Screening for Breast Health

Breast cancer is the most common form of canceramong females in Hong Kong, fortunately survival rates are very high if detected early. The risk of breast cancer is higher with increased age, though it is possible for breast cancer to occur in younger age groups.

Although the breast self-examination is no longer recommended as a screening tool for breast cancer. Women are encouraged to remain “breast aware”, that is, to be familiar with the normal look and feel of their breasts.

Breast Health

If women notice any change in the appearance or feel of the breasts, seek medical attention promptly for further investigation.

Breast Health 2


Breast cancer

Breast cancer develops when normal cells in the breast change and grow out of control. It can happen in BOTH women and men, yet the rate in women is higher. Early breast cancer usually does not cause pain or show any symptoms at all. As cancer grows, however, it can cause the following changes:

  • A lump or thickening in or near the breast or under the armpit
  • A change in the size or shape of the breast
  • A change in the way the breast or nipple looks or feels
  • Ridges or pitting of the breast - the skin resembles the surface of an orange
  • Nipple discharge or nipple tenderness; the nipple may also be inverted, or pulled back into the breast

Cancer can invade the breast tissue and spread to the underarm lymph nodes and other sites of the body, such as the lungs and bones. However, the survival rate of breast cancer is very high if it is detected at an early stage.

Breast cancer screening

It is believed that family history plays an important role in breast cancer. However, only five to six percent of all breast cancer cases are believed to be genetically related. Two genes, BRCA1 and BRCA2, are involved in the development of breast cancer and women can have a blood test to check for the presence of these genes if there is a family history of breast cancer.

Whilst regular screening for breast cancer will not prevent the disease, studies have shown that it will increase the chance of early detection, at a stage when it is easier to treat.

1. Self-examination
According to the recommendation by Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) in 2021, breast self-examination is not a screening tool for breast cancer but if women notice any change in the appearance or feel of the breasts, please seek medical attention.

2. Breast ultrasound
CEWG also suggests that a breast ultrasound is not useful as a screening tool. However, it may help to assess an abnormality seen on screening mammography and to clarify features of a potential lesion. It may also be considered in patients with a very dense breast that may affect the sensitivity of mammogram assessment.

3. Mammograms
Women at high risk with the BRACA 1 or BRACA 2 gene or a strong family history of breast and ovarian cancer are advised to have an annual mammogram. Other women in the general population above 44 years old are recommended to have a mammogram every two years if they have the following risk factors:

  • A history of breast cancer among first-degree relative
  • Prior diagnosis of benign breast disease
  • No previous pregnancy
  • Late age of first live birth
  • Early age of first menstrual period
  • High Body Mass Index (BMI)
  • Physical inactivity

The following tests can also be done to investigate breast cancer if necessary.

4. Breast MRI
The use of breast MRI to screen for breast cancer is controversial. Breast MRI uses magnetic resonance to create a fine image of the breast. It does not have radiation. It is not necessary for most women to use MRI as a cancer screening tool because when compared with a mammogram, it is less effective in detecting certain breast problems. It may produce a false positive result of breast cancer. However, studies have shown that in women of young age and high cancer risk (e.g. with BRCA1 or BRCA2), breast MRI is a more sensitive screening test to detect breast cancer than a mammogram.

Breast Health 3

Having mammogram

A mammogram is a fairly routine procedure though some women may find it uncomfortable. Before the procedure, a short questionnaire will be completed to determine the medical history. A gown will be provided, the bra and any accessories around the neck should be removed.

During the procedure, a female radiographer will position the patient’s breasts on the plates. This can make some women feel uncomfortable, but the radiographer is trained to do this and works quickly. The x-ray plates will compress the breast tissue. This can be painful, but will last no more than 30 seconds.

Each breast is x-rayed at least twice, once from the top down and the other from side to side so that the radiographer can get a good look at the tissue.

When booking a mammogram consider:

  1. It is best to have the mammogram right after the period, as the breast will be least tender or swollen. If menstruation is about to start or has started, try to reschedule the appointment.
  2. Do not wear deodorant or talcum powder.
  3. This test is not suitable for pregnant women.
  4. If oral contraceptives are used, schedule the test on the day a new pill pack starts.

What if the result is abormal?

Do not panic if the result of the mammogram is abnormal. Nine out of 10 women with an abnormal mammogram turn out NOT to have breast cancer. Depending on the doctor’s assessment, more diagnostic tests might be needed in order to investigate the abnormality. An example would be a breast biopsy where a small amount of tissue from the breast is taken out and sent to a laboratory to test for the presence of cancer cells.

If the doctor thinks that the abnormal result is probably not due to cancer, another mammogram in six months might be suggested.

What about the risks?

Screening is recommended for early detection of breast cancer, which will enable treatment to take place when it is easier to control the disease. However, ladies should also understand the risks involved.

A mammogram involves using radiation, however, the dose of radiation is very low. The evidence clearly suggests that the life-saving benefits of early cancer detection far outweigh the risk of low-level radiation exposure.

Screening for breast cancer may produce false-positive results that require further testing. There is also a possibility for over-diagnosis, which means that patients receive treatment for cancer that, if undiscovered, would not have caused any harm.

Always seek the advice and guidance of attending physicians to discuss options that are relevant to the individual’s unique circumstances, such as age, family history, and other considerations.


Checked by:
Dr. Linda Hui

Centre for Health Protection, Hong Kong

The materials contained here are for general healthinformation only, and are not intended to replace theadvice of a doctor. Matilda International Hospitaland Matilda Medical Centres will not be liable for anydecisions the reader makes based on this material.