Breast cancer: for every woman and every age, the right prevention

By Cristiano Antonino On Jan 1, 2023

Breast cancer, or breast cancer, is the most frequent cancer in the female population, affecting one in eight women: its incidence increases progressively with age and, to date, it is the leading cause of female death from cancer

Breast cancer, primary prevention

As with other cancers, primary prevention is essential for breast cancer, targeting the causes and predisposing factors through an appropriate lifestyle: a diet rich in fruit and vegetables, low in animal fats, avoiding smoking and sedentary lifestyle is recommended.

Primary prevention alone, however, is not enough and must be adequately supplemented by secondary prevention that, through the use of specific tests, succeeds in detecting a tumour when it is still in its early stages and does not manifest itself with symptoms: at this stage the chances of cure are very high.

The first step towards this type of prevention is to join a screening programme.

Through the gradual spread of mammography screening programmes, it has been possible to record a decrease in breast cancer-specific mortality with values of up to 40% in women who, after receiving an invitation, have undergone mammography screening.

In addition to mammography, there are also other instrumental examinations that help diagnose the presence of breast cancer.

Breast cancer, which examinations should be performed before the age of 40?

Until the age of 40, given the low incidence of breast cancer, if there are no symptoms or a high degree of familiarity, there is no indication of preventive examinations.

Self-analysis is always recommended, to check for any changes or lumps, which, in this age group, are mainly benign lesions.

In this age group, in the presence of clinical changes or palpable lumps, breast ultrasound is indicated.

Breast ultrasound is a non-invasive examination that, through the use of ultrasounds, is able to define the origin of the clinical symptom by diagnosing the presence of a solid lump (generally a benign fibroadenoma) or liquid (cyst); ultrasound is also able to characterise any changes in the lymph nodes of the axillary cavity and, in this age group, remains the reference examination.

From the age of 40 there is a progressive increase in the incidence of breast cancer

In this age group, the reference examination to be performed as a first level test is mammography.

Breast ultrasound, on the other hand, is used as a second-level examination that – if the radiologist deems it appropriate – can complete and supplement the information provided by mammography.

Mammography is an instrumental method that, through the use of ionising radiation, performs an assessment of the morphology of the breast allowing the identification of abnormalities, including those of tumour origin.

With the introduction of digital tomosynthesis mammography, it has been possible to further increase both the sensitivity (the ability to identify tumours in the breast) and specificity (i.e. the ability to reduce the number of interpretative doubts) of this method.

Breasts are not all the same and differ, depending on the amount of fibro-ghiandular tissue present, into less or more dense breasts: as the density increases, the diagnostic performance of mammography, and also of Tomosynthesis, decreases as the fibro-ghiandular tissue can completely mask a lesion, preventing its diagnosis.

In denser breasts, it may therefore be necessary to supplement the investigation with breast ultrasound, which then takes on the definition of a second-level test.

Breast cancer, when should mammography be performed? How often?

Falling within the Essential Levels of Care (LEA), mammography is offered (through screening) and in any case guaranteed to all women between the ages of 50 and 69: organised screening programmes invite, by letter and every two years, all women in this age bracket to have a free mammogram.

Some regions extend this possibility to women in a younger age group, between 45 and 49, on an annual basis.

Women who do not participate in screening programmes can still have mammography, which is strongly recommended.

Since scientific evidence shows an increase in the incidence of breast cancer already from the age of 40, mammography is already suggested from this age.

Therefore, regardless of the presence of symptoms or family history, women should have a mammogram as early as the age of 40.

It will be the radiologist, based on the breast density detected and other assessments related to the individual anamnestic and clinical picture, who will indicate the appropriate frequency at which the examination should be performed again.

Indicatively:

Women with a breast classified as ‘dense’ should have a mammography examination once a year, which is the most useful interval for ensuring an effective diagnosis in this type of breast.

If suspicious symptoms (such as a palpable lump, a blood discharge, palpable lymph nodes in the armpit) occur before the annual interval, a breast ultrasound can establish the nature of the symptom.

Women with breasts classified as ‘low density’ and those who are not familiar with the tumour may have mammography at a longer interval, but never more than two years.

Even in this case, however, it is advisable to pay close attention to any clinical symptoms and, in case of doubt, to contact the specialist as soon as possible.

For reasons of radiation protection, in the absence of clinical symptoms the interval between one mammography check-up and the next should never be less than twelve months.

And after the age of 69?

Since, as previously reported, the incidence of breast cancer increases with age, from the age of 70 onwards one should not let one’s guard down and stop mammography check-ups, which should be maintained as long as one’s general state of health permits.