What you need to know
Mammography is widely accepted as the best method to detect breast cancer early, before it becomes palpable. When carried out according to European guidelines it is the best standard form of early detection available today and the scientific evidence shows that it improves mortality rates from the disease. The European guidelines recommend that digital mammography or digital breast tomosynthesis be used in organised screening programs for asymptomatic women with an average risk of breast cancer. Digital mammography is an imaging technique that creates 2D X-ray images of the breast and stores them in a computer. This method is preferred over film mammography as the images can be manipulated for optimal viewing, can be shared for further opinions, and has a lower radiation dose. Radiologists check the images for irregularities and compare them against previous mammograms for changes. Digital breast tomosynthesis is a pseudo-3D imaging technique based on a series of low dose images of the breast from different angles. This method has the potential to heighten visualization and overcome tissue superposition, thus improving detection of breast lesions.
Before Screening: The Invitation from the Ministry of Health
Mammography screening programs should be population-based, where healthy (i.e. asymptomatic) women aged 45 - 74 in the general population are invited to come for screening.
According to European guideline recommendation, women should be invited by letter, and if electronic means are used, this should be followed up by an SMS notification or an automated phone call. The Cyprus Ministry of Health invites by letter women aged 45 - 74.
Women should be informed of the benefits and possible harm of screening using decision aids, such as printed materials or webpages describing outcomes of screening and their chances of occurring.
After Screening: Possible Results
The most common and likely result of mammography screening is a negative result (i.e. no signs of breast cancer).
According to European guidelines, women should receive a letter and be informed as soon as possible, but no later than 30 days.
If anything suspicious is detected, further assessment is needed to make sure that only clinically relevant lesions are treated. Women should receive a letter and a phone call to be invited for further testing. This includes digital breast tomosynthesis, ultrasound and if a biopsy is needed, this should be needle core biopsy or stereotactic-guided needle core biopsy, depending on the lesion type. Testing should be provided by quality-assured breast cancer services.
Special Population in the European Guidelines
The ECIBC's European Guidelines on Breast Cancer Screening and Diagnosis are for screening in asymptomatic women of average breast cancer risk, aged 45 - 74 years.
European guidelines recommend organised screening every 2 to 3 years in women aged 45 to 49, and no screening in women 40-44.
ECIBC guidelines recommend organised mammography screening every 3 years in women aged 70 to 74.
Women with Dense Breasts
European guidelines recommend no extra screening in women with dense breasts (e.g., with ultrasound or MRI), but those aged 45 to 74 who are asymptomatic and know they have dense breasts from previous screening tests should have digital breast tomosynthesis. High breast density is considered a risk for breast cancer because lesions can be difficult to detect.
Women at Higher Risk for Breast Cancer
Some women are considered to have a higher than average risk for breast cancer and require personalised monitoring outside a population-based screening program. This includes women with a family history of breast cancer and BRCA1 and BRCA2 mutation carriers. The European Society of Medical Oncology (ESMO) recommends annual MRI and annual mammography (the same year or alternating years) in women with a strong familial history of breast cancer, with or without proven BRCA mutations.
The Importance of Early Detection
Breast cancer incidence has increased since the introduction of mammography screening and continues to grow with ageing of the population. Yet, in many countries, the mortality rate has decreased in recent years because of earlier detection and improved treatment through population-based mammography screening and awareness programs.
Mammography screening for women aged 45 to 74 years old is recommended because there are greater benefits than harms. The risk of dying from breast cancer is reduced and the risk of developing breast cancer in stage III or greater may be reduced. Screening every 2 or 3 years, depending on the age group, is recommended over annual screening because this reduces chances of overdiagnosis (e.g., unnecessary biopsies and anxiety).
Detecting breast cancer in its early stages helps provide treatment earlier before the disease can become invasive and affect vital tissue and organs. It can also reduce the need for more aggressive therapies with more adverse effects.
Detecting Breast Cancer
Detecting breast cancer at its earliest stages increases a woman’s chances of survival and can reduce the need for certain more aggressive therapies.
Screening should be provided by specialised breast cancer services/centers that fulfill European quality and safety requirements as set out by the ECIBC.
Women at Higher Risk for Breast Cancer
Some women are considered to have a higher than average risk for breast cancer and require personalised monitoring outside a population-based screening program. This includes women with a family history of breast cancer and BRCA1 and BRCA2 mutation carriers.
Advocate for all European women
Europa Donna advocates for all European women to have access to nationwide population-based mammography screening programs conducted in accordance with the European Guidelines on Breast Cancer Screening and Diagnosis developed by the European Commission Initiative on Breast Cancer (ECIBC), which are updated regularly based on the latest scientific evidence.