Breast Cancer Screening: Who, When, and Why It Matters

Akithmi Koththigoda

Oct 5

4 min read

October is Breast Cancer Awareness Month – a time when pink ribbons and awareness campaigns are everywhere. Yet, awareness is only one part of protecting our health. Understanding how breast cancer screening works, who it is intended for, and why recommendations differ from person to person can help us make more informed decisions.

What is Breast Cancer Screening?

Breast cancer occurs when cells in the breast malfunction and grow uncontrollably, forming a mass known as a tumor. In some cases, these cancer cells can spread to other parts of the body, which makes them malignant. Screening refers to checking for breast cancer before a person has symptoms. The goal of this procedure is to find breast cancer early, when it may be more treatable and before the cancer cells have started traveling throughout the body [1].

The most familiar screening method is a mammogram, an X-ray image of the breast. Mammograms can identify certain changes in breast tissue that may not be noticeable through touch or other symptoms [2]. Another form of screening involves magnetic resonance imaging (MRI), which uses magnets and radio waves to take pictures of the breast. Breast MRI is often recommended alongside mammography for women at high risk of breast cancer, such as those with certain inherited genetic mutations, a strong family history of breast cancer, or a history of radiation therapy to the chest at a young age [3].

There is an important distinction between screening and diagnostic testing. Screening is performed when someone does not have symptoms. If you notice new changes to breast tissue, additional testing may be needed to determine what is causing it – a diagnostic mammogram, ultrasound, biopsy, or other test may be used depending on the situation. A screening mammogram is therefore not designed to answer every question about a person’s breast health.

Who Should Be Screened?

There isn’t one universal screening schedule that applies to everyone.

Recommendations for screening are generally based on factors such as age and individual risk. For people at average risk, major medical organizations publish guidelines that help determine when routine mammography should begin and how frequently it should be performed. For example, the U.S. Preventive Services Task Force currently recommends mammography every other year for women ages 40 to 74 with average risk [3]. The American Cancer Society has different recommendations, including annual mammograms for women ages 45 to 54 and the option to begin annual screening between ages 40 and 44 [2]. In this context, annual screening refers specifically to getting a mammogram once a year, rather than receiving multiple types of screening tests. For women at higher risk, additional screening methods, such as MRI, may also be recommended.

These differences do not necessarily mean that one organization is ignoring the evidence. Screening recommendations involve weighing several factors, including how likely screening is to detect cancer, the chances cancer may be missed, and how often screening leads to false alarms or unnecessary procedures. This is one reason why it is important to reach out to your healthcare provider to determine what the best course of action is for you.

In other words, “When should I get screened?” isn’t necessarily a question with the same answer for everyone.

Why Does Early Detection Matter?

Breast cancer is not a single disease, and its behavior can vary considerably. In general, finding cancer at an earlier stage provides more opportunities for treatment and helps prevent its spread to other parts of the body. However, screening is not perfect. A mammogram can sometimes miss a cancer, and it can also detect an abnormality that turns out not to be cancer. This can lead to additional imaging or a biopsy.

That’s why screening involves balancing potential benefits and potential harms rather than assuming that more testing is always better [1].

Screening Isn't Equally Accessible To Everyone

Knowing that screening exists is only part of the equation – you also need to be able to access it.

Transportation, insurance coverage, cost, availability of screening centers, language barriers, work schedules, and other factors can make it harder for some people to receive recommended care. This means that breast cancer awareness isn’t only about encouraging individuals to get screened. It also involves asking whether everyone has a fair opportunity to access early detection and treatment [4].

What Should You Remember?

Breast cancer screening can play an important role in detecting breast cancer early, but screening recommendations depend on individual circumstances.

The most important takeaways are:

Screening looks for disease before symptoms appear.
Mammography is the primary screening method for most people at average risk.
Age and personal risk factors influence screening recommendations.
Screening has benefits and limitations – it isn’t a guarantee that cancer will be found or prevented.
Access to screening is an important part of health equity that needs to be addressed through awareness.

Breast Cancer Awareness Month is more meaningful when awareness leads to understanding. Knowing who should be screened, when screening is recommended, and why access matters gives people the information they need to have better conversations about their health.