Screening For Breast Cancer – Tests, Guidelines

Screening for breast cancer involves promoting breast awareness and educating women on breast health. For early detection of breast cancer, mammography is the recommended mode of screening. However, breast magnetic resonance imaging (MRI) may be used in selected high-risk populations.

Breast self examination and other tests

Breast Self-Examination (BSE), clinical breast examination (CBE) and ultrasound (for women between 35 and 39) are not screening modalities but are are useful in understanding the results of your mammography. They are therefore of help in early diagnosis of breast cancer. For example, clinical breast examination (CBE) during your routine visit to the doctor provides and opportunity to learn more about breast health from your doctor.

When should you screen for breast cancer

The age of starting screening for breast cancer as well as how often you should screen depends on your risk factors for breast cancer and assessment of your risks profile by your doctor as high risk or average risk.

You have high risk for breast cancer if….

• Affected first degree relatives
• Previous abnormal breast biopsy
• Previous chest wall radiation (x-ray)
• Previous breast cancer

Breast Cancer screening recommendations for women with high risk

Women in the high-risk population require more intensive screening and/or genetic counseling.

High risk	Recommendations on breast cancer screening
Women with one or two first degree relatives with invasive breast cancer, but who do not meet the criteria for referral to Medical Genetics	Clinical Breast Examination - starting at age 25 years Annual mammography starting 10 years younger than the youngest case in the family, but no earlier than age 25 and no later than age 40; Complementary imaging like ultrasound and MRI in addition to the above where justified.
Women who have had certain types of breast cancer and have undergone surgery and the doctors want to check if the cancer has spread further. In medical jargon - Women with a breast biopsy showing atypical hyperplasia or lobular carcinoma in situ and following surgical management to rule out invasive carcinoma.	Clinical Breast Examination every 6-12 months Annual mammography
Women with a history of chest wall radiation (i.e. mantle radiation for treatment of Hodgkin’s lymphoma) at age 30 or younger	Annual mammography and MRI starting 5 years after radiation given, but starting no earlier than age 25 and no later than age 40 Annual Clinical Breast Examination
Women with previous breast cancer require screening of contralateral breast	Clinical Breast Examination every 6-12 months Annual mammography

You have average risk for breast cancer if you …..

• Have met any of the high risk
• Are a man
• Do not have any symptoms suggestive of breast cancer

Breast cancer screening recommendations per age category for women with average risk

Average risk for breast cancer does not mean no risk. In fact, a majority (80%) of breast cancers occur in those with average risk of the disease. In breast cancer, your age is important. This is because being exposed for a long time and/or to high levels of female sex hormones (estrogens) has been linked to an increased risk of breast cancer.

Age	Breast Cancer Screening Recommendation	How frequently?
25 - 34 years	Clinical Breast Exam every 3 years Mammogram is not recommended	1 to 3 years
35 - 39 years	Clinical Breast Exam and Ultrasound OR mammography*	1 to 3 years
40 - 55 years	Clinical Breast Exam and mammography	Every year
56 - 74 years	Clinical Breast Exam and mammography	Every two years
75 years and older	At this age, you need to discuss with your doctor your health concerns and needs and preferences. Decide if there's need to continue screening
* The balance of benefits and risks is not great enough to recommend routine screening using mammography. Discuss with your doctor if based on his clinical judgement and your individual needs, to have mammography and if so, how frequently.

References

• Ministry of Health, Nairobi, Kenya. Kenya National Cancer Screening Guidelines, November 2018
• National Cancer Institute