This position statement applies to the early detection of breast cancer in asymptomatic women (women without breast changes). The statement does not apply to diagnostic tests used to assess individual women presenting with breast changes.
Summary of recommendations
- It is recommended that women of all ages, and regardless of whether they attend mammographic screening, are aware of how their breasts normally look and feel and report any new or unusual changes promptly to their general practitioner.
- No one method for women to use when checking their breasts is recommended over another.
- It is recommended to reduce the risk of death due to breast cancer that women aged 50–74 years attend the BreastScreen Australia Program for free two-yearly screening mammograms having considered the benefits and downsides.
- Mammographic screening is not recommended for women younger than 40 years of age.
- Women aged 40–49 years and 75 years and over are eligible to receive free screening mammograms through the BreastScreen Australia Program but they do not receive an invitation to attend. In deciding whether to attend for screening mammography, women in these age groups should balance the potential benefits and downsides for them.
- For women of all ages who are at increased risk† of developing breast cancer it is recommended that an individualised surveillance program be developed in consultation with the woman’s general practitioner and/or specialist.
It is important that women of all ages understand the importance of finding and treating breast cancer early. Detection of breast cancer while it is still small and confined to the breast provides the best chance of effective treatment for women with the disease.1, 2 Benefits of early detection include increased survival, increased treatment options and improved quality of life. For women, increasing age is one of the strongest risk factors for breast cancer with about 75% of cases found in women aged 50 years and older.3, 4 However, in younger women, tumours are likely to be larger and more aggressive and overall survival is lower than for older women with the disease.4-6
The early detection methods covered by this position statement are:
- breast awareness – awareness by a woman of the normal look and feel of her breasts
- clinical breast examination – physical examination of an asymptomatic woman’s breasts by a medical or allied health professional
- screening mammography – use of mammography in asymptomatic women to detect breast cancer at an early stage (BreastScreen Australia is the national mammographic screening program).
The position statement has two sections – a review of evidence to date about the benefits of these methods in reducing mortality from breast cancer, and recommendations based on this evidence. Recommendations are made for women of different ages who are at population risk* and for women of all ages who are at increased risk† of developing breast cancer. In making the recommendations, Cancer Australia considered the importance of translating population-based evidence into messages that are relevant for individual women.
References
- Centers for Disease Control and Prevention. The National Breast and Cervical Cancer Early Detection Program - Reducing Mortality Through Screening. Atlanta, 2004.
- Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53 (3):141-69
- National Breast and Ovarian Cancer Centre. Breast cancer risk factors: a review of the evidence. Surry Hills, NSW, 2009.
- Australian Institute of Health and Welfare & Cancer Australia. Breast cancer in Australia: an overview. Cancer series no. 71. Cat. no. CAN 67. AIHW Canberra, 2012.
- Adami H, Malker B and Holmberg L. The relation between survival and age at diagnosis in breast cancer. N Engl J Med 1986;315 (9):559–63
- Host H and Lund E. Age as a prognostic factor in breast cancer. Cancer. 1986;57 (11):2217-2221
- Hill D, Jamrozik K, White V, et al. Surgical management of breast cancer in Australia in 1995. NHMRC National Breast Cancer Centre,Sydney, 1999.
- Hackshaw AK and Paul EA. Breast self-examination and death from breast cancer: a meta-analysis. Br J Cancer. 2003;88 (7):1047-53
- Humphrey LL, Helfand M, Chan BKS and Woolf SH. Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137 (5 Part 1):347-360
- Kösters J GP. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews. Issue 2. 2003;(Art. No.: CD003373 ):DOI: 10.1002/14651858.CD003373.
- Semiglazov VF, Manikhas AG and Moiseenko VM. Results of a prospective randomized investigation [Russia (St.Petersburg)/WHO] to evaluate the significance of self-examination for the early detection of breast cancer. Vopr Onkol. 2003;49 (4):434-41
- Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002;94 (19):1445-57
- UK Trial of Early Detection of Breast Cancer Group. 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet. 1999;353 (9168):1909-14
- Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med. 2015;372 (24):2353-8
- Barton MB, Harris R and Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 1999;282 (13):1270-80
- Mittra I, Mishra GA, Singh S, et al. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after 3 rounds of screening. Int J Cancer. 2010;126 976-984
- Sankaranarayanan R, Ramadas K, Thara S, et al. Clinical Breast Examination: Preliminary Results from a Cluster Randomized Controlled Trial in India. J Natl Cancer Inst. 2011;103 1-5
- Boulos S, Gadallah M, Neguib S, et al. Breast screening in the emerging world: high prevalence of breast cancer in Cairo. Breast. 2005;14 (5):340-6
- International Agency for Research on Cancer. Breast Cancer Screening. World Health Organization,Lyon, 2002.
- Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography. Ann Intern Med. 2003;138 (3):168-175
- Coates RJ, Uhler RJ, Brogan DJ, et al. Patterns and predictors of the breast cancer detection methods in women under 45 years of age (United States). Cancer Causes Control. 2001;12 (5):431-42
- Johnstone PA, Moore EM, Carrillo R and Goepfert CJ. Yield of mammography in selected patients age < or = 30 years. Cancer. 2001;91 (6):1075-8
- Cancer Australia. Position statement on overdiagnosis from mammographic screening. Accessed: August 2015.
- National Breast Cancer Centre. Screening women aged 40-49 years: A summary of the evidence for health professionals. Sydney, 1998.
- Irwig L GP, Barratt A, Salkeld G. Review of the evidence about the value of mammographic screening in 40-49 year old women. NBCC,Woolloomooloo, 1997.
- Ashley S, Royle GT, Corder A, et al. Clinical, radiological and cytological diagnosis of breast cancer in young women. Br J Surg. 1989;76 (8):835-7
- Bender HG, Schnurch HG and Beck L. Breast cancer detection: age-related significance of findings on physical exam and mammography. Gynecol Oncol. 1988;31 (1):166-75
- Bennett IC, Freitas R, Jr. and Fentiman IS. Diagnosis of breast cancer in young women. Aust N Z J Surg. 1991;61 (4):284-9
- Tabar L, Duffy SW and Burhenne LW. New Swedish breast cancer detection results for women aged 40-49. Cancer. 1993;72 (4 Suppl):1437-48
- Tabar L, Fagerberg G, Duffy SW, et al. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am. 1992;30 (1):187-210
- Cancer Australia. Position Statement on use of thermography to detect breast cancer. Accessed: August 2015.
- BreastScreen Australia. BreastScreen and You. Accessed: August 2015.
- Australian Government Department of Health. BreastScreen Australia. Accessed: August 2015.
- Cancer Australia. MRI for high risk women. Accessed: August 2015.
- Cancer Australia. Advice about familial aspects of breast cancer and epithelial ovarian cancer: A guide for health professionals. Accessed: August 2015.