screen for breast cancer? How can you examine yourself at home to ensure breast health?

The Importance of Early Breast Cancer Screening

Early breast cancer screening is essential to detect cancer at its earliest stages. According to the American Cancer Society, if breast cancer is detected early and has not spread, the five-year survival rate is 99%.

Of course, this percentage decreases as breast cancer detection is delayed, or if it reaches advanced stages or spreads to other organs, making treatment more challenging. Therefore, the earlier breast cancer is detected, the easier the treatment.

How to Screen for Breast Cancer?

Breast cancer can be screened and diagnosed in several ways, with the doctor selecting the most appropriate method for the patient’s condition. The main methods include:

1. Mammogram (X-ray of the breast)

High-energy X-rays are used to capture images of the breast's interior. This procedure only takes 10-15 seconds, where the breast is placed between two X-ray plates that press together to capture clear images of the breast.

Tomosynthesis

Also known as 3D mammography, it captures images of the breast from multiple angles and compiles them into a three-dimensional image. It may be more effective in detecting small breast cancers, especially in dense breast tissue.

2. Breast Ultrasound

This test uses high-frequency sound waves to create images of the inside of the breast. A gel is applied to the breast, and then an ultrasound probe is moved over the skin, with the image displayed clearly on the screen. This test may take 10-15 minutes.

3. Breast MRI

Breast MRI relies on magnetic resonance imaging to capture images of breast tissue, without using radiation like X-rays.
This test is mainly used for those at high risk of breast cancer, or those with extremely dense breast tissue or breast implants. It can also be used if other imaging tests produce unclear results.
The test may take up to 40 minutes, and while painless, the associated noise can be annoying.

4. Breast Biopsy

A doctor may need to take a tissue sample to check for breast cancer and determine its type and stage. A small sample of cells or tissue is taken from the lump or affected area and examined under a microscope for cancerous cells.
There are different ways to collect a sample, such as:

• Fine needle aspiration: A thin needle is inserted into the abnormal tissue, guided by ultrasound to ensure correct placement. Small pieces of tissue are then extracted through the needle. The doctor may use a local anesthetic to numb the area before the needle insertion.
• Core biopsy: Several tissue samples are removed using a fine needle, with local anesthetic applied, and guided by X-rays, ultrasound, or MRI to target the correct area.
• Vacuum-assisted core biopsy: A needle is inserted and connected to a suction device, removing a larger amount of tissue. It is more accurate in some cases and is often guided by X-rays or ultrasound.
• Surgical biopsy: If a needle biopsy is not possible or the diagnosis remains unclear, a surgical biopsy may be needed to remove part or all of the lump under general anesthesia.

5. CT/PET Scan

A CT or PET scan may be used to examine breast cancer in the hospital, providing clear cross-sectional images of the breast. It helps determine whether breast cancer has spread and evaluates the effectiveness of treatment or whether the cancer has returned after treatment.

6. Breast Scintigraphy

This test uses nuclear medicine to investigate breast tumors detected in previous imaging tests.
It is a non-invasive procedure that involves injecting the patient with a radioactive substance or drug, which emits radiation. The substance accumulates differently in various types of tissues, helping the doctor determine whether cancer is present.

7. Additional Tests

Other tests may be required, especially if previous tests confirm breast cancer. These tests aim to determine whether breast cancer has spread to other parts of the body:

Bone Scan: A bone scan is used to see if breast cancer has spread to the bones. A small amount of radioactive solution is injected into the vein through the arm. The solution is drawn to abnormal areas of bone. After a few hours, the bones are examined with a scanning device to detect cancer spread. The procedure is painless, and the solution is harmless.

PET Scan: A small amount of radioactive solution is injected into the vein in the arm or hand. Cancerous areas in the body will absorb more of the radioactive solution and appear brighter in the scan.

Breast Cancer Screening at Home

Breast self-examination at home can help detect any lumps in the breast early, though it cannot determine whether a lump is cancerous or not. However, it is essential for knowing whether the breast appears normal and for detecting any early changes.

It is recommended to perform breast self-exams after the menstrual period. If you have reached menopause or have irregular periods, you can choose any day each month to examine your breasts. The self-exam is performed as follows:

1. Visual Inspection in Front of a Mirror

• Remove your shirt and bra and stand in front of a mirror.
• Place your arms at your sides and look for any changes in the shape of your breasts, the skin, or the nipples.
• Then, raise your arms high above your head and look for the same changes.
• Finally, place your hands on your hips and press firmly to tighten your chest muscles.
• Check for the same changes again and examine both breasts.

2. Standing Breast Self-Examination

• Use your right hand to examine your left breast, then switch.
• Using the pads of your middle three fingers, press on every part of the breast, first with light pressure, then medium, then firm.
• Feel for any lumps, thickened areas, or other changes.
• Move in a circular pattern to cover all areas.
• Press gently near the armpit.
• Check the area under the areola, then press on the nipple to check for any discharge.
• Repeat these steps on the other breast.

3. Lying Down Breast Self-Examination

• When lying down, the breast tissue spreads evenly, making it easier to feel changes, especially for larger breasts.
• Lie down with a pillow under your right shoulder and place your right arm behind your head.
• Use your left hand to examine your right breast, and vice versa.
• Using the pads of your fingers, press on all areas of the breast and under the armpit.
• Switch the pillow to the other side and examine the other breast and armpit.
• Check under the areola, then press on the nipple to check for discharge.

Self-examination at home is not a substitute for visiting a doctor or undergoing breast imaging tests like mammograms or ultrasounds.

Genetic Testing for Breast Cancer

Approximately 5-10% of breast cancer cases are hereditary, meaning that inherited genetic mutations from one parent are often responsible for breast cancer. The two most well-known mutations related to breast cancer are changes in the BRCA1 and BRCA2 genes.

In 2023, the American College of Radiology recommended that all women undergo a breast cancer risk assessment by age 25, which includes genetic testing.

In 2024, the American Society of Clinical Oncology and the Society of Surgical Oncology issued recommendations that anyone newly diagnosed with breast cancer at age 65 or younger should undergo testing for the BRCA1 and BRCA2 genes.

Genetic tests involve taking various samples, including blood, saliva, or skin. These samples are sent to a laboratory, and processing may take several weeks.

External Appearance of Breast Cancer

There may be some external changes in the breast that could suggest the presence of breast cancer. The main details of a breast affected by cancer include:

• Swelling of the whole or part of the breast.

• Thickening of some areas of the breast.

• Change in the shape or size of the breast.

• Presence of a lump in the breast.

• Dimpling or puckering of the skin.

• Nipple retraction or inversion.

• Abnormal nipple discharge.

• Rash on the nipple or breast.

Internal Appearance of the Breast on Imaging

In a normal breast X-ray, the background appears black, and the breast shows as shades of gray and white. The dense breast tissue, including connective tissue and glands, appears white.

Dense tissue can make it difficult to detect breast cancer, so a mammogram alone may not be sufficient. Other imaging methods, such as ultrasound, may be required for further examination.

Breast tumors also appear as dense, white areas on mammograms.

It’s worth noting that breast tissue density decreases with age, making it appear more gray on X-rays. Every woman's breast tissue is unique, so no two breast images will be identical.

Breast Cancer Appearance on Imaging

Any area that looks different from normal tissue may be a cause for concern. Radiologists look for dense, white areas on mammograms, noting their size, shape, and edges. A breast lump or tumor may appear as a concentrated white area or gray shadow. The tumor may be benign or cancerous.

Normal Nipple Discharge

Nipple discharge may not be a cause for concern if it is:

• Clear, yellow, brown, green, or white.
• Coming from both breasts.
• Occurring only when the nipple is squeezed.
• Coming from the milk ducts within the breast.

When is Nipple Discharge Abnormal?

Nipple discharge may be abnormal if it is:

• Bloody.
• Coming from only one breast.
• Occurring spontaneously without squeezing the nipple.
• Accompanied by symptoms such as breast pain, redness, swelling, or changes in the nipple's appearance.

Nipple Discharge in Breast Cancer

Abnormal nipple discharge may be a sign of breast cancer and may require a breast examination.

Bloody or clear nipple discharge may be a sign of breast cancer, especially if it is coming from only one nipple and is accompanied by a lump or mass in the breast.

Appearance of a Rash in Breast Cancer

Inflammatory breast cancer is a rare type of cancer that may cause a rash on the breast. It does not begin with a lump or mass that can be felt. Its symptoms include:

• Discoloration of areas of the skin, turning pink, red, or purple, usually covering more than one-third of the breast.
• A persistent rash.
• Continuous itching, pain, or a burning sensation, and one breast may feel warmer than the other.
• Nipple changes, including inversion.

The rash associated with breast cancer may not always be itchy, and there are other causes of breast rashes besides cancer, such as:

• Mastitis.
• Breast abscess.

Appearance of a Breast Cancer Lump

A cancerous breast lump may feel firm rather than soft or spongy. Its edges are often irregular and asymmetrical, and the lump is usually fixed in place, not moving around. However, breast exams and imaging tests are necessary to confirm the presence of breast cancer.

Ways to Prevent Breast Cancer

Certain tips can help reduce the risk of breast cancer, especially for women who are more susceptible. The most important of these tips include:

1. Increase Physical Activity

Physical activity has been shown to help reduce the risk of breast cancer. It is recommended to exercise for at least 30 minutes daily. Even simple exercises, such as light walking, can be beneficial in improving physical activity.

2. Maintain a Healthy Weight

Obesity and being overweight are risk factors for breast cancer. Maintaining a healthy weight may be one way to prevent breast cancer. Regular exercise and a healthy diet can help in achieving this.

3. Follow a Healthy Diet

A healthy diet helps in maintaining weight, boosting overall health, and reducing the risk of breast cancer. Some research suggests that a diet rich in certain foods may be beneficial, including:

• Leafy vegetables.
• Seeds and nuts.
• Whole grains.
• Fruits.

4. Early Pregnancy

Research has shown that not having the first child until reaching the mid-thirties or later increases the risk of breast cancer. Therefore, early pregnancy is recommended if possible.

5. Breastfeeding

Many studies have linked breastfeeding to a reduced risk of breast cancer, possibly because it decreases the total number of menstrual cycles. Breastfeeding is preferred whenever possible.

6. Avoid Hormonal Treatments

Taking birth control pills or hormone replacement therapies after menopause may increase the risk of breast cancer. It is advisable to avoid them or reduce their dosage, or seek other less harmful alternatives.

7. Regular Breast Screening

Regular self-examinations and occasional imaging tests for the breast may help reduce the risk of breast cancer or at least detect it early when it is easier to treat before it worsens. Women over the age of 40 are advised to have a mammogram once a year.