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1. What is the aim of early detection or breast screening?

The aim of breast screening is to detect breast cancer early so that with effective treatment women can live longer.

2. How does it work?

When breast cancer develops it goes through a stage whereby its cancer cells are confined within the breast ducts. This is known as the non-invasive stage.  If we can detect breast cancer at this stage we know that the cancer cells have most likely not spread to the armpit lymph nodes or elsewhere in the body.

3. What are the advantages of early detection? 

When a breast cancer is detected and treated at an early stage there are several advantages:

• Most important of course is the fact that such women can live longer.
• These tumours are often small (less than1 cm diameter) and are suitable for less mutilating surgery e.g. lumpectomy as compared to mastectomy.
• There is also a higher chance of avoiding chemotherapy after surgery.
• If no cancer is detected by breast screening, a woman can feel more reassured.

4. What are the methods of early detection?

The only effective and proven method to detect breast cancer early is an X-ray of the breasts called mammogram. Mammogram is able to detect microcalcifications (calcium dots), which is an early sign of non-invasive duct cancer, and also breast cancers that are too small to be detected by clinical examination (less than 1 cm diameter). Other methods such as Breast Self Examination, Clinical Examination, Ultrasound Scan (Breasts) have not been proven to be effective.

5. Is mammogram painful?

A certain amount of compression of the breast is required to obtain a clear image on the mammogram. This may be uncomfortable and painful. However in a survey in UK, only 10% of women said it was painful.

6. Is mammogram harmful?

The common belief is that since mammogram is a form of X-ray it is harmful to our body. However the radiation dose from mammograms is quite low and hence the risk to our health remains low. The risk is comparable to smoking 3 cigarettes!

7. Is there any proof that breast screening works?

YES. Studies in US and Europe have shown that regular breast screening in women aged 40 years and above can reduce the risk of death from breast cancer by up to 50%. This translates into lives saved.

8. Is breast screening effective in all women?

Studies have shown that Breast Screening is most effective in women 50 to 70 years old. The effectiveness of breast screening for women in her seventies remains unproven.

9. Where can I go for breast screening?

Breast screening is available as part of a general health check found in most government outpatient clinics and Singapore Cancer Society. Breast screening involves a clinical breast examination performed by the doctor followed by a mammogram. Facilities for mammogram and X-rays are available in most hospitals. 
The Ministry of Health launched a nationwide campaign to screen women above 40 years for breast cancer. The cost of mammogram is heavily subsidised.

10. What happens if a woman’s mammogram is abnormal?

This does not mean that the woman has breast cancer. A large proportion of the abnormalities found on mammogram are not due to cancer. The woman will be recalled by the doctor for further tests such as magnification views of the mammograms and ultrasound scans. Only in a small proportion of women, an abnormality suspicious of cancer is confirmed by these further tests. These women are offered a surgical biopsy to rule out a cancer.

11. What is a surgical biopsy?

This is a small operation to remove the abnormality in the breast for laboratory examination to rule out a cancer.  This operation is usually performed under general anaesthesia as a day surgery procedure.

12. What are the disadvantages of breast screening?

• Mammogram is painful to some women and there is a small risk from radiation exposure
• Unfortunately no diagnostic tests including mammogram are 100 percent accurate and some normal women may have mammograms showing an abnormal result. They have to undergo further tests and surgical biopsy to rule out a cancer. This can be costly and inconvenient to these women. Such women may also be subjected to unnecessary mental stress.
• On the other hand, some women with breast cancer may have a normal mammogram i.e. the cancer was missed by the tests. Such women may be falsely assured.

13. What are our government’s guidelines for breast screening?