Ask the doctor: I’m confused about breast cancer screening

Dear Doctor,

I am approaching 40 years and gearing up for regular breast cancer screening. I have, however, come across conflicting recommendations about when to start screening and how often. Please advise me.

Answer:

Your concern about recommendations for breast cancer screening is very relevant. And it’s true that in recent past, various professional bodies have given somewhat different opinions on the timing of breast cancer screening. What is not in doubt is that some sort of screening is advisable.

There is debate about the age for commencing breast cancer screening. The ages of 40 years, 45 years and even 50 years have been suggested. We are talking here about routine screening for those without symptoms, and those who do not fall into special categories of higher risks for breast cancer. Beyond the age of commencing screening, there is also the question of how often to screen. Is it every year, every two years, or even longer intervals?

Assuming you fall into the average risk category, what you need is an individualised approach to your screening. A session with your family physician, or a breast disease specialist will help guide decisions. A review of your individual risk factors should be carried out, and relevant advice given on risk reduction. You should then discuss the pros and cons of screening. Your physician should help with the interpretation of current differing guidelines. Once you reach a common understanding, making a decision on when to start your screening, and how often, should be easy.

There are women at higher risks of breast cancer, and their approach to screening is entirely different. There may be a familial history of early onset of breast cancer, or even an already identified genetic predisposition. In such cases the onset of screening may be advised earlier, with more frequent screening intervals. Continued screening must be balanced against pre-emptive surgical treatment once a pre-determined age is attained.

Once you agree on a screening schedule, do your best to adhere to it. But any schedule must be reviewed regularly as your circumstances may change over time. As new knowledge accumulates, recommendations on your screening may also change. Nothing about screening is cast in stone.

The ultimate aim of breast cancer screening is to reduce the number of women dying from breast cancer. But in addition to screening, you can take several steps to reduce your own risks of getting afflicted. Your lifestyle plays a big role. Stop smoking, cut down your alcohol intake, and maintain a normal weight with healthy eating habits combined with physical activities. Know your breasts and get anything unusual checked in good time, regardless of your screening interval. 

Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist. You can reach him via [email protected]