• N-Houssami

Screening and detection

Early detection of breast cancer saves lives. Detecting any abnormalities early on ensures that women have all treatment options available to them. The earlier breast cancer is found, the better the chance of surviving it.

In Australia, free routine mammographic screening is available through BreastScreen Australia services in each state for women aged 50 to 74 years old.  Women 40 to 49 years old can also have mammography, but breast screening is less effective because the density (thickness) of breast tissue makes it more difficult to see a cancer in the x-ray and fewer women are diagnosed in this age group.

This service is not offered to women under the age of 40 because research suggests that younger women do not benefit from routine mammographic screening because they have denser breast tissue than older women. It is also not offered to men due to their lack of breast tissue.

All women are encouraged to be ‘breast aware’ – that is, familiar with the normal look and feel of their breasts. If a woman does find a suspicious breast change, her GP will refer her to imaging tests to confirm the presence of the change. If the imaging results appear suspicious, she will be referred for a biopsy for confirmation and diagnosis.

Different types of screening and detection

Clinical examination – A clinical breast examination involves a thorough physical examination of the whole breast area, including both breasts, nipples, armpits and up to the collarbone. The doctor will also ask about the woman’s personal and family history of breast cancer and whether she has any symptoms.

Mammograms – A mammogram is an x-ray picture of the breast. Mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease on a regular basis. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-ray pictures, or images, of each breast that are analysed by a radiographer for evidence of tumours.

Magnetic Resonance Imaging (MRI) – This is a way of producing an image of the inside of the body using magnetic fields. Women under 50 years who are at high risk of breast cancer are eligible for routine screening with MRI under Medicare. To access this screening service, younger women must be referred by a GP or specialist.

Ultrasound – This method uses sound waves to outline a part of the body. A breast ultrasound is used to see whether a breast lump is filled with fluid (a cyst) or if it is a solid lump. An ultrasound does not replace the need for a mammogram, but it is often used to check abnormal results from a mammogram.

Biopsy – A biopsy is the removal of a small sample of tissue from the breast or lymph nodes, for examination under a microscope. Analysis by a pathologist will help diagnose both the presence of breast cancer and its type which will help determine the appropriate treatment plan.

How research can help

With detection being a major factor in preventing deaths from breast cancer, researchers are working on more effective methods to detect the initial development of breast cancer, and also ways of monitoring and detecting when breast cancer returns and spreads to other parts of the body.

Liquid biopsies / blood tests – Researchers know that tumour cells release circulating DNA (ctDNA) into the blood, which would make a liquid biopsy (blood sample) a cost-effective and less invasive diagnostic and prognostic tool for determining if cancer has moved beyond the primary site and is spreading to other parts of the body through the blood. This is still a work in progress, and NBCF funds Prof Kirill Alexandrov who is developing a blood test that can be read at home on a smartphone.

3D mammography / tomosynthesis – 3D mammography, also known as breast tomosynthesis, is a type of digital mammography in which x-ray machines are used to take pictures of thin slices of the breast from different angles and computer software is used to reconstruct an image. It is not yet determined whether 3D mammography is more effective in reducing deaths between check-ups and avoiding false positive results. NBCF is funding a project which will provide the data that will underpin approval for 3D mammography to be included in the national breast screening program.

Double reading mammograms – NBCF funds a trial program that aims to improve the accuracy of mammogram reading by ensuring that a mammogram scan is always read twice to pick up any errors – this helps to avoid false positives and is seeing good results so far.

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