Breast cancer — screening

• Risk of breast cancer increases with age. Most common over 50 years. Finding early can mean cancer is small, more effectively treated and less likely to have spread
• More than half of all breast cancers are diagnosed after investigating breast changes found by woman or her doctor
• BreastScreen Australia is a joint commonwealth, state and territory initiative providing free screening service to targeted groups of women

Screening mammograms​

• If woman is asymptomatic — screening mammogram Table 6.1
• If woman has symptoms — medical consult and diagnostic mammogram — See breast problems

• Women 50–74 years — screening mammogram every 2 years
• Women 40–49 years and 75 years and over — not enough evidence to support routine screening in these groups — eligible for screening mammogram on request at BreastScreen services
• Women under 40 years — dense breast tissue in younger women makes it hard to detect changes — not eligible for screening mammograms through BreastScreen services
• Women at high risk (eg strong family history of breast cancer or ovarian cancer or known predisposing gene mutation in family) need to be screened more closely (ie more frequently and from younger age)
• Medical consult about need for specialist input. May need surgeon, gynaecologist, genetics referrals
• Online tools available to assess breast cancer risk (eg familial risk assessment (i-Prevent)

Do

• Encourage breast self-awareness
• AND if over 50 years and no mammogram in last 2 years  do breast exam as part of Adult Health Check, encourage mammography screening
• Encourage women to come to clinic if they notice
  
• Lump OR change in shape or size of breast
• Change to nipple — crusting, ulcer, redness, inversion
• Nipple discharge
• Change in skin — redness, dimpling, puckering
• Unusual persistent pain, especially if only in 1 breast
• Encourage routine mammogram screening for women 50–74 years

Talk with woman about screening for breast cancer

• Explain what mammogram is, why it is done, what it can show
• Many women worry about compression and pain during mammogram procedure. Reassure them that it is only momentary and mild for most women
• Important that woman tells BreastScreen service who her usual doctor or clinic is and asks for copy of results to be sent to them
• Rarely, screening mammogram needs to be repeated for technical reasons and not because abnormality was detected. Woman will be notified and asked to attend screening again
• If abnormality found — need to attend assessment clinic in major centre
• Will have more x-rays and may have ultrasound or biopsy to make diagnosis
• Travel assistance covers travel costs for additional investigations

Promote breast screening

• Keep local recall and reminder list for screening mammograms
• Important to notify communities of screening dates
• Talk to older women about screening mammograms
• During Adult Health Check
• At women’s meetings
• Use resources — posters, pamphlets, information sheets
• Women’s health educators can provide training and support
• Group bookings may be available. Check with BreastScreen service
• Consider group trips to town when breast screening operating
• Encourage other community organisations (eg women’s centre, council) to support these initiatives
• Link women in with other services while in town