Breast cancer awareness and screening
Read answers to your questions about breast cancer awareness and screening as part of our Breast Cancer Q&A with experts from Breakthrough Breast Cancer and Breast Cancer Care.
Breast cancer awareness
Ewe: I do try to remember check my breasts, but wonder how obvious a lump would be? They're so textured anyway I find it hard to tell if it's a normal lump that's always been there that is just part of me or if it's something unusual - I just can't remember from one month to the next.
Lisad123isgoingcrazy: I think it's very hard for woman to do a breast exam. Wouldn't it be better if a GP or nurse offered a breast exam whenever you go for a smear, etc? I have only been offered once when I found a lump (was nothing) but still always wonder if I'm doing it right.
Easywriter: As a large-breasted woman, I really worry about checking my breasts, especially after I heard a statistic that seven out of 10 lumps will be missed by a woman checking her breasts. I feel as if I would be able to check the higher areas of breast tissue (near my collarbone and under my arms) reasonably well. However, with the tissue that one would conventionally think of as being a breast, I think I would be very lucky to feel anything as there is so much tissue.
Wubblybubbly: I would really like to see an awareness campaign that covers all the different types of breast cancers, particularly inflammatory breast cancer, which doesn't present with a lump and is still, far too often, misdiagnosed. I didn't have a clue that there were so many different types of breast cancer. I naively thought that large or painful lumps were nothing to worry about. From talking to friends and family, it seems many women still don't actually know what to look for, beyond the pea-sized, painless lump.
Breast Cancer Care nursing team: It's interesting to read your questions about being breast aware and Wubblybubbly's comment about women knowing they need to check not only for a lump. This is exactly what being 'breast aware' is all about.
Your breasts change constantly throughout your life from puberty, through adolescence, the childbearing years and then the menopause. There's no right or wrong way to check your breasts.
Being breast aware means getting used to looking and feeling your breasts regularly. You can do this in the bath or shower, when you use body lotion or when you get dressed. Just decide what you are comfortable with and what suits you best.
There are a number of breast changes which you should get checked out promptly by your GP. While a lump or thickening of the breast is one sign, other breast changes to be aware of include:
- A change in the size or shape of your breast
- Redness or a rash around the nipple
- A change in skin texture such as puckering or dimpling
- A nipple that 'starts' to be inverted or begins to be pulled in (many women have inverted nipples which can be normal for them)
- A discharge from a nipple that is spontaneous
- Swelling in your armpit or around the collar bone
- Constant pain in the breast or armpit.
It's worth remembering that most of these changes are likely to be normal breast changes and not a sign of breast cancer, but getting any symptoms checked out quickly by your GP is part of being breast aware.
The majority (around 80%) of breast cancers occur in women over the age of 50 and the older you become, the greater your risk of developing breast cancer is. Breast cancer is not common in younger women but it is important for all women to be breast aware and know how their breasts will change throughout life and understand their risk.
Ewe, there is no set time to check your breasts, but it is best to do it on a regular basis. Some women find their breasts feel different either before or after a period as normal hormonal fluctuations can affect the breasts.
Easywriter, many women are worried that they will be unable to pick up changes, but no one knows your body as well as you do, and you really are the best person to notice anything that is different for you. The more confident you become in being breast aware, whatever size you are, the more likely you are to notice any unusual changes. Lisad mentions having a breast exam at the time of a smear. You may find it interesting to know this is not recommended. This is because by checking your breasts regularly means you will get to know what they normally look and feel like, whereas having a health care professional checking occasionally is unlikely to be as effective.
You can download a booklet from Breast Cancer Care called Your breasts, your health throughout your life. It explains more about breast awareness.
Dr Caitlin Palframan, Policy Manager, Breakthrough Breast Cancer: At Breakthrough Breast Cancer, we get a lot of questions from women worried about how they should be checking their breasts. Because of this, we have developed our Touch Look Check breast awareness information to help.
No one knows your body better than you and everyone will have their own way of touching and looking for changes - there's no special technique and you don't need any training.
It's important to check the whole breast area, including your upper chest and armpits - try to get into the habit of doing it regularly, maybe in the bath or shower, or before getting dressed in the morning. And remember, you're not just checking for lumps. Look for unusual changes to your nipples, in the size and shape of your breasts and in skin texture too.
We've just launched an iPhone app to show women what they should be looking out for and different options for how to check that they might find useful. It can be downloaded from ibreastcheck.com but don't worry if you haven't an iphone, all the information is also on our website at breakthrough.org.uk/tlc.
Breast cancer screening
Imbecileningles: I wonder if there is such a thing as a baseline mammogram, or similar - a bit like mole mapping for people at higher risk of skin cancer?
Ladylush: I'd like to see a facility where someone can turn up and get checked – even if it's for a fee. That would put my mind at rest. Are mammograms still aimed at women 50+?
Easywriter: I am 42 this month and so nearing the screening age (which only increases the worry). Do you recommend any addition methods to check larger breasts and is there anywhere that will offer me screening without relieving me of £200 into the bargain? (I have spoken to my doctor about this and whilst they are sympathetic they say there is no free/nearly free NHS screening available in Sheffield until you become 50.)
Travellerintime: What are the pros/cons of starting screening from age 40, as opposed to 50? I think it's harder to check premenstrual women as their breasts are denser, so harder for a mammogram to pick things up on. When I was diagnosed, younger women at the clinic seemed to only have ultrasounds, but those can pick up lots and let's face it there's no x-ray involved so it's safer. I asked my GP about it and he says he thinks cost has an awful lot to do with it.
Cupcaked: Also screening is not foolproof either, and may even lull people into false sense of security so they don't bother self-checking if getting mammogram. I speak from experience. I went for mammography at age 44 after a friend was diagnosed in early 40s. It was done through local cancer charity Action Cancer, a year before I found the lump by accident. I was not self-checking regularly, I have to say, because I thought mammography would have picked anything nasty up. But clearly a lot can happen in a year. I say again, know your own.
Dinahrod: Ultrasound isn't offered routinely on NHS, or at least not in my area, for under 40s even if you have a history of breast cancer in the family - I asked about having it. Apparently, ultrasound gives a lot of false alarms which is why they won't do it and you have to wait until you're 40 for mammograms instead, although I understand it is offered in other countries.
Dinahrod: Are mammograms any more reliable than 20 yrs ago?
Breast Cancer Care nursing team: Thank you for your very relevant questions about screening. Many of you ask about the age range for breast screening.
The NHS Breast Screening Programme invites women every three years for a mammogram (breast x-ray) between the ages of 50 and 70. By 2012 women between the ages of 47 and 73 will be included. Women over the age of 70 are still entitled to breast screening every three years if they ask for it. Your name is taken from your GP's list if you are eligible and you are then invited for breast screening.
The purpose of breast screening is to detect breast cancer before there are any signs or symptoms. It is not for women who have noticed any changes that they are worried about which need to be reported to their GP.
Ladylush, you asked if you can turn up and get checked, but this is not possible within the NHS Breast Screening Programme.
Although mammography is the most reliable way of detecting breast cancer early, like other screening tests it is not perfect and not all breast cancers will be seen on a mammogram. This may be because some breast cancers are very difficult to see or very occasionally the doctors reading the mammogram may miss the cancer, no matter how experienced they are.
Cupcaked, you rightly point out the importance of being breast aware even though you may be having regular mammograms. Part of being breast aware is attending screening when invited, but as the majority of breast cancers are detected by the woman herself, it is also knowing what your breasts look and feel like normally so you can report any change promptly to your GP.
Travellerintime, you asked about the pros and cons of breast screening starting at 40. A screening programme has to screen or look for cancers in the population where they are most likely to occur. The majority of breast cancers occur in women over the age of 50 (about 80%) and the older you become the greater your risk of developing breast cancer. Also, as you mention in the posts, because younger women have denser breast tissue it makes interpretation or reading of the mammogram more difficult. This means means they are not as accurate in detecting abnormalities in younger women, which is why the screening programme does not invite younger women for routine breast screening.
In answer to DinahRod's question, the effectiveness and accuracy of mammograms (when used in the appropriate age group) has improved since the late 1980s (when breast screening was first introduced in the UK) making them a reliable screening tool. The mammogram films or pictures taken as part of NHS screening programme as Imbecileningles describes, can be used as a baseline to compare future mammograms. A newer technique, which is being introduced throughout the UK, is digital mammography. This will gradually replace film mammography and has been shown to produce better quality images.
Ultrasound scans (a scan that uses high-frequency sound waves) may be one of the investigations used to assess an abnormality in the breast but this type of scan is not a screening tool and has not been shown to be an effective alternative for mammographic screening.
Hopefully this has clarified some of your discussion on breast screening, but you can find more information on about this topic on Breast Cancer Care's website. Or you can use the Ask the Nurse email service or helpline on 0808 800 6000 if you have more questions.
Dr Caitlin Palframan: The NHS Breast Screening Programme was set up by the Department of Health in 1988 in response to the recommendations of a working group, chaired by Professor Sir Patrick Forrest, which had been set up to consider whether or not to implement a population screening programme in the UK. These recommendations (sometimes know as The Forrest Report) found that mammography was the best method for population breast screening. The NHS Breast Screening Programme was the first of its kind in the world. It began inviting women for screening in 1988 and national coverage was achieved by mid-1990s.
A mammogram is a special type of X-ray that looks at the tissue of the breast. As it is able to reveal changes too small to be felt, it can potentially detect a change before you or your doctor has noticed anything different.
Mammography is still the best test currently available to screen for breast cancer. However, you may be interested to know that the NHS is currently implementing digital mammography which has several benefits over conventional mammography. More information about this is available at this link.
smee: So, should women in this slightly higher risk group be offered screening before they're 50? After all, in lots of countries women are routinely screened from 40. I know there are arguments as to why this isn't always a good idea, but in my case it most definitely would have been.
Dr Caitlin Palframan: For most women, age is their biggest risk factor for breast cancer – as you get older, your risk of breast cancer increases. Breast cancer is far more common in older, post-menopausal women: over 80% of breast cancer cases in the UK are in women over the age of 50.
Women over the age of 50 are offered routine breast screening through the NHS Breast Screening Programme. At present, younger women are not offered routine screening unless they have a significant family history of the disease that means they are at higher risk of developing breast cancer. This is because breast tissue is denser in younger women, making it hard to detect any problems and because breast cancer is relatively rare in pre-menopausal women.
We know that the NHS Breast Screening Programme is currently reviewing whether any other groups of younger women have a high enough risk of breast cancer at an earlier age to justify early breast screening. However, we believe it is unlikely that additional breast screening will be extended to women who gave birth later in life as this lifestyle choice leads to only a small increase in breast cancer risk.
MmeLindt: For the past 18 years I have lived abroad. First in Germany, then for the past two years in Switzerland. This morning I had my third smear at my gynecologist here in Switzerland, as we are reminded on a yearly basis to go for a smear. At the same time, it is normal for the doctor to check the patient's breast and advise you on the best way to check your breasts. It does make me feel a bit better knowing that if there are any changes then they will be picked up early, but is there evidence that Switzerland and Germany have lower cancer rates?
Dr Caitlin Palframan: It is not clear whether regular breast examinations carried out by a doctor or nurse (clinical breast examination) are effective in reducing breast cancer mortality. In the UK, clinical breast examination is not recommended - instead women should be breast aware, knowing what is normal for them so they can spot any unusual changes. No one knows your body better than you.
Female breast cancer incidence rates vary considerably, with the highest rates in Europe and the lowest rates in Africa and Asia. There is a slight difference in incidence and mortality rates between the UK and Germany. According to 2008 estimates from Cancer Research UK, Germany had a breast cancer incidence rate of 110.1 women per 100,000 developing breast cancer with a mortality rate of 24.5. The UK had an incidence rate of 119.1 women per 100,000 with a mortality rate of 27. Unfortunately we do not have statistics for Switzerland regarding incidence and mortality.
It is important to remember that the difference in incidence and mortality rates could be due to several factors, including different lifestyles and diets as well as differences in breast awareness, screening and treatment. In addition, different countries collect data in slightly different ways which makes it difficult to compare across countries.
We have made every effort to ensure that the content of these answers is accurate and up to date, but we accept no liability in relation to typographical errors or third-party information. Please be aware that the responses from the Breast Cancer Care and Breakthrough Breast Cancer teams are not a substitute for professional medical care. If you have any concerns about your breast health or any treatment you are receiving you should discuss these with your doctor. Responses from Breast Cancer Care and Breakthrough Breast Cancer are only accurate at the time of posting as medical knowledge and treatment can change over time.