Breast cancer screening: when should I start and how?


Breast cancer is the most prevalent type of cancer in the world. Not only do the tests detect more than 2 million new cases each year, but an estimated 600,000 women die from breast cancer and its complications.

The point that many health systems around the world do not realize is that early detection can dramatically reduce mortality rates and make conservative breast surgery (BCS) possible instead of complete mastectomies. In addition, if the cancer is diagnosed before it spreads to other parts of the body and remains restricted to the breast only, the five-year life expectancy skyrockets to more than 90%.

Considering these statistics, starting screening practices at an early age has never been more important. All the different orientations and approaches may seem overwhelming, but experts converge on one point: it is always better to make mistakes in advance.

Here’s what you should do every decade and in between, with the advice of the specialist radiology professor Füsun Taşkın.

In her 20s

Although self-examination is not technically a screening for breast cancer, most cases are diagnosed thanks to the fact that women notice new developing masses or visual irregularities during self-examination. Therefore, Taşkın recommends that women check their breasts to see if there is anything out of the ordinary once a month, one week after the end of menstruation. These regular self-checks should begin in adolescence or, at the most, at the age of 20, and continue throughout life.

Taşkın warns that, however, self-checks cannot replace mammograms and do not reduce deaths related to breast cancer.

“Even if you don’t detect a palpable mass in your monthly breast exam, regular mammograms after age 40 should never be neglected,” she says, because a mass can mean that things are already too late in some cases.


1 Start by visually examining your breasts. Sit in front of a mirror, without a bra or shirt, and examine your breasts with your eyes. Keep your arms relaxed at your sides.

Looking forward, look for any dimples, wrinkles or changes in size, shape or symmetry. Look back at your nipples and see if you can notice anything new or if they are inverted.

Repeat these steps with your hands pressed to your hips, your arms at your sides, but your torso slightly bent forward, and your arms raised above your head and your palms pressed together. Finally, be sure to check below for changes in symmetry.

2 Now, move on to the tactile part of the exam. Use your hands to examine your breasts.

Lie on your back on a flat surface to help spread the breast tissue in an even layer, facilitating the sensation of lumps and lumps. Using your fingertips, not the tips, start to feel all the breast tissue. Most doctors recommend using the middle three fingers to do this.

Exert different levels of pressure to feel different tissue depths. With your firmer touch, you should be able to feel the tissue closest to the chest wall and ribs. If you are not sure how hard to press, consult your nurse or doctor.

Follow a pattern: some recommend going in circles from the outside in; some prefer to follow a sectional approach and divide the breast into sections, like a pie chart. Start with a light touch and press to feel the deeper layers.

3 – Don’t forget to examine your armpits and collarbones. Start at the collarbone and head towards the nipple. Don’t rush and don’t be in a hurry. Be sure to spend a few minutes examining it.

If you find:

  • A hard lump or knot in your chest or near your armpit
  • Dimples, bumps or ridges on the skin of your chest
  • Changes in nipple shape or discharge
  • Redness, heat, swelling or pain
  • Itching, thickened skin, scales, sores or rashes
  • Bloody nipple discharge

You should immediately contact your doctor, who may recommend additional tests to investigate.

25 years onwards

Whether you have health problems about your breasts or not, and regardless of your medical history, Taşkın recommends that women start visiting specialist polyclinics and their gynecologists for a professional examination from the age of 25.

Under 30 or no matter what age

Breast ultrasound is the first step of action and choice of screening for women under 30 years old, as well as adolescents, with some complaints regarding the breasts.

Taşkın adds that ultrasound is also a reliable method that is used together or as a complement to mammograms from the age of 40.

“Ultrasonography is a highly sensitive method that detects and evaluates massive and non-forming breast cancer. Helps doctors understand the structure and characteristics of the breast tumor. “

Emphasizing that a significant part of breast biopsies are performed under ultrasound guidance, Taşkın states that, as ultrasound does not use ionizing radiation, it can be used safely at any age and even during pregnancy. (Did you know these myths about breast cancer?)

35 years and above

Although magnetic resonance imaging (MRI) is the most sensitive method for detecting breast cancer, it is not often used in cancer screening as the first step in the general population; however, it is the most widely preferred screening method in women considered to be at high risk.

If you are considered to be at high risk for breast cancer, doctors will likely recommend that you start MRI scans at a younger age and MRI scans together with annual mammograms from the age of 35.

Taşkın says that MRIs contribute a lot to the early detection and effective treatment of breast cancer, especially in young women who do not benefit from mammographic screening.

40 years on

Mammography, whose reliability has been scientifically proven, is the “gold standard” in breast cancer screening. Therefore, it is essential that women have an annual mammogram from the age of 40, even if they have no breast complaints. If you have a family history of breast cancer, your doctor may advise you to start it early.

Taşkın says that mammography tests reduce cancer mortality rates by 30%, on average, thanks to early diagnosis.

“Early diagnosis means more effective and timely treatment. Thus, as mortality rates decrease, treatments with fewer side effects and conservative breast surgeries become possible. “

Taşkın also stresses that if mammography is performed for “diagnostic purposes”, that is, in women with health problems or a history of cancer, there is no age limit to start and can even be performed in pregnant or breastfeeding women. (For more information on mammograms, check out this link.)


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