The importance of screening tests

Nearly 8,500 people a year are diagnosed with breast cancer in Hungary, and one in every eight or nine women are affected by the disease. Around 10% of new patients are under the age of 45, meaning they are not yet targeted by organised public health screening programmes. More than 2,000 people die of breast cancer every year.

Breast cancer is not a preventable disease: there is no vaccine against it. On the other hand, we do have tools for its early diagnosis, and survival rates can be significantly increased in the event of early detection.

Few people know that it is possible to develop breast cancer even below the age of 40, so if you become aware of anything unusual you are advised to get it checked immediately by having an ultrasound and/or mammography. Starting from around 18 years of age, women are advised to undergo annual gynaecological screening tests (cytology, pelvic ultrasound, breast examination), while women between the ages of 45 and 65 receive regular invitations for breast cancer screening. Even among the over 65s, the risk of breast cancer does not disappear and mammographic examinations are recommended for this age group, too. Unfortunately, only half the women who receive invitations do in fact attend the screening tests, although there is a greater chance of recovery if the disease is detected early.

During breast cancer awareness month, those in the at-risk population are encouraged to participate regularly in screening tests and carry out frequent self-examinations, since survival rates are significantly higher if the disease is diagnosed in its early stages. We need to take care of ourselves so that we can spend as much time as possible with our loved ones.

Mammographic screening

When you attend a mammographic screening, you will be welcomed by the X-ray assistant who will manually examine your breast tissue and ask if you have any complaints and whether you have a family history of cancer, and breast cancer in particular. Four images of the breasts are then taken, and you will usually get dressed again with great relief, happy that you won’t be back for another couple of years.

But what happens if you do need to return?

The mammograms are assessed independently by two qualified radiologists, and if anything suspicious is observed, or if anything is not entirely clear, you will be called back. But it’s not as alarming as it sounds. In 80% of cases, it is simply an insignificant alteration that requires clarification, and after a more thorough examination you will be sent home and only need to turn up at the next screening examination.

If you are called back, you will be greeted by a doctor who will certainly take some additional mammograms and who will typically perform an ultrasound examination as well. Additional tests may be necessary to establish a diagnosis, so a sample will be taken from any suspicious lesions.

Biopsy. How much does it really hurt?

A biopsy can be performed in one of two ways: using a fine needle or a thicker needle.

Fine needle biopsy

In Hungary, samples are typically taken using a fine needle, and while the procedure may cause slight discomfort, even this can be alleviated by anaesthesia. In the case of fine needle aspiration, a thin needle is inserted into the area in question and a cell sample is collected that is then sent for further examination. It is possible to determine from the cell sample whether the lesion is benign or malignant. There is certainly no need to be afraid of terrible pain or torture, and fine needle aspiration makes a rapid diagnosis possible.

Thicker needle biopsy

In a so-called core biopsy, a thicker needle is used for the examination. A local anaesthetic is administered, then a tiny incision is made in the skin and a tissue sample is taken from the area in question using a needle with a diameter of 1 mm. By examining the tissue sample, it is possible to get a more detailed picture of the lesion. It is a common misconception that the insertion of a needle can cause a tumour, or that if a sample is taken from a tumour in this way, the tumour might become metastatic, but there are absolutely no data to support such claims. A biopsy is nothing to be afraid of and might even save your life. In the case of a core biopsy, the histological examination will take longer but will provide far more information that can be of value when it comes to deciding on a potential course of treatment.

The samples taken using fine needle aspiration or in a core biopsy are sent for histological examination, and the results are available within a few weeks. You can then either breathe a sigh of relief and have nothing more to do until the next screening test other than examine yourself regularly and follow as healthy a lifestyle as possible, or you can expect to undergo some kind of treatment or surgery based on the results.

Even in the worst case scenario that a malignant tumour is confirmed by the examinations, you can be assured that, thanks to mammographic screening, the problem has been detected early, giving you a far better chance of full recovery.


Breast self-examination

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here’s what you should look for:

  • Breasts that are their usual size, shape, and color
  • Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor’s attention:

  • Dimpling, puckering, or bulging of the skin
  • A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out) Redness, soreness, rash, or swelling
  1. While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky or yellow fluid or blood).
  2. Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
  3. Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
  4. Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you’ve reached the deep tissue, you should be able to feel down to your ribcage.
  5. Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower.