According to the current UK guidelines for breast cancer screening, mammography is recommended for all women between 50 and 71 years old, every 3 years. Some areas increase the age range to 47 to 73 years old. Breast cancer risk increases with age, however, it can be useful to speak to a breast specialist at a younger age. Prof Zoe Winters, Consultant Breast Surgeon at New Victoria Hospital, talks about the importance of early diagnosis and the benefits of our One-Stop Breast Clinic.
The importance of breast cancer prevention
Breast cancer prevention is a goal that all doctors and nurse practitioners in the field aspire towards. It starts with clear communication on personal breast awareness and breast self-examination and is also based on how soon and how often women should have mammograms and /or ultrasound (US).
We now have the benefits of digitally enhanced mammograms, including 3-D tomosynthesis. Doppler-assisted breast ultrasound (US) that measures increased blood flow in a specific lump or area of the breast may also increase interpretative accuracy. US is
used to guide needle tissue biopsies, to accurately confirm the correct diagnosis of any breast lump.
When is it a good time to have mammograms?
There is no consensus worldwide on how soon and how often women should have mammograms.
The benefits of mammogram screening in women in their forties have recently been reported by the UK Age trial. The study randomly invited women from 39/40 to 48 years of age to have yearly screening mammograms (group of 53,000). This test group was compared to a standard care group undergoing mammograms from 50 years of age and repeated every 3 years (group of 162,000).
At 10 years, there were less breast cancer deaths in the early screening mammogram test group (83), compared to 219 in the standard of care 50-year-old plus group. This amounted to a significant or 25% reduction in breast cancer deaths.
Other European countries and the USA have practised screening mammograms from either 40 or 45-years of age every year.
Why UK guidelines recommend breast cancer screening for women over 50 only?
In the UK, the National Screening Committee and the NHSBSP Publication No 49 set the national Breast Cancer screening guidelines.
Breast cancer incidence peaks between 50 and 70 years of age. The wider the age range, the greater the chances to incur an overdiagnosis, where women are more likely to be diagnosed with benign, harmless forms of cancer.
High-intensity international screening programs showed that after 25 years of follow-up, >50% of mammogram-detected small cancers were over-diagnosed. This means an early diagnosis of a cancer that would not otherwise have shortened that woman’s survival.
However, could these improved breast cancer death rates be the results of much improved current breast cancer medical/drug treatments rather than early mammogram screening?
Overdiagnosis can have a negative impact on women’s mental wellbeing and potentially discourage them from participating in further screenings in the future.
Although it is important to know that breast imaging examination can’t distinguish between harmful and benign types of cancer, this is the only and most efficient tool for early diagnosis.
Knowing your breasts is the first step towards early diagnosis
The Breast Cancer Now online publications website is an excellent source of patient information that clarifies key changes that every woman should be aware of and alerted to when examining their breasts.
Breast cancer symptoms you should pay attention to
Women should be aware of any changes to either of their breasts, however small it may seem. This may be a change in the shape or size of the breast and/or the nipple. Any concern about a persistent lump is important.
Many of these concerns do not automatically mean that there is breast disease, but the latter can only be ruled out through a specialist examination and breast imaging such as mammograms and/or ultrasound.
Other concerns that should be investigated are:
- breast pain
- nipple discharge
- nipple rashes
- permanent nipple indentation
- breast skin dimpling
Not all the changes are a sign of cancer
The breasts develop from two separate milk duct lines, and therefore a “normal asymmetry” is possible in terms of their shape, size and amounts of breast tissue.
Most breast lumps are not disease, but relate to normal breast tissue that is asymmetrical with unequal distributions of breast tissue that is not “a smooth surface under the skin”.
The latter results in the sense of a lump, whereby you may be feeling normal tissue.
Neither cysts, nor breast pain are risk factors for breast cancer in over 95% of cases but should still be investigated at a One -Stop Breast Clinic.
How does the One-Stop Breast Clinic work?
Most normal lumps are fluid-filled cavities called cysts that occur based on normal ageing of the breast milk ducts or tubules draining the breast milk sacs or terminal lobules.
Any solid breast lump usually requires a tissue biopsy to determine its diagnosis.
Women of any age who are concerned about their breasts can contact our One-Stop rapid diagnosis Breast Clinic.
This is how the One-Stop Breast Clinic works:
- Step 1 – Specialist Consultation
If you are concerned about any changes in your breasts or have risk factors, you can book an Outpatient appointment with a Breast Surgeon at New Victoria Hospital. The specialist will listen to your concerns, ask questions about your lifestyle, family history, and assess your case.
- Step 2 – Appropriate examination
After a clinical breast exam, if there is any suspicion of tissue abnormalities, these cases are acted upon immediately. Your Consultant Breast Surgeon will book the appropriate Imaging exams to further investigate your case.
- Step 3 – Tissue biopsy
On the same day of your Imaging examination, you can be offered a tissue biopsy. This is a non-invasive procedure to collect a sample of your breast tissue with a needle, for a precise diagnosis.
- Step 4 – Results
Results from a tissue biopsy may take up to 72 hours as they are discussed within a dedicated multi-disciplinary team meeting, comprising radiologists, pathologists, surgeons, and oncologists. You will be reassured and guided
through the treatment options.
The benefits of the One-Stop Breast Clinic
Many women find One-Stop Breast Clinics very beneficial.
A new randomised trial in the USA called the WISDOM study that stands for “Women Informed to Screen Depending on Measures of Risk” is a study that is often shared with many women in One-Stop Breast Clinics.
This trial uses a personalised breast cancer risk score in the past 5 years. This score is based on age, race, affected first degree relatives, prior breast biopsies, proliferative breast conditions with atypia (abnormal cells), breast density score assessed using a BI-RADS and genomics (high/moderate penetrance genes) and 96 polygenic risk score (lower risk common genetic variants).
The rapid diagnosis One-Stop Breast Clinic aims to provide results at the same time as the consult in over 95% of patients.
The One-Stop Breast Clinic:
- facilitates a referral to a specialist consultant clinical geneticist
- provides you detailed information sheets on “Genes and Families” (Breast Cancer Now publications, ref 4) that gives you a clearer idea on gene risk factors
- gives you peace of mind sooner with a fast diagnosis process
When you should have your breast checked by a specialist
Although the current UK guidelines suggest mammography screening for women over 50, there are many cases where a breast examination either through a Consultation, an ultrasound scan or mammography can give you peace of mind.
You should consider visiting the One-Stop Breast Clinic if:
- You have a family history of breast cancer and/or ovarian cancer
- You are concerned about a change in the skin or tissue texture of your breasts
- You have done a genetic test before 2014, as more in-depth, specific gene testing is available
- You want to avoid long waiting times for your results
If you have noticed any recent changes in your breast or are concerned about any risk factor for breast cancer, you can book an appointment with our Consultant Breast Surgeons at New Victoria Hospital’s One-Stop Breast Clinic by calling us on 020 8949 9020 or:
