Screening for Breast Cancer

Breast cancer is the most common cancer among women in the world. In Singapore, 2,000 women are diagnosed with breast cancer every year. Early detection through screening, however, can improve the chances of survival. Breast cancer that’s found early, is easier to treat successfully. Getting regular screening tests is the most reliable way to find breast cancer early. In general, screening tests include:

Breast Self-Examination (BSE)

A breast self-examination (BSE) is a way to examine your breasts on a regular basis to look for any changes. Examining your breasts on your own regularly is an important step you can take to detect breast cancer early. The purpose of BSE is to enable you to become familiar with the normal feel of your breast tissue so that you can recognise any abnormal changes.

BSE should be done once each month by women 20 years and older. The best time to do BSE is 7-10 days after the start of menses, when the breasts are least tender. If you no longer menstruate, do BSE on a fixed date every month, for example the first day of each month.

Clinical Breast Examination

Have a doctor or breast specialist nurse examine your breasts once every year if you are 40 years and above. This includes a visual examination and a manual check of the entire breast and underarm area for changes. Changes in the breast may not be due to cancer and diagnostic tests may be performed to assess these changes.

Mammogram Screening

This is the most common and primary screening tool for detecting breast cancer. It detects changes such as abnormal densities or calcium deposits in the breasts.

In a mammogram, low-dose X-rays are used to create images of the breast. The radiographer will position each breast in the mammography unit and compress it for a few seconds to take different views of each breast.

Women above 40 years old should go for a mammogram every year, while those above 50 years old should do it every two years.

Depending on the mammogram results, the doctor may recommend further tests such as breast ultrasound, tomosynthesis and MRI for further evaluation.

Breast Ultrasound

An ultrasound scan is a supplemental test for women with very dense breasts, which make it difficult for a mammogram to detect small abnormalities. When done in addition to a mammogram and breast self-examination, it can help the doctor decide if more tests such as a biopsy is needed.

Ultrasound scans use high-frequency sound waves to at the inside of your breast. A gel is put on the skin of the breast, followed by moving a small hand-held probe across the breasts to produce detailed images of the inside of the breasts.

Women above 40 years old can do both a mammogram and ultrasound scan as part of their annual screening. Those above 50 can include an ultrasound scan during their two-yearly mammography screening.

Breast MRI

MRI (magnetic resonance imaging) is a scan that is usually used in further evaluation of patients who have been diagnosed with breast cancer.

MRI uses radio waves and strong magnets to make detailed, cross-sectional pictures of the breast.

Breast MRI can only be recommended by doctors after determining if the woman is at high risk for breast cancer (either because of a very strong family history or a gene abnormality).

3D Mammography (Breast Tomosynthesis)

3D mammography, or breast tomosynthesis, is an advanced form of mammography. This newer type of mammogram, is an imaging test that combines multiple breast X-rays to create a three-dimensional picture of the breast.

Traditional mammography obtains just a single image. 3D mammography produces more images. These multiple images of breast tissue slices give doctors a clearer image of breast masses. It makes it easier to detect breast cancer. Some studies have shown 3D mammography may find a few more breast cancers than 2D mammography.

Screening Recommendations:

When and what

If you are…

39 years old and below:

• Monthly breast self-examination

 40-49 years old:

• Monthly breast self-examination
• Annual screening mammography

50 years old and above:

• Monthly breast self-examination
• Two yearly screening mammography