Regular breast cancer screening and self-examination helps your chances of survival

December 12, 2022

The prevalence of breast cancer is expected to cause more than 2.5 million deaths between 2020 and 2040, if nothing is done to avert it – the World Health Organisation (WHO) has suggested that reducing global breast cancer mortality by 2.5% annually could prevent at least 25% of breast cancer deaths by 2030 and 40% by 2040 among women under 70 years of age. One of the initiatives proposed by WHO includes early detection for breast cancer.

In an interview with Singapore-based Dr. Rameysh Danovani, Consultant Radiologist and Medical Director, Specialist Women’s Imaging, explains the significance of early detection and how the screening process might proceed.

HCA: Missed screenings for breast cancer are increasingly common; can you give an overview of breast cancer and common oversights that lead to missed screenings?

Data from many countries and WHO indicate that breast cancer remains the number one cancer affecting women, and at the same time, survival rates from early-stage breast cancer is high. According to 2019-2020 data published by the American Cancer Society, the overall 5-year survival is as high as 99%, provided that the cancer is detected at an early stage and localised to the breasts.

However, if the cancerous cells have spread or metastasised to other body parts, the reported survival rate can be as low as 27%.

Factors that contribute towards missed screenings are multifactorial, although for the most part, it boils down to the need to educate the general public, as the lack of awareness, misinformation and misconceptions regarding mammography screening for breast cancer remains a key driving factor. Cultural predisposition and mental unreadiness to face possible abnormal screening results are also common factors seen in clinical practice.

Moreover, a recently published whitepaper titled, “Barriers to breast cancer screening in Singapore,” which included authors from the Health Promotion Board, Singapore and Saw Swee Hock School of Public Health, highlighted several key barriers impede the uptake rate of breast cancer screening. For example, the fear of the breast cancer screening process and outcomes, as well as low perceived susceptibility to breast cancer.

The literature review also stated that “I’m healthy” and “I’m not at risk” were commonly cited as reasons for avoiding breast cancer screening among women.

The whitepaper can be accessed here: Barriers to breast cancer screening in Singapore

HCA: How can early detection be helpful?

Early detection means detecting cancerous cells at an early stage, which are usually small in size and localised to the breasts even before they are large enough to cause significant harm to the patient. When the disease is localised to the breasts, treatment options can be more targeted and hence effective, with a higher chance of eliminating as much cancer as compared to large tumours or those that have already spread to other parts of the body.

When more cancer cells are eliminated, patients stand a better chance at survival and there is a higher possibility that their breasts could be saved. Hence, early detection could improve survival rates for breast cancer patients.

HCA: How does the screening process proceed?

Currently, mammography has been the modality proven to increase the chances of survival for patients with breast cancer, which can be as high as 40%. This, along with the factors mentioned above have led to the implementation of national breast screening programs currently ongoing in many countries including Singapore. Our breast screening programme provides screening mammography to women aged 40 and above (yearly for those aged 40 to 49, and once every two years for those aged 50 to 70).

Women eligible for this breast screening programme could approach the polyclinics for their mammograms, or they could have a consultation with their family physicians or breast surgeons of choice who would refer them to the relevant imaging centres. It is also common practice to add ultrasound to the mammograms to maximise the chance of detecting cancers cells, as high breast density is a common problem amongst the Asian population.

Aside from that, the screening process is generally straightforward and seamless. An experienced mammography centre would be able to guide women on how they can prepare themselves before the appointment, and this includes removal of jewelries that may obscure parts of the breasts.

During the imaging process itself, the breasts are gently compressed in order to provide stable imaging focal point which would optimise the diagnostic quality of the images obtained. With modern mammography equipment, the imaging process should only last for a few seconds for each of the views performed and should not result in lasting discomfort. Once completed, the radiologists will review these images, and the decision will be made for additional views if necessary.

HCA: Is screening dangerous or painful?

Screening mammography is neither dangerous nor painful. Modern machines utilise very low radiation dosages and are able to obtain highly diagnostic images. The amount of radiation exposed only amounts to approximately 4 to 6 months of background natural radiation, and examinations such as CT scan would routinely deliver higher radiation dosages in comparison to mammogram.

The compression of the breasts during mammography examinations are also safe, even for patients with breast implants. While there are patients who experience discomfort during mammograms, majority of them do not, and are well tolerated by most patients.

HCA: Can a patient check themselves regularly? If so, how?

Women are advised to routinely examine their own breasts by performing a breast self-examination (BSE) monthly, so that signs of breast cancer can be detected early and brought to medical attention even before their next screening test is due. This is because mammograms are not recommended to be performed more than once a year, and cancer can still develop in the interim. There is an abundance of resources available online, as well as from medical professionals and organisations like the Breast Cancer Foundation, that can guide women on how to perform BSE correctly.

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