New mammography rules: Beating cancer with regular screening

India has a high cancer burden. The Indian Council of Medical Research (ICMR) along with the National Cancer Registry Programme (NCRP) in its report last year said that the number of cancer cases in the country is expected to go up from 14,60,000 in 2022 to 15,70,000 in 2025. With a staggering 1,78,000 new cases of breast cancer diagnosed every year, it is the most common cancer among Indian women, according to a 2020 report by Globocan, an online database providing global cancer statistics and estimates of incidence and mortality. Close to 90,400 died of the disease, as per the report. It is also among the most common cancers in the country.

Proper and regular screening or diagnosis can be the first crucial step in addressing the challenge. An X-ray of the breast, “having regular mammograms can lower the risk of dying from breast cancer,” says the US Centers for Disease Control and Prevention (CDC). Recently, a US preventive task force recommended women start getting regular mammograms at age 40. Earlier, the US Preventive Services Task Force had pegged the same at 50.

According to Dr Vedant Kabra, principal director, surgical oncology, Fortis Memorial Research Institute, Gurugram, it is seen that the average age of breast cancer patients in India is about a decade younger than their western counterparts. “I would recommend starting screening mammograms at 40 years and repeat it every one to two years,” he says.

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Explaining mammography, the doctor says, “Mammogram is a special type of X-ray used to scan the breast. It utilises a special machine used exclusively for this purpose. Each breast is imaged twice at different angles by compressing it between the plates. One image is taken by compressing it side to side and the other is by compressing the breast from top to bottom. It usually takes around 5-10 minutes for the whole procedure.”

According to Dr Viju Murthy, consultant—breast surgical oncologist, HCG Cancer Centre, Mumbai, “The compression during mammography can be uncomfortable, but it is important. It allows the breast tissue to spread and flatten. This ensures a clear view of the breast and reduces the amount of radiation needed to make an image.”

There are not one but three types of mammograms. “First is the film-screen mammogram, which is conventional black and white films and was used many years ago. Second is the 2D Digital mammograms using even lesser doses of radiation and hence safer. Third is the 3D Digital mammograms with tomosynthesis which generate more accurate, high-quality images from different angles and hence there is less frequent need for retaking the images,” explains Dr Murthy.

Although doctors recommend going for screening starting at 40 years, “women with average risk should undergo mammography at one to two years’ interval,” says Dr Murthy. According to her, irrespective of age, if a woman is symptomatic with a lump in the breast or in the armpit, or nipple discharge should undergo diagnostic testing.

While just being a woman is itself a risk factor for breast cancer, even those with an average risk opting for screening can help as mammograms can save lives, the doctor adds.

Among the risk factors include a family history of breast cancer, certain genetic mutations (such as BRCA1 and BRCA2) and age.

In recent years, there has been a significant rise in breast cancer cases, doctors say. Several factors can be responsible for that, such as “lack of knowledge and understanding of breast cancer, genetic mutations, lifestyle choices such as smoking and drinking, and environmental elements like air pollution and radiation,” says Dr Akshita Singh, consultant breast oncology, Mazumdar Shaw Medical Centre, Narayana Health City, Bengaluru. “It is important for women to prioritise their breast health. They should get themselves checked regularly. Timely diagnosis and treatment can improve the prognosis significantly,” she adds.

Apart from mammograms, there are other ways to detect breast cancer, which include clinical breast exams, breast self-exams and imaging tests such as ultrasound or MRI scans. In fact, those at a higher risk “may need to start screening earlier and undergo additional tests, such as MRI scans, in addition to mammograms,” says Dr Singh. “It is important for women to discuss their options with their medical expert and determine the best course of action based on their individual risk factors and medical history,” she adds.

However, mammography as screening is not recommended during pregnancy and lactation. “In case it is needed for diagnostic purposes, it can be done during pregnancy with appropriate shielding of the abdomen and can be performed in a lactating lady. However, it is crucial to understand that pregnancy and lactation-related changes bring down mammogram’s sensitivity,” says Dr Kabra.

For the general population, while experts recommend screening, exposure to radiation can cause concern in some. However, doctors say it is a safe process. “In general, mammography is safe as the radiation exposure with a mammogram is 0.4 mSv (millisievert). A woman is exposed to an average radiation dose of 3mSv per year just by background radiation in day-to-day life. The amount of radiation she receives while screening is about equal to that received over seven weeks from natural surroundings or background radiation,” explains Dr Murthy. However, regular screening can have some downsides, but “there is always a risk-benefit ratio of lives saved versus potential harms, to be considered with any imaging,” the doctor says, adding that “frequent screening could lead to false positive results, which can lead to anxiety, additional testing, invasive procedures, overdiagnosis and radiation exposure. Hence screening 1-2 years is adequate for average-risk women.”

If diagnosed

When one is diagnosed with breast cancer, the next course of action depends on the type and severity of the ailment. The treatment can involve a combination of surgery, chemotherapy, radiation, hormone and targeted therapies. “Treatment plans are tailored to the individual, taking into account the size and growth rate of the tumour, the patient’s age, general health, menopausal status and other factors,” says Dr Singh. “Regular follow-up appointments are key for monitoring for any recurrence or changes in the disease,” she adds.

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DOs & DON’Ts

Things to be kept in mind while going for a mammogram

• Inform the doctor/technician if you are pregnant or likely to be pregnant or lactating
• Inform about any discomfort in a particular posture as one needs to stand and lean forward for the optimum positioning of the breast during the screening process
• If you still have periods, you should schedule the mammogram a week after the period. It is because the breasts are less tender then
• It is better to schedule the appointment early in the day as you cannot wear deodorant, powder, lotion, or ointment around the chest area. It is because these may look like a breast problem on the X-ray
• Wear a two-piece outfit. You will have to remove the top for the mammogram and wear a gown
• Always carry old mammogram films for comparison
• While the cost of the procedure differs based on machine, technique and institute, it can range anywhere between Rs 1,500 and Rs 4,000
• Remove any necklace or piece of jewellery worn around the neck
• Avoid consuming caffeine three to four days before the screening

SYMPTOMS OF BREAST CANCER

• Lump in the breast
• Changes in the size or shape of the breast
• Dimpling of the breast skin
• An inverted nipple
• Discharge from the nipple
• Redness or scaling of the nipple
• Swelling or warmth of the breast