Breast cancer screening: Debunking myths and misconceptions

With an alarming 1.44 lakh new annual cases in India, breast cancer is ranked as number 1 cancer in India among urban females and 2nd most common cancer in rural females.

More and more younger women are getting detected with breast cancer in India as compared to the western population. All factors that disturb the hormonal milieu pose a risk towards developing breast cancer. As against common beliefs, antiperspirants, usage of tight/ underwired bras and multiple miscarriages have not shown any correlation to breast cancer. On the other hand, breastfeeding, 5 hours of intense physical activity per week, consuming diet rich in fruits, vegetables and dairy whereas avoiding diet containing high-fat and red meat are shown to have protective effects.

BSE (Breast Self Exam) and screening Mammography are the pillars of early detection of breast cancer.
BSE includes a step-by-step self-evaluation for breast changes :

1) Stand in front of the mirror, hands placed on hips : Observe for dimpling/ puckering/ bulging of skin, redness/ soreness/ rash and any change in position/ pulling-in (inversion) of nipple.
2) Raise your arms above your head and lookout for same findings.
3) Lie down flat and check underarm and breast area from collar bone to upper abdomen and armpit to cleavage, with opposite hand, inch-by-inch in circular motion, with firm pressure, making sure not to miss any area.
4) Repeat the same method in standing/ siting position.
5) Look for any nipple discharge - observe consistency and colour.
In case of any above-mentioned finding, consult a doctor.

Studies have shown that approximately 25% breast cancers are first detected by BSE. However, to detect breast cancer months to years before actual symptoms develop, screening with Mammography is recommended. Women in whom early cancer is picked up on screening mammography, require less aggressive surgeries and chemotherapy and are more likely to be completely cured of the disease making breast cancer screening a game-changer.


A mammogram is a low dose X-ray of the breast. It can detect breast cancer at a very early stage, when treatment is more likely to be successful. A standard system called the Breast Imaging Reporting and Data System (BI-RADS) is used to quantify risk of cancer, with an increasing trend of cancer risk from scores of 1 to 6.
Breast Cancer Average Risk (General Population) Moderate Risk High Risk
Percentage Risk <15% 15%-20% >20%
Start Screening 40yrs 40yrs 25-30yrs
Screening Modality Mammogram Mammogram +/-MRI Mammogram +/- MRI

The American College of Radiology (ACR) recommends that by the age of 25yrs, every woman should get evaluated by a doctor to see if she falls in high-risk category. These women require a different approach towards prevention, screening and early detection of cancer.

With the advent of 3D-Tomography/ digital-tomosynthesis, early detection of microcalcifications, small masses and architectural distortion, has significantly improved. Newer machines have higher resolution, lower radiation, faster acquisition and improved comfort. Computer Assisted Device (CAD), Artificial Intelligence and Contrast Enhanced Digital Mammography (CEDM) are latest technological advances in mammography that can be used as problem solving tools in patients with dense breasts or high suspicion of cancer.

Ultrasonography of breast, when added to mammography, improves sensitivity of picking up breast lesions and also improves lesion characterization. In most centres, mammography combined with sonography is a routinely followed screening test. MRI is a helpful tool in suspicious lesions and in annual screening of high risk women.

According to the ICMR, despite such high incidence of breast cancer in India, only <3% of Indian women undergo screening tests. October every year is observed as breast cancer awareness month, called Pink October. This month we take the opportunity to learn and spread importance of early detection and treatment of breast cancer in improving the overall health of women in our society, aiming towards a healthy and happy life. When it comes to breast cancer, we can all agree, "A stitch in time saves nine".

(Author: Dr Shraddha Sinhasan-Pawar-Consultant Radiologist- Jaslok Hospital and Research Centre)