Written by Luan Lawrenson-Woods
Alongside self-checks, routine screening is another way that breast cancer can be detected early The age you start routine screening and what type of scans or imaging you have will depend upon your individual circumstances and risk profile.
Dr Sam Sood (FRACS) is a Specialist Breast Oncoplastic and General Surgeon and explains that routine screening is “when a woman has a mammogram just to get herself ‘screened’ for signs of cancer, but she has no symptoms such as a lump, pain, dimple or nipple discharge” (note: symptoms are not limited to what’s listed here – see our ‘Self Check’ article for more information). If you have previously been diagnosed with breast cancer, your post-treatment scans are known as ‘surveillance’ scans.
Women over 40 can have a free mammogram every two years at BreastScreen (the national breast cancer screening initiative) without a referral, although they won’t be invited to have one by BreastScreen until they are 50. However, Dr Sam says, “The protocol is to have a mammogram every two years from the age of 50, but we recommend women from the age of 40 can do it every two years”.
Routine screening at BreastScreen is usually with a 2D digital mammogram that uses low doses of x-rays to create an image of the breast that enables them to ‘screen’ patients for signs of cancer that are too small to be felt during a physical examination. This is done by a radiographer, an allied health professional who is trained to take medical images like mammograms. The images are read and reviewed by two independent radiologists. A radiologist is a specialist medical doctor who is trained to interpret scans like mammograms. At BreastScreen, both radiologists must agree that everything looks normal before a patient is given the ‘all clear’ – “it's quite a stringent process and the radiologists are heavily audited”, explains Dr Sam.
If you have your routine screening at a private imaging centre, they may use tomosynthesis mammography, which takes x-rays from different angles that give a more detailed 3D image. While 3D mammograms are not necessarily part of the standard routine screening at BreastScreen, if something shows up on your routine screening that needs further investigation, you may have a 3D mammogram as part of a follow-up assessment or diagnostic imaging.
When to start routine screening if you are high risk
The age that you start routine screening, and the frequency of your mammograms, depends upon your personal circumstances. It is therefore important to be breast aware and know your family health history.
Dr Sam recommends annual mammograms for women over 40 who:
- Have very dense breasts;
- Have a first degree relative with breast cancer;
- Have previously had radiotherapy that could increase their risk;
- Carry a genetic variant that increases the risk of breast cancer;
- Is of Ashkenazi Jewish heritage;
- And anyone who does not have a known genetic variant but has a strong family history of breast cancer (2 or 3 people in their wider family).
These are some of the reasons that an annual mammogram may be recommended. Dr Sam advises that you have a breast assessment with your GP or specialist to agree a routine screening protocol that is personalised to your individual circumstances, family history and hereditary or genetic risk.
In addition, Dr Sam says that women with risk factors for breast cancer should have an ultrasound as well as a mammogram as an ultrasound can give a more detailed image. Ultrasounds do not form part of routine screening at BreastScreen, so this may need to be sought elsewhere if you have your routine screening with them.
Abbreviated MRIs for those with an increased risk
Women who have a very high risk of breast cancer may be eligible for an abbreviated MRI that provides even more detailed images. Abbreviated MRIs do not form part of the standard routine screening offered by BreastScreen and are carried out elsewhere.
This form of MRI is quicker than a regular MRI and Dr Sam says it has recently started to form part of the routine screening protocol for women who are identified as being at risk because of their family history, Ashkenazi Jewish ancestry or if they have a genetic variant. Those who are eligible may have the cost subsidised by Medicare up until they are 50 (60 after 1st Nov. 2022).
MRIs are not standard routine screening for women with a low risk of breast cancer. Dr Sam explains that they are not recommended for everybody because it leads to a lot of anxiety, “MRIs are super sensitive, so that means that it picks up everything, benign or malignant, that often require some biopsies that then sets off a ‘cascade’ of medical investigations that may not be necessary if the findings are benign”.
While there is no set age to stop routine screening, Dr Sam again stresses that it is something that depends upon an individual’s health history and breast assessment with their GP or specialist.
Results and follow-ups
The results from routine screening are sent to your GP, as well as to your breast surgeon, if you are under the care of one, or the specialist that has referred you. A radiologist may also contact you about your results. If you are recalled after your mammogram that does not mean that you have breast cancer, but it is essential for you to have a follow-up assessment and tests.
Dr Sam says that it’s important to know that there is no ‘one protocol fits all’ when it comes to routine screening or follow-up assessments, she advises to “Keep it simple. Do your regular self-checks and get your mammograms as part of your routine screening. If something of concern is found, get a referral from your GP to see a breast specialist and they will put together an individualised follow-up plan for you”.
If you are recalled following a routine screening, or are diagnosed with breast cancer, you may require further diagnostic imaging. You can read more about diagnostic and staging imaging here.
And remember, even if you have routine screening, you still need to do regular self-breast checks. Sign up for Pink Hope’s reminder here
Check out Pink Hope’s Glossary for more detail about some of the terms used here.
This article has been reviewed by Dr Samriti Sood, a FRACS qualified Specialist Breast Oncoplastic and General Surgeon who is a full accredited member of the Society of Breast Surgeons of Australia and New Zealand. Dr Sood is a Senior Clinical Lecturer at the University of Sydney, a member of the ANZ Breast Cancer Trials Group and a Medical Officer with BreastScreen NSW.