A few remarks about breast cancer screening
From time to time, I hear comments from the general public about the minimum age to be included in the breast cancer screening program, the proposed frequency and breast self-examination. I would therefore like to make a few remarks on these subjects.
Breast Cancer Screening Program
In Quebec, women aged 50 to 69 with an average risk of breast cancer are invited to have a mammogram every 2 years from the age of 50. The average risk is defined by not having any signs or symptoms associated with breast cancer and not having any particular factors, such as a personal history of breast cancer, a family history of cancer or a genetic mutation which can cause cancer. Other women are excluded from the program.
Women who have had breast cancer have a medical follow-up adapted to their situation. Women at higher risk are invited to talk with their physicians well before their 50s, since in these cases screening is generally recommended 10 years before the age of the youngest person to have had cancer. In case of family history, all cases are not equivalent. For example, a sister with aggressive bilateral breast cancer at a young age increases the personal risk more than a mother with breast cancer at a “normal” age. It is what my geneticist who told me.
Why only from the age of 50?
- 1 in 2 (50%) is diagnosed in this age group (50 to 69 years).
- According to current knowledge:
- The benefits outweigh the disadvantages for the women targeted by the program.
- Before 50 years, the disadvantages increase and the benefits diminish.
- Less than 20% of breast cancers develop before age 50.
- Before the age of 40, women often have dense breasts (that is, composed of more ligaments, glands and channels than fat) and this usually decreases with age.
- Dense breasts make the detection of cancer more difficult because they have the same appearance on the mammogram.
Some say that 2 years between 2 mammograms is too long and it would have to be every year. In my opinion, they forget one thing: mammography does not take away the importance of knowing and observing her breasts.
Women before 50
The lack of a screening system is not the only obstacle that women under 50 can face. Here are a few:
- Not being in the target audience, they may not feel concerned and therefore less aware of breast cancer.
- There are several symptoms that we never hear about (no matter the age).
- Some health professionals believe that the patient is too young to have breast cancer.
- Some doctors, including specialists, underestimate the rarer symptoms and act as if rare is equal to never.
Some people complain that in Canada physicians no longer recommend to teach breast self-examination to their patients. What they do not say and which has been badly broadcasted is that self-examination has been replaced by breast observation. In fact, it is the teaching of a particular technique of self-examination of the breasts which is no longer recommended since according to the research the method used to observe and feel the breasts would not matter. Women are thus free to observe themselves and feel the breasts in the way they want and are encouraged to do so. Collarbones and armpits should also be examined for lymph nodes. Any new and persistent changes, whether recognized or not as a sign or symptom of cancer, should be reported to a physician.