Breast Cancer Screenings

Overview

Breast cancer screening means having a test to look for signs of breast cancer before you notice any symptoms. The most common screening test is a mammogram — a low-dose X-ray picture of the breast. Screening is not the same as diagnosis: it can find changes that need a closer look, but most of those changes turn out not to be cancer. The aim is to catch any cancer early, when treatment tends to work best.

Breast cancer is the most common cancer in women worldwide, and screening programmes are offered in many countries. Being invited for screening is a normal, routine part of healthcare for millions of women every year.

Screening is mainly offered to women, because breast cancer is far more common in women than in men. Risk rises with age, which is why most programmes start around age 50. Breast cancer can also affect men, transgender and non-binary people, and people with a strong family history may be offered screening at a younger age. If you are unsure whether screening applies to you, your doctor or local screening service can advise.

Symptoms

Common symptoms

• Screening itself has no symptoms — it is done when you feel well. The symptoms below are the breast changes that matter if you notice them between screenings:
• A new lump or thickening in the breast or armpit
• A change in the size, shape or feel of one breast
• Dimpling, puckering or a rash on the skin of the breast
• The nipple turning inwards, changing shape, or developing a rash or crusting
• Fluid leaking from the nipple (especially if it is blood-stained)
• Swelling, redness or warmth of the whole breast
• Pain in one breast or armpit that does not go away

Symptoms in children

• Breast cancer is extremely rare in children and teenagers.
• Breast changes in children and teenagers are usually a normal part of puberty — for example, small tender buds under the nipple, or slight unevenness between the two sides.
• If a child has a firm lump, unusual discharge or one-sided swelling, it is still worth asking a doctor, mainly for reassurance.

Symptoms in older adults

• Risk of breast cancer increases with age, and screening programmes usually continue into the early 70s.
• In the UK, women over 71 are not invited automatically but can request screening by contacting their local screening service.
• Older adults may notice lumps less easily, so being breast aware — knowing what is normal for you — remains important.
• Other health conditions may need to be weighed up when deciding whether screening is right for you; this is a good conversation to have with your doctor.

Causes

Main causes

• Breast cancer happens when cells in the breast start to grow and divide in an uncontrolled way. This is usually caused by changes (mutations) in the genes that control how cells grow.
• Most of these gene changes happen during a person's lifetime and are not inherited.
• A small proportion of breast cancers are linked to inherited gene changes, such as faults in the BRCA1 or BRCA2 genes, which can run in families.
• Hormones such as oestrogen can influence breast cell growth over many years, which is one reason why factors linked to lifetime hormone exposure affect risk.

Risk factors

• Being female — the biggest single risk factor
• Getting older — risk rises steadily with age
• A close relative (mother, sister, daughter) with breast or ovarian cancer, especially at a young age
• Inherited gene changes such as BRCA1 or BRCA2
• Starting periods early or going through the menopause late
• Not having children, or having a first child after age 30
• Taking hormone replacement therapy (HRT) for several years
• Drinking alcohol regularly
• Being overweight or obese, especially after the menopause
• Previously having breast cancer, or certain non-cancerous breast changes
• Past radiotherapy to the chest, for example for another cancer

When to see a doctor

See a doctor urgently if:

• You have found a new lump or thickening in your breast or armpit
• Your breast looks red, swollen or feels hot, or you have a fever
• There is blood-stained discharge from your nipple
• A nipple has turned inwards or changed shape recently
• The skin of your breast is dimpled, puckered or has a new rash

Book a routine appointment if:

• You have been invited for breast screening — book your appointment
• You have a family history of breast or ovarian cancer and want to talk about your risk
• You are over the screening age range and would like to request a mammogram
• You have questions about breast awareness or how to check your breasts
• You notice a change that has been there a while and is not going away

Diagnosis

Screening and diagnosis are two separate steps. A screening mammogram looks for changes in people without symptoms. If something needs a closer look, you will be invited to a breast clinic for further tests, which together confirm whether a change is cancer or something harmless. Being called back after screening is common and does not mean you have cancer.

Tests that may be done

• Mammogram — a low-dose X-ray of the breast, taken standing at a machine with the breast briefly pressed between two plates
• Clinical breast examination — a doctor or nurse feels the breasts and armpits
• Breast ultrasound — a painless scan using sound waves, often used for younger people or for lumps found by touch
• Biopsy — a small sample of tissue taken with a fine needle or a slightly larger needle, then checked under a microscope. Local anaesthetic is used so it should not hurt
• Further imaging such as MRI, in some situations
• Blood tests and other tests if cancer is found, to plan treatment

What to expect at your appointment

A screening appointment usually takes about 20 to 30 minutes, and the mammogram itself only a few minutes. You will need to undress from the waist up and will be given a gown. The pressure of the plates can feel uncomfortable for a few seconds but is not usually painful. If you are called back, the breast clinic visit may take a couple of hours, and you will often get some results the same day. Waiting for results can feel anxious — it can help to bring someone with you and to write down any questions beforehand.

Treatment

If a change turns out to be cancer, treatment is planned by a team of specialists and depends on the type of breast cancer, its size, whether it has spread, and your preferences. Treatment for early breast cancer is often very successful. Your team will explain the options clearly and involve you in decisions.

Self-care at home

• Go to your screening appointments and any follow-up visits
• Keep a simple note of questions, symptoms and side effects to discuss with your team
• Be gentle with yourself — rest when you need to, and accept offers of practical help
• Stay active in ways that feel manageable; gentle walking and stretching can help with tiredness and mood
• Ask your pharmacist or specialist nurse before taking any new medicines, supplements or herbal remedies
• Look after your skin during radiotherapy or after surgery as your team advises

Medical treatments

Treatment may include one or more of the following, depending on your situation: surgery to remove the cancer; radiotherapy, which uses targeted X-rays to kill cancer cells and reduce the chance of return; chemotherapy, which uses medicines to destroy cancer cells throughout the body; hormone therapy, which blocks the effect of hormones that some breast cancers need to grow; targeted therapy, which attacks specific features of cancer cells; and immunotherapy, which helps the immune system fight cancer. Your specialist team will explain which approaches suit you, their likely benefits and side effects, and how long treatment is expected to last.

When is surgery considered?

Surgery is very often part of treatment for early breast cancer. It may mean removing just the cancer with a margin of healthy tissue (breast-conserving surgery), usually followed by radiotherapy, or removing the whole breast (mastectomy), which may be followed by breast reconstruction. Surgery may also be used to check or remove lymph nodes under the arm. Sometimes chemotherapy is given before surgery to shrink a larger cancer first. Your team will discuss the pros and cons of each option with you.

Living with this condition

Living through screening, tests or treatment takes up time and energy. Many people find it helps to plan around appointments, keep a calendar, and let family, friends or employers know what support you might need. Side effects vary a lot from person to person, and your team can usually offer ways to manage them — so do speak up rather than put up with things.

Lifestyle tips

• Keep physically active within what feels comfortable for you
• Eat a varied, balanced diet with plenty of vegetables, fruit and fibre
• Limit alcohol, and avoid smoking or ask for help to stop
• Try to keep to a healthy weight for you
• Prioritise sleep and rest, especially during treatment
• Stay connected with people you trust, and make time for things you enjoy
• Check your breasts regularly so you know what is normal for you

Diet and exercise

There is no single diet that treats or prevents breast cancer coming back, but eating well and moving more can help you feel better, manage tiredness and support your overall health. Aim for a balanced plate most days, drink enough water, and build up activity gradually — a short daily walk is a good start. If treatment has affected your appetite, your specialist team or a dietitian can give practical advice.

Mental health and emotional wellbeing

Being diagnosed with cancer, or even just waiting for screening results, can bring worry, low mood, sleep problems and a sense that life has been turned upside down. These feelings are very common and are not a sign of weakness. Talking to a counsellor, specialist nurse or psychologist can genuinely help, as can peer support from others who have been through similar experiences. If you ever feel unable to cope or have thoughts of harming yourself, please reach out for help right away — contact your local emergency number or a crisis support line in your country, and tell someone you trust how you are feeling.

Prevention

Breast cancer cannot be completely prevented, and it is not anyone's fault if it happens. However, some healthy habits can lower your risk: limiting alcohol, staying active, keeping to a healthy weight, and not smoking. If you have a strong family history or an inherited gene change, you may be offered extra screening, risk-reducing medicines or a discussion about risk-reducing surgery — this is a specialist conversation to have with your doctor.

Vaccines

There is currently no vaccine that prevents breast cancer. Vaccines are available for some other cancers, such as cervical cancer and some liver cancers, but these are different diseases.

Screening programmes

Screening aims to find breast cancer early, when treatment is more likely to be simpler and more successful. In the UK, the NHS Breast Screening Programme invites women aged 50 to 71 for a mammogram every three years, and women over 71 can request one. Some people at higher risk due to family history are offered screening earlier or more often. In other countries, the age range and how often you are invited may differ — check with your local health service. Screening has benefits and also some downsides, such as false alarms and overdiagnosis (finding a slow-growing change that would never have caused harm), so it is reasonable to discuss any questions with your doctor.

Complications

If left untreated

• A breast cancer that is not treated can grow larger within the breast and spread to lymph nodes under the arm
• It can spread to other parts of the body, such as the bones, lungs or liver, which is harder to treat
• Advanced cancer can cause pain, tiredness, breathlessness and other symptoms that affect daily life
• There is also the emotional strain of living with an untreated or advanced illness

Long-term outlook

The outlook for breast cancer has improved a great deal over recent decades. When breast cancer is found early — which is exactly what screening is designed to do — most people live long, full lives after treatment. Survival rates in countries with established screening and treatment programmes are among the best of any cancer. Every person's situation is different, so your specialist team is the best source of information about your own outlook.

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