No one can prevent breast cancer.

Hence doctors recommend regular breast screening after the age of 40 in average risk women, and before 40 in high-risk women.

Early detection is the best protection against breast cancer because it can dramatically improve the chances of complete cure and survival.

Four breast surveillance modalities, i.e., self-breast examination, breast ultrasound, MRI, and mammography are compared here for your better understanding:

Self-breast-examination

• Most medical organizations do not recommend self-breast-examination^[1] because it does not help early detection. By the time the lump is big enough to be felt by your or your doctor’s hands, its already too big, and too late in most cases.
• Its detection rate (sensitivity) is very low. Self-breast-examination is successful in detecting breast cancer only 20 to 30 times out of 100 overall, with lower detection older women^[2].
• It promotes unnecessary breast biopsies due to increased false positives^[3], especially with trained hands, because the feedback based on touch is vague and often misleading.

Breast Ultrasound

• Ultrasound is more a diagnostic tool than a screening tool. It is most often used to further assess palpable and non-palpable masses detected by the screening mammography^[4].
• Ultrasound can neither take a whole image of the breast nor reach its deep areas like a mammogram can. Ultrasound also cannot detect microcalcifications – the tiny calcium deposit around a tumor, which can be seen by a mammogram to help doctors detect very early breast cancer.

• Interpretations may vary from operator to operator in ultrasound because it requires highly skilled operators, and examination techniques are not standardized^[5].

• Ultrasound false positives are more for solid tumors compared to mammography^[6].

MRI

• The high cost of MRI – approximately 10 times the mammography cost, and its lower specificity i.e., ability to correctly identify women without breast cancer compared to mammography prohibit its routine use for screening general population^[7]. It may be sometimes used as a supplementary modality after a mammogram.

• MRI is time consuming, requires intra-venous contrast administration, and may be problematic for claustrophobic patients⁷.

Mammography

• All reputed medical organizations worldwide such as CDC USA, and Breast Imaging Society of India (BISI) recommend Mammography for routine screening of all women aged 40 years and older for early breast cancer detection. The women in high-risk groups are advised to start screening mammography at much earlier age.

• Reputed studies show a significant reduction in breast cancer deaths in those who underwent regular mammography^[8]. Mammography is the only method of screening for Breast Cancer shown to decrease mortality. An expert panel headed by University of California reviewed 18 different detection systems and concluded that mammography remains the gold standard^[9] for early detection.

• With a cost much cheaper than MRI, the detection rate (sensitivity) of mammography of early breast cancers is 89 – 97%^[10], which is very high.

• Mammography’s ability to correctly identify women without breast cancer (specificity) is 83.2% to 99.2%^[11] – much higher than that of MRI and the other modalities.

• With improved comfort to patients, low-dose radiation, and rapid scans, the latest technology in mammography called 3D mammography detects 20%- 65% more invasive cancers than the earlier technology 2D alone, with an average increase of 41%^[12].
• 3D mammography reduces callbacks by up to 40% compared to 2D alone^[13].

What action can you take today?

If you are eligible for regular breast screening either by age (40 years and above), or due to high-risk factors as above (in which case before 40 years), ask your doctor about an annual 3D Mammography plan – a simple ritual that can save your life!

1. https://www.mayoclinic.org/tests-procedures/breast-exam/about/pac-20393237
2. O’Malley, Michael S., and Suzanne W. Fletcher. “Screening for breast cancer with breast self-examination: A critical review.” JAMA 257.16 (1987): 2196-2203. https://jamanetwork.com/journals/jama/article-abstract/365753
3. Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for Breast Cancer. JAMA. 2005;293(10):1245–1256. doi:10.1001/jama.293.10.1245 https://jamanetwork.com/journals/jama/fullarticle/200479
4. Gordon PB. Ultrasound for breast cancer screening and staging. Radiol Clin N Am. 2002;40:431-44112117185 https://www.radiologic.theclinics.com/article/S0033-8389(01)00014-8/fulltext
5. Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for Breast Cancer. JAMA. 2005;293(10):1245–1256. doi:10.1001/jama.293.10.1245 https://jamanetwork.com/journals/jama/fullarticle/200479
6. Irwig L, Houssami N, van Vliet C. New technologies in screening for breast cancer: a systematic review of their accuracy. Br J Cancer. 2004;90:2118-212215150556 https://www.nature.com/articles/6601836#Tab1
7. Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for Breast Cancer. JAMA. 2005;293(10):1245–1256. doi:10.1001/jama.293.10.1245 https://jamanetwork.com/journals/jama/fullarticle/200479
8. Elmore, J. G., Armstrong, K., Lehman, C. D., & Fletcher, S. W. (2005). Screening for breast cancer. JAMA, 293(10), 1245–1256. https://doi.org/10.1001/jama.293.10.1245
9. https://www.webmd.com/breast-cancer/features/mammography-still-gold-standard-for-breast-cancer
10. Zeeshan M, Salam B, Khalid QSB, Alam S, Sayani R. Diagnostic Accuracy of Digital Mammography in the Detection of Breast Cancer. Cureus. 2018;10(4):e2448. Published 2018 Apr 8. doi:10.7759/cureus.2448 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991925/
11. https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.29593
12. Friedewald, SM, et al. “Breast cancer screening using tomosynthesis in combination with digitalmammography.” JAMA 311.24 (2014): 2499-2507 https://pubmed.ncbi.nlm.nih.gov/25058084/
13. Friedewald SM, Rafferty EA, Rose SL, et al. Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography. JAMA. 2014 https://jamanetwork.com/journals/jama/article-abstract/1883018