Breast cancer: early detection methods

Breast cancer is the most common form of cancer in women. More than 6,000 women receive this diagnosis every year in Switzerland. The specialist medical term is “breast carcinoma”, which refers to malignant tumours that develop in the breast tissue. The risk increases with age. Around 80% of women with the disease are aged 50 or older. But the chances of survival are better than they are for some other forms of cancer, such as lung cancer or pancreatic cancer. Thanks to modern medicine and early detection, about 80% of patients are currently still alive five years after being diagnosed with breast cancer.

Early detection makes it significantly more likely that treatment will be successful. The earlier a breast carcinoma is discovered, the more targeted and therefore less harmful its treatment can be. That is why the early detection of breast cancer is crucial for successful treatment. Regular examinations enable doctors to spot suspicious changes in good time, and thus preserve breast health.

One simple way of spotting breast cancer early is to regularly check your breasts yourself. This gives women a sense of the natural texture of the tissue, and makes them more aware of any changes. Specialists recommend that you systematically check your breasts once a month. Carefully examine the whole breast and armpits, and feel around them with your hands. Breast cancer can sometimes be detected in its initial stages, particularly if a lump is close to the surface of the skin. The timing of when you should thoroughly check your breasts depends on your hormonal cycle:

• No hormonal contraception: Breast tissue feels softer in the days immediately following your period. This makes lumps or other changes easier to detect.
• Contraception using the pill: The best time is at the start of a new one-month pack, because hormonal fluctuations affect the breast tissue.
• After the menopause: After the menopause it is advisable to check your breasts every four weeks or so.

Not every change that you notice will be a sign of breast cancer. If you notice anything unusual, you should see a doctor immediately. They will clarify whether further investigations such as an ultrasound scan or a mammogram are required.

It is not always possible to feel breast cancer, so regular self-examinations alone are not enough. Mammography supplements early detection by making minor changes in the tissue visible. X-raying the breast is currently considered the most important early detection method. This can identify even very small breast tumours that cannot be felt with the hands.

During the examination, a specialist positions the breast between two plexiglass panels. These press the tissue together to ensure even distribution and therefore better image quality. Some women find mammograms painful due to the amount of pressure placed on the breast.

Mammography: yes or no?

A mammogram is a simple examination that can rapidly detect changes in the breast. It reveals suspicious changes in the tissue, but offers no indication of whether potential tumours are benign or malignant.

The Harding Center for Risk Literacy at the University of Potsdam has summarised the potential advantages and disadvantages of the early detection of breast cancer using mammograms based on the available scientific studies.

Mammograms don’t always give meaningful results. In such cases, other imaging techniques such as ultrasound and magnetic resonance imaging (MRI) of the breast can provide a more precise diagnosis. These procedures are done in addition to or replace mammography for the early detection of breast cancer.

Ultrasound breast scans

Ultrasound is used as a screening method to detect breast cancer if mammography fails to provide clear results. Ultrasound scans also make sense for certain groups of people. Here’s an overview of the different types:

• Unclear results: A mammogram is often unable to clearly recognise cysts. An ultrasound scan provides additional information, and distinguishes between fluid-filled cysts and solid lumps in the breast.
• Young women: In younger patients, dense breast tissue makes it harder to make assessments using mammography. In these cases, ultrasound provides clear images and makes it easier to detect anomalies.
• Women with breast implants: Mammograms cannot be performed on patients with implants. Ultrasound is a radiation-free way to examine the breast tissue without squashing it.

Breast MRI

Breast MRI is not a standard procedure for the early detection of breast cancer. This method is necessary in certain situations, however:

• Unclear results: MRI is often used if mammography or ultrasound fail to provide clear results.
• Increased family risk: Women with a genetic predisposition to develop breast cancer are given regular MRI examinations in order to spot changes in the breast tissue at an early stage.
• Follow-up care and suspicion of relapse: MRI is used for early detection and investigation following breast cancer treatment or if a breast tumour is thought to have recurred.

There are other methods for diagnosing breast cancer in addition to mammography, ultrasound and MRI. Some of those methods, such as thermal imaging of the breast, give imprecise and unreliable results, and are not suitable for early detection. You should ideally talk to your doctor about what kind of examination makes sense in your case.

A breast biopsy is not a routine examination for breast cancer screening. It is used when imaging techniques such as mammography or MRI provide conspicuous results. This procedure clarifies whether a change in tissue is benign or malignant. It involves the doctor taking a tissue sample and investigating it for cancer cells. In most cases, the tissue sample is taken as an outpatient procedure, using local anaesthetic.

If the biopsy confirms the suspicion of a breast carcinoma, further investigations are carried out. In this case, medical experts use immunohistochemistry to detect specific breast cancer markers. These provide information on the tumour’s biological properties. Doctors also determine whether the breast cancer has spread. A computed tomography (CT) scan of the chest and abdomen using a contrast medium helps detect metastases in other parts of the body. In certain cases, breast cancer is visible in a CT scan, particularly if the tumour has characteristic tissue structures. The results of these investigations are used to select the best available treatment.

If you have a family history of breast cancer, you can get genetic testing for the early detection of breast cancer. This will determine whether you have an increased risk of developing breast carcinomas. A positive result indicates an increased risk but does not confirm the presence of any cancer cells. Likewise, a negative result does not rule out the possibility of developing breast cancer. A history of breast cancer in the family remains a factor even if there are no detectable genetic changes. Medical experts use the test to identify specific tumour markers for breast cancer. This can then be used as a basis for taking targeted measures to prevent breast cancer.

Breast cancer cannot be prevented entirely. A healthy lifestyle reduces the risk of developing it, however. Eating a balanced diet with minimal alcohol and sufficient exercise is good for your health. Examine your breasts regularly yourself, and go to check-ups. These measures support your breast health and help you spot breast cancer at an early stage.