How Should Chinese Women Approach Breast Cancer Screening?

Breast cancer has now become the most common malignant tumor worldwide and is one of the most prevalent cancers among Chinese women, posing a serious threat to their physical and mental health. While significant progress has been made in the treatment and drug development for breast cancer, providing more targeted treatment options for different types of patients and improving survival rates and quality of life, our ultimate goal is to reduce the incidence of breast cancer through screening and prevention. Early detection is crucial for improving treatment outcomes and extending survival times. This article discusses breast cancer screening and how high-risk groups can reduce their risk of developing breast cancer.

When Should Women Start Breast Cancer Screening?

Breast cancer screening involves conducting effective, simple, and economical breast examinations on asymptomatic women to achieve early detection, early diagnosis, and early treatment.

The peak incidence age for breast cancer in Chinese women is between 45 and 54 years, which is about ten years earlier than in Western countries. Therefore, it is recommended that women at average risk begin breast cancer screening at age 40. For high-risk groups, screening may start earlier, before age 40.

There is also an upper age limit for breast cancer screening. Most international guidelines recommend ending screening at 65 to 70 years old. However, since the incidence of breast cancer remains relatively high in older adults, whether to continue screening depends on the individual’s overall health, life expectancy, and the presence of comorbidities. If an individual has multiple comorbidities and limited life expectancy, breast cancer screening may be reduced or stopped. Thus, women over 70 years old should consider getting screened at a medical facility.

What Tests Might Be Involved in Breast Cancer Screening?

The common methods for breast cancer screening include clinical breast exams, mammography, ultrasound, and magnetic resonance imaging (MRI).

1. Mammography Mammography is widely recognized for reducing breast cancer mortality in women over 40, especially those over 50, in Asia. However, its accuracy is less optimal in women under 40 or those with dense breast tissue. Therefore, it is not recommended for women under 40 without clear high-risk factors or abnormalities detected in clinical breast exams.

Many people worry about radiation exposure, but the radiation dose from routine mammography is low and does not pose a health risk. However, women without specific indications should avoid repeated mammography within a short period.

1. Breast Ultrasound Breast ultrasound can be an effective supplement to mammography, especially in cases of dense breast tissue. It can improve the sensitivity of screening when mammography indicates dense breasts. Follow your doctor’s instructions to determine if an ultrasound is necessary.
2. Clinical Breast Examination There is currently no evidence that clinical breast exams alone as a screening method improve early breast cancer diagnosis or reduce mortality. However, in economically underdeveloped areas with limited equipment and lower awareness of diseases, it remains a screening option.
3. Breast MRI MRI can be used as a supplementary examination for suspected cases found in mammography, clinical breast exams, or ultrasounds. It can be combined with mammography for breast cancer screening in BRCA1/2 mutation carriers.

How Should Women Perform Breast Self-Examinations?

While breast self-examination does not improve early detection rates or reduce mortality on a population level, it is meaningful for individuals as it increases cancer awareness and helps detect abnormalities early. Premenopausal women are advised to perform self-examinations 7 to 14 days after their menstrual period.

The following four steps can guide self-examination:

1. Look: Stand in front of a mirror and observe whether both breasts are symmetrical, if there is any change in skin color, or if the nipples are inverted.
2. Feel: Raise one hand and use the other to press the breast with four fingers (excluding the thumb), moving in circles from the inside out to check for lumps or hard knots.
3. Press: Press and check the outer side of the breast to the armpit for any lumps.
4. Squeeze: Gently squeeze the areola to check if there is any nipple discharge.

How Often Should Breast Cancer Screening Be Done?

The age, tests, and frequency of breast cancer screening vary depending on the individual’s risk.

For women at average risk (i.e., those not classified as high-risk):

• Ages 20-39: No breast cancer screening is needed.
• Ages 40-70: Women should actively seek screening at healthcare facilities or participate in community or workplace-organized screenings, such as the free “Two Cancers” screening for eligible women. The recommended frequency is every 1-2 years for a mammogram. If the results indicate dense breasts (mammogram shows glandular tissue type c or d), an additional ultrasound may be suggested by a doctor.
• Ages 70 and above: Women should actively seek screening at healthcare facilities. The recommended frequency is every 1-2 years for a mammogram.

For high-risk women, screening generally starts earlier and is more frequent, with the following recommendations:

• Start screening before age 40.
• Annual mammogram.
• Breast ultrasound every 6-12 months.
• Clinical breast examination every 6-12 months.
• MRI as needed.

Who is Considered High-Risk?

You may be considered at high risk for breast cancer if you meet any of the following criteria:

1. Genetic or Family History: Women with any of the following: A first-degree relative (mother, daughter, sister) with a history of breast or ovarian cancer. Two or more second-degree relatives (aunts, grandmothers) diagnosed with breast cancer before age 50 or with ovarian cancer. At least one first-degree relative carrying a known BRCA1/2 mutation or being a BRCA1/2 mutation carrier herself.
2. Previous Breast Conditions: Women with a history of ductal or lobular atypical hyperplasia or lobular carcinoma in situ.
3. Radiation Exposure: Women who received chest radiation therapy before age 30.

Additionally, after assessing a woman’s age, ethnicity, age of menarche, age at first childbirth, personal breast disease history, family history of breast cancer, and the number of breast biopsies, if the 5-year risk is ≥1.67%, she may also be considered high-risk.

Finally, for high-risk women, besides following the above screening recommendations, it’s important to make lifestyle changes to reduce breast cancer risk, such as:

1. Avoid Obesity: Engage in regular aerobic exercise and maintain a healthy weight.
2. Healthy Diet: Avoid smoking, limit alcohol consumption, avoid moldy food, fried, pickled, or grilled foods, minimize processed meats, reduce sugary drinks, drink tea in moderation, and eat plenty of fresh fruits and vegetables.
3. Manage Emotions: Long-term stress, depression, or tension can weaken the immune system and negatively impact health.
4. Use Hormonal Drugs Wisely: Avoid blindly using hormonal supplements or cosmetics that contain hormones based on unverified claims.
5. Avoid Radiation Exposure.
6. Maintain a Regular Routine.