breast cancer screening

Breast cancer screening

Breast cancer is the most common cancer in women in France. It is also the main cause of cancer mortality among women. Several actions can be put in place to promote early detection of breast cancer. The interest is to be able to treat this cancer more easily and to limit the sequelae related to certain treatments.

A clinical examination of your breasts (palpation) by a health professional is recommended every year from the age of 25.

If you are between 50 and 74 years old and you have no symptoms, no risk factors other than your age, a mammogram every two years, supplemented if necessary by an ultrasound, is recommended. As part of the Organized Breast cancer Screening Program, a second systematic reading of the normal mammograms is ensured by a second experienced radiologist, for safety. Like any medical act, screening has benefits but also limits. It is important to be informed before you knowingly decide to do a screening.

In case of higher risk, other monitoring arrangements may be offered to you. This information package on how to screen and monitor breast cancer does not replace a medical consultation with a qualified health professional.

Breast Cancer: Early detection
Breast cancer, with nearly 59 000 new cases estimated in 2017, is the most common cancer in women, in front of colorectal cancer and lung cancer. Nearly 80% of breast cancers affect people over the age of 50.

In addition, breast cancer, responsible for 12 000 deaths estimated in 2017, remains the leading cause of cancer mortality among women. NET survival at 5 years improved over time, from 80% for women diagnosed between 1989 and 1993 to 87% over the diagnostic period 2005-2010.

Breast cancer is a multifactorial disease. Several risk factors involved in the development of breast cancer have been identified: hormonal and reproductive factors, family or personal history, lifestyle or environmental risk factors. However, there are still uncertainties about the weight of many of these factors in the development of this cancer. It is still difficult at the moment to put in place a prevention strategy in the face of breast cancer in order to protect itself completely and avoid screening.

In this context, the detection of breast cancer at an early stage of development can help to treat more easily but also to limit the sequelae associated with certain treatments.

Several actions can be put in place to promote early detection of this cancer:

The consultation of a doctor in case of changes in the breasts: appearance of a ball, a lump in the breast or under an arm (armpit); Skin modification (retraction, redness, edema or appearance of orange skin); Modification of the nipple or areola-area surrounding the nipple-(retraction, colour change, seepage or flow); Changes in the shape of the breasts. These signs do not necessarily mean the presence of cancer but should be reported to the doctor;

A clinical examination of the breasts (palpation), recommended every year at the age of 25 years. This quick and painless examination can detect a possible anomaly. It can be carried out by a general practitioner, a gynecologist or a midwife;

A screening mammography (radiological examination) associated with a clinical breast examination, proposed every two years to women aged 50 to 74 years in the absence of an apparent symptom or risk factor. A complementary ultrasound can be offered if necessary. As part of the organized screening programme, which has been in place since 2004 for women aged 50 to 74, normal mammograms are the subject of a second systematic reading, for safety, provided by another expert radiologist. Like any medical act, screening for breast cancer has benefits and limitations, which is important to know before making a decision;

Specific monitoring modalities, depending on their level of risk, for women with personal or family medical histories, or certain genetic predispositions.

Your doctor, general practitioner or gynecologist, is a privileged interlocutor to answer your questions about breast cancer and its screening and to guide you, depending on your age and your level of risk, towards the most suitable follow-up modality.

Risk levels: What screening, for which woman?

The risk of developing breast cancer increases with age. Indeed, it is after 50 years that the most risk of developing breast cancer (80% of breast cancers occur after this age). In the absence of other risk factors, there is talk of a "medium" level of risk.

Some women with a personal or family medical history, or certain genetic predispositions, have an aggravated risk, known as "high" or "very high", to be diagnosed with this cancer.

Every situation is unique. This is why your doctor, general practitioner or gynecologist, determines the most appropriate screening or follow-up procedures for your case.

"Medium" Risk level "high" risk level "very high" for all women

"Average" level of risk women with no other risk factors than their age

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The two main risk factors for breast cancer are:

Being a woman: more than 99% of breast cancer affects women. Men too may be affected, but this is much rarer (less than 1% of cases);

Age: 80% of breast cancers affect people over 50 years.

If you are between 50 and 74 years old and do not have any personal or family history about this disease, or a symptom that can evoke breast cancer, your risk level is considered "medium".

The Organized screening program is recommended to you. Every two years, women aged 50 to 74 years are invited to have a mammography and a clinical examination performed by a certified radiologist. The whole is supported at 100% by the health insurance, without advance of costs. Mammograms deemed normal are subject to a second reading, for safety, provided by another certified radiologist. 

Learn more about the Organized screening program

Other elements may play a role in the onset of breast cancer, but they do not justify specific screening procedures:

High breast density after menopause;

The taking of hormonal treatments (contraceptive pill, treatment of menopause);

Smoking, alcohol consumption, overweight or obesity, not or little physical activity.

High risk level women at a particular risk, regardless of age

Some women are more likely than average to be diagnosed with breast cancer. They are talking about a "high" level of risk.

They are women:

Who have a history of breast, uterine and/or endometrial cancer (body of the uterus) or certain conditions of the breast (atypical hyperplasia or benign proliferative condition);

Who have been exposed to high-dose thoracic irradiation before the age of 30, for example for the treatment of Hodgkin's lymphoma.

If your breast cancer risk level is considered "high", specific monitoring will be offered to you depending on your situation and age. You are not affected by the organized breast cancer screening program, even if you are between 50 and 74 years of age. Talk to your doctor: it will determine your level of risk with you and guide you to the most appropriate follow-up modality for your situation.

Follow-up procedures may consist of:

The same screening tests as those for organized screening but commenced at a different age and at closer intervals;

Other detection techniques in addition to or in place of mammography, such as ultrasound or MRI;

Specific surveillance.

"Very high" risk level genetic predisposition to breast CANCER

Some genetic predispositions, such as family mutations BRCA 1 or BRCA 2, expose women who are carriers to a "very high" risk of breast cancer.

If your doctor considers that you may be in this case, he or she will suggest that you contact a oncogenetics consultation. A specialist will ask you about your personal and family medical history to build a "family tree" to assess the likelihood of a predisposition. In terms of all the information, he or she will prescribe a genetic test. Only this test will determine with certainty whether you are presenting the desired mutation.

If your breast cancer risk level is actually "very high", you will be taken care of in a specific way, with clinical surveillance as early as 20 years and radiological as early as 30 years. You are not affected by the organized breast cancer screening program, even if you are between 50 and 74 years of age.

In some cases, a oncogenetics consultation may also be offered to other women in your immediate family (daughters, sisters,...).

For all women

A clinical examination of the breasts every year from 25 years

A clinical examination of the breasts (palpation) Once a year is recommended to all women from 25 years of age, regardless of their level of risk.

This quick and painless examination can detect a possible anomaly. It can be done by a generalist, a gynecologist or a midwife.

From 50 to 74 years

Every two years, if you are between 50 and 74 years of age, you are invited to have a mammography (radiological examination) and a clinical examination in a licensed radiologist, as part of the Organized Breast cancer screening program. The whole is supported at 100% by the health insurance, without advance of costs. For safety, mammograms deemed normal are systematically reviewed by a second experienced radiologist. About 6% of the breast cancers detected annually under this program are identified during this second reading. A complementary ultrasound can be offered if necessary.

The decision to engage in a screening process is a personal choice: it is important to be aware of the benefits and limitations of this screening process before deciding whether or not to participate.

Breast cancer screening: You are under 50 years

Before the age of 50, there is no need to use breast cancer screening unless you have a high or very high risk level. Indeed, there are not enough studies that have shown the efficacy of this screening before 50 years.

On the other hand, a clinical examination of your breasts (palpation) is recommended every year at the age of 25 years.

Organized screening: From 50 years, why?

The annual Breast Clinical exam

From the age of 25 and whatever your level of risk, it is recommended to carry out a clinical breast examination (palpation) once a year. This quick and painless examination can detect a possible anomaly. It can be done by a generalist, a gynecologist or a midwife.

Breast-level symptoms

Contact your doctor if you find symptoms such as:

The appearance of a ball, a lump in the breast or under an arm (armpit);

A modification of the skin: retraction, redness, edema or appearance of orange skin;

A modification of the nipple or areola (area surrounding the nipple): retraction, colour change, seepage or flow;

Changes in the shape of your breasts.

 These signs do not necessarily mean that it is breast cancer but, for safety, it is advisable to seek medical advice as soon as an anomaly is spotted.

High or very high risk level

If you are under 50 years of age and have a high or very high risk of breast cancer, your doctor will offer you the most appropriate screening modality for your situation and age.