I feel healthy. Why should I screen myself?
Even if you feel absolutely fine, you should get yourself screened at a hospital regularly for breast cancer with Mammography.
Mammography is proven to be the best screening modality for early detection of breast cancer and you can have the best chance of getting completely cured.
Feeling fine and having a health problem may not always go hand in hand. For example: In case of high blood pressure or diabetes, most patients will have no symptoms in the early stages. Whereas simple tests done by medical professionals can reveal these conditions and help manage them better.
Similarly, early breast cancer may be asymptomatic. The 5 year survival with localized breast cancer is as high as 93%1. Hence, the earlier you detect, the better is the management.
I have no family history of breast cancer. Why should I screen?
Most women who get breast cancer have no family history at all.
Only 5- 10% of the breast cancers may be due to hereditary reasons1 i.e., women with family history of breast cancer among blood relatives. Such women at higher risk. Another small but high-risk group is if ovarian or some other type of cancer that has affected someone in the family of blood relatives. Therefore, having no family history does not offer any additional protection against breast cancer.
Regularly screening yourself at a hospital, preferably with 3D mammography along with the other modalities as needed – such as Ultrasound or MRI, is the only way you can fight breast cancer before it becomes too big to handle.
I eat healthy and I exercise. Why screen?
Breast cancer is not comparable to a lifestyle disease like diabetes or heart disease. While healthy eating and exercise may reduce the risk but cannot prevent breast cancer. Limiting consumption of fats and alcohol, avoiding smoking, moderate exercise, breast feeding, etc, are known to reduce the risk of breast cancer (as well as other cancers). However, these measures alone do not guarantee that breast cancer will not occur. Despite a healthy lifestyle, breast cancer may still strike even if you have no family history. Wisdom lies in detecting it early at a stage when it is curable. Breast mammography is the gold standard for early detection of breast cancer in asymptomatic women, who has no family history of breast cancer. Annual Breast Mammography therefore after the age of 40 needs to be a part of your healthy lifestyle. If there has been a family history, you may have to start screening even earlier and sometimes with ultrasound and MRI too. Remember mammography saves lives and breast cancer can be cured if detected early.
I don’t want bad news. Why screen?
On the contrary, regular screening delivers good news to most women. The incidence of breast cancer varies from 80 to 113 for every 100,000 people across the world. The aim of screening is to detect early for these 80 to 113 people and to rule out breast cancer in others. Secondly, 3D mammo detects not only early cancer but also pinpoints its location for complete removal of the tumour by biopsy. So, it is a much better and positive news to detect early because of near total cure and normal life expectancy. Scientific data shows that five-year survival after early detection and treatment is 96%- 100%1.
Also remind yourself that most lumps, even if detected by 3D mammo, are not cancerous. Hence its always better to know for sure and have a sound sleep rather than pretend as if it will not happen to you.
Can I request a Mammo for breast screening myself without a Doctor prescription?
Yes, you can. Please check with the hospital or breast clinic facility whether they have 3D mammography.
Screening for breast cancer using 3D mammography helps detect breast cancer much earlier and with more accuracy compared to 2D mammography, dramatically improving chances of complete cure.
3D mammography is especially beneficial in detecting small cancers in women with even dense breast tissues. Chances of false detection too are low with 3D mammography compared to 2D and other modalities.
3D mammography has proven to be the best in early breast cancer detection. In fact, more than 90% of 45,000 women in a national survey said they do not mind traveling an extra distance to avail 3D mammography after learning its benefits over the other modalities.
Do speak with your health care provider to enquire about the 3D mammography facilities in your nearest locations.
Is 3D Mammo an established procedure?
Yes. 3D mammogram is a US FDA approved technology. Its efficacy over 2D has been proven by numerous clinical studies which have examined the results in more than 1.7 million screenings.
A 3D Mammography exam provides clearer, more detailed images of the breast area compared to conventional 2D mammography. As a result, 3D exams are clinically proven to detect more invasive cancers than 2D mammography alone.
How often should I undergo Mammo?
Screening mammograms can be done once a year after the age of 40 years in asymptomatic patients of average risk, which means all 40+ women.
For women in high risk group, its better to start annual Mammogram screening from 30 years of age. The general rule is start 10 years before the age at which a first degree relative was diagnosed with breast cancer.
The best thing for you to do is to talk to your Doctor or Radiologist and assess your risk factors to decide the age to start mammograms.
Am I in average risk or high risk group for breast cancer?
A risk factor is anything that increases the probability of getting a disease. Being a woman and getting older are the two factors that put you in average risk category for breast cancer. In addition to this- if you have dense breasts, a family or personal history of breast or ovarian cancers, certain genetic inheritances such as BRCA1 & BRCA2, early menstruation before 12 years of the age, late menopause after 55 years of age, use of hormonal replacement therapy after menopause etc. are known to be associated with higher risk of breast cancer.
Being in the average risk group does not mean that you cannot get breast cancer.
Hence it is important to undergo regular screening mammograms after the age of 40 years as per your doctor’s advice and follow a healthy lifestyle.
Will my breasts get painfully compressed for a long time during Mammography?
3D Mammography is a non-invasive procedure. Only a good medical image of your breasts using a low dose of X-rays will be taken. There will be some pressure applied on breasts to hold it firm and unmoved when X-ray image is being taken. But this is not painful. Secondly, the time for which the breasts are held between two trays is very short – less than 4 seconds per scan.
When young women in premenstrual phase undergo 3D mammography, it may cause some discomfort. Hence it is advisable for this group of women to get it done immediately after their menstrual cycle.
What are dense breasts? How are they related to breast cancer?
Only a mammogram can reveal if you have dense tissues in the breasts or not. It cannot be felt in a clinical exam by your Doctor or during self-exam by you. Breasts are called dense when they contain relatively more glandular and fibrous tissue and less fat. Nearly 50% of all the women of age 40 and above are likely to have dense breasts1, and the percentage is usually higher for the younger population.
Dense breasts carry two additional risks compared to fatty breasts in terms of breast cancer: 1) Women with dense breasts have a higher risk of breast cancer compared to fatty breasts. 2) It is more difficult for mammograms to see through dense breasts and detect cancer if any. 3D mammograms have a higher detection rate than 2D as established by a clinical study called STORM-2. Number of additional views too can be reduced in 3D compared to 2D. Due to its advanced technology, 3D can see through dense breasts and produce a clearer picture of the tissues and any small suspicious growth.
Can I reduce my breast density naturally?
If you thought breast density means breast size – no, they are two different things. Breast density is said to be more only when the amount of glandular and fibrous connective tissues is more in the breast compared to fat. Not when the breast size is big or small in size.
There is no known or scientifically proven way to reduce breast density. Some amount of density may reduce with increasing age but it is not in one’s control.
The first step, if you don’t know if you have dense breasts or fatty breasts, is to get a screening mammogram done to know your density.
There is a system among Doctors called BI- RADS that groups four different types of breast density.
Category A: Almost entirely fatty tissue found in about 10% of the women
Category B: Scattered density found in about 40% of the women
Category C: Heterogeneously dense breast found in about 40% of the women
Category D: Extremely dense breasts found in about 10% of the women
If you are told by your Doctor that you have dense breasts after the mammogram, you are likely to be in category C or D. Once you know that you have dense breasts, there is no need to feel more anxious or worried. However, you need to be aware of two things that a) dense breasts carry a higher risk of breast cancer and b) it is difficult for conventional 2D mammogram to see through dense breasts as compared to 3D mammogram. Hence it may be prudent for you to undertake a 3D screening Mammogram every year after 40 years of age, in consultation with your Doctor to avoid any surprises.
What is breast self examination? How to do it?
Breast self-examination (BSE) is an inspection of breast done by yourself which helps you to understand the normal look and feel of the breast. BSE is a convenient no cost tool that can be done on regular basis starting at the age of 20.
When to do it?
The best time to do a monthly self-breast exam is about 3 to 5 days after your period starts. Do it at the same time every month. Your breasts are not as tender or lumpy during this time in your monthly cycle. If you have gone through menopause, do your exam same day of every month preferably on your birth date so that you don’t forget.
How to do it?
Visual examination of the breast
Use your hand to examine the breast
Certain important points of BSE:
Use pads of your fingers preferably 3 middle fingers for examination
Use different pressure levels- lighter pressure for the skin /superficial part of breast, Higher pressure for deeper part of breast
Follow a pattern like the face of a clock
Take your time don’t rush
When to see a doctor?
● Lump/Thickening in the breast or underarm persisting throughout menstrual cycle
● Change in size , shape and contour of the breast
● Bloody and clear discharge from nipple
● Redness of skin /nipple
● Dimpling / Puckering of skin on the breast/ nipple
Make a journal where you record the finding of BSE every month
How do I know if it is a lump in my breast?
Many women find their breasts to feel lumpy. Breast tissue naturally has a bumpy texture. Some women have more lumpiness in their breasts than others. If the lumpiness can be felt throughout the breast and feels like your other breast, then it is likely normal breast tissue.
Its best to examine your breast after a period when it is least lumpy. A cancerous lump in your breast or armpit feels harder than the rest of the breast. It is like feeling a marble (hard lump) in a pillow (normal breast tissue). Please use the flat of your hand, and not your fingers and thumb to feel the lump, which is usually painless (and that is why unfortunately most patients come in late).
Every lump that feels this way may not be cancer but needs to be checked out by a doctor, particularly if it doesn’t go away.
The other signs to look out for are:
● change in the look or feel of the breast
● change in the look or feel of the nipple
● discharge from the nipple particularly if its spontaneous, considerable, bloody/or like tap water
What should I do if I find a lump in my breast?
It may be unsettling for you to feel a lump in the breast. But do not panic. Not all breast lumps are cancerous and majority of lumps in the breast are non-cancerous or benign lesions like fibroadenoma, accumulation of fluid called cysts, accumulation of fat or even sometimes could just be a prominent breast tissue.
All you need to do is not to ignore the lump and get an expert consultation. You may be asked to get a mammogram done if you are above 40 years or an ultrasound if you are less than 30 years or either one of these if you are between 30 and 40 years of age.
If you are getting a mammogram done, make sure that the hospital or the centre also has a 3D mammogram. 3D mammogram is much more accurate in identifying the lesion and characterizing them than 2D mammogram especially if you are young and have dense breast tissue.
When should I go to the Doctor for a breast lump?
Being familiar with how your breasts normally feel, makes it easier to detect when there’s a change in your breasts. Hence monthly self-examination helps although it is not a good method for early detection of breast cancer.
Consult your doctor if:
● You find a new breast lump or thickening that feels different from the surrounding tissue
● You notice a change in the size, shape or appearance of your breast
● Breast pain doesn’t go away after your next period
● You notice skin changes on your breast, such as itchiness, redness, scaling, dimpling or puckering
● You have a newly inverted nipple
● You notice spontaneous nipple discharge1
If a diagnostic screening advised, please check if the hospital has a 3D mammogram because a 3D mammo is clinically proven to detect on an average 41% more invasive cancers compared to 2D mammo. Much fewer call backs on 3D compared to 2D because image clarity is much superior. And for dense breasts which is present in about half the adult women population, 3D is the best available technology to see through the tissue if there is any cancerous lump or a benign condition.
Will breast cancer come back after treatment?
The purpose of regular screening for early detection is to completely cure an early cancer and keep it from coming back. 3D Mammography plays a big role in early detection, with a greater clarity and better accuracy.
Early detection and appropriate treatment greatly reduce the risk of a recurrence. Early detection also offers the advantage of preserving the breast or avoiding complete removal.
Majority of the women treated for breast cancer tend to do well. However, there is a potential risk of recurrence. If it recurs in the same breast it is called local recurrence, This is recognized by regular physical exam on follow up and annual 3D mammogram.
If breast cancer recurs in other parts of the body, it is called a metastasis. This will need further tests to assess the extent of disease and treatment options will be offered after discussion with a multidisciplinary team.
In a nutshell, it is important to continue with 3D mammographic surveillance even if you feel perfectly healthy after the breast cancer treatment.
Should I screen myself regularly after undergoing breast cancer treatment?
Many people wrongly assume that there is no screening needed after undergoing breast cancer treatment. Necessity and frequency will depend on the type of breast cancer treatment received. Although specific plan will be shared by the treating Doctor, a general guideline as below might be useful.
Lump Removal (Lumpectomy):
A mammogram of the affected breast is usually done six months after completion of initial therapy. This is called a surveillance mammogram. Many patients are able to go back to a yearly schedule of imaging their breasts soon after this.
Unilateral (one-sided) Breast removal with or without Reconstruction
Imaging is still needed for the unaffected breast to detect any possible changes in your breast tissue. A yearly surveillance mammograms on the unaffected side may be needed.
Bilateral (both sides) Breast removal with our without Reconstruction
If all of the breast tissue is removed, then such women will not need any routine imaging since all of the breast tissue on both sides has been removed.
What is a cancer support group?
Probably the greatest moral support a cancer patient can get is from those who are in the same boat or from those who have ‘been there, done that’. Cancer support groups are safe platforms for not only the patients but also their relatives to share their experiences and cope successfully with treatment, side effects, and rehabilitation.
There are online, phone and face to face versions of the support group. Some are general groups that invite all patients recovering from different types of cancers to be a part of these platforms. Some are specific to breast cancer. One can also start a support group with help from the hospital or a local cancer related NGO.
If one support group doesn’t meet a patient’s expectations, it doesn’t mean the groups are not a good idea. It may be better to participate in a few other groups and see if you eventually get comfortable. A single success story shared by a cancer warrior herself could motivate her fellow sisters in their battle to face the crab head on and win over it.
What are the risks of 3D Mammogram?
The first risk in people’s mind is the concern about radiation exposure with mammogram, which is actually very low. The total radiation dose in a 3D mammogram session is about as same as a conventional 2D mammogram and is well within the guidelines. However, the big advantage of getting a 3D mammo done is in catching an early cancer with far more accuracy and far less chances of call backs.
The second risk is that a mammogram may wrongly identify an abnormality as cancer, and after additional tests, it turns out to be benign or consistent with normal tissue. This is known as a false-positive result, However, it is clinically proven that the chances of a 3D Mammo making such errors are remote and 40% less than 2D.
Third risk is false negative result, which means that the mammogram misses detection of a very small cancer. This chance is very low. And if you have a healthy practice of undergoing annual 3D mammogram screening, a year later, the 3D Mammo is most likely to catch it when it is still small enough to be completely cured. The chances of missing the second time are extremely low compared to 2D and some other modalities.
Why did Angelina Jolie undergo breast surgery when she was healthy?
A very small proportion of women (less than 1% of the population) carry a high risk gene fault, BRCA1 or BRCA2. For such women the lifetime risk for ovarian cancer is up to 60% and for breast cancer, up to 80%.
Angelina Jolie, who has a strong family history of breast and ovarian cancers, announced in 2013 that she carried the BRCA1 gene, which put her at significant risk of developing these cancers. At that time, Ms Jolie undertook a preventative surgery and got both her healthy breasts removed. Such risk-reducing surgery is one option for consideration by women who have a strong family history, which could potentially put them at increased risk.
What is the relationship between ovarian cancer and breast cancer?
When there are multiple cases of breast cancer and ovarian cancer on the same side of the family, it is called Hereditary Breast and Ovarian Cancer Syndrome (HBOC). The chance of having HBOC increases if:
● One or more women in the family are diagnosed at age 45 or younger
● One or more women are diagnosed with breast cancer before age 50 with an additional family history of cancer, such as prostate cancer, melanoma, and pancreatic cancer
● There are breast and/or ovarian cancers in multiple generations on the same side of the family, such as having both a grandmother and an aunt on the father’s side both diagnosed with these cancers
● A woman is diagnosed with a second breast cancer in the same or the other breast or has both breast and ovarian cancer
● A male relative is diagnosed with breast cancer
● There is a history of breast cancer, ovarian cancer, prostate cancer, and/or pancreatic cancer on the same side of the family
● Having Ashkenazi Jewish ancestry
Less than 1% of the population is likely to have HBOC1. However, if the HBOC lineage is present in the family, then the probability of developing breast or ovarian cancers tremendously increase for such women.
If you have any questions about your own family history and wish to ascertain if you have HBOC, please talk to your Doctor and discuss your concerns and suspicions openly without any hesitation.
What needs to be done if some abnormality is detected on screening mammogram?
When abnormalities in the breast are detected on screening, it might not always be possible to tell whether its benign or cancerous.
Hence a few more imaging tests may be carried out and if the finding looks typically benign on these tests, no further tests may be needed. In a few cases, a follow-up may be advised.
If the appearance is more like a cancer, a biopsy may be needed to confirm its nature. The tissue specimen obtained from the biopsy is used to make a final diagnosis and treatment plan if it is a cancer.