Breast cancer is one of the most common malignancies in females.Every female should know about its screening procedures

Screening is important for those patients likely to develop breast cancer and for patients in whom early treatment is more effective than later treatment in reducing mortality.

Salient features

1. Most women are at average risk (less than 15 percent lifetime risk) of developing breast cancer.

2. High-risk patients are the ones with
   a. Personal history of cancer of the ovary, breast, peritoneum, or fallopian tube
   b. Genetic mutation (eg, BRCA1 or BRCA2)
   c. History of the previous radiotherapy to the chest between ages 10 and 30

3. Screening warranted above the age of 40 year

4. Age 40-49 screening individualized ( Patients choice)

5. Age 50-74 screening suggested

6. Above 75 screening advised only if expected life of greater than 10 years

Modality of screening

1. Average-risk women ( No risk factor, age>40 years)

a. Mammography every 2 years
b. If any abnormality in Mammography then ultrasound or MRI
c. Women should be educated about breast health awareness.
d. Self-breast examination and clinical breast examination no longer form part of screening procedures.

2. Moderate-risk women
   a. Women with breast cancer in a first-degree relative but without a known genetic syndrome.
   b. Mammography every 2 years
   c. In case of any abnormality then MRI / Ultrasound of breast

3. High-risk women ( lifetime risk of development of cancer >20%)
   a. Referral to a high-risk screening clinic for evaluation
   b. Intensified surveillance and consideration of genetic testing and risk reduction treatment
   c. Annual Mammography of breast
   d. Supplemented by MRI of a breast after 6 months of mammography ( Individual gets one modality of investigation either MRI or mammography every 6 months)

Benefit of screening

a) A decrease in breast cancer mortality.
b) Absolute benefit is lower in younger women who have a lower baseline risk of cancer

Harms associated with breast cancer screening

a) Potential for overdiagnosis
b) False-positive findings
c) Patient anxiety
d) Unnecessary treatment and its associated risks.