Principal Director, Medical Oncology & Hemato-Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, India
Part 3 of 12 in Diagnosing Common Cancers & Blood Disorders
Breast Cancer Screening: What to Do at 18, 30 and 40
August 28, 2026
Dr. Niti Raizada closes every breast cancer case in her masterclass the same way: with the screening schedule that would have caught the disease earlier. It is a three-tier schedule, built around age, and it assigns a specific action to the patient, to a trained clinician, and to imaging.
From 18: monthly self-examination
Self-breast examination should begin at 18 years of age and be repeated once a month. Dr. Raizada frames this as a conversation that belongs in families, among friends, neighbours and colleagues, not only in a clinic. The technique itself is simple: the opposite hand examines the opposite breast, using three fingers held flat against the tissue, and the examination should extend to the axilla and the neck, not just the breast itself. Short instructional videos are available online for anyone who wants to learn the technique. Any lump that is found should be evaluated promptly rather than watched.
From 30: a clinical breast examination every six months
Starting at 30, Dr. Raizada recommends a clinical breast examination every six months, performed by a trained specialist. That specialist can be an oncologist or a gynaecologist, although treatment itself is usually delivered by an oncologist. Importantly, the exam does not need to be restricted to specialists: nurse practitioners, physician assistants, internal medicine doctors, general surgeons, gynaecologists and oncologists can all be trained to perform it competently. What matters is training, not job title, because missed lesions on clinical examination are common when the examiner has not been properly trained.
Dr. Raizada's broader recommendation to GPs is direct: any woman who comes to a clinic for any reason should be offered a breast examination as a routine part of the visit. If a male doctor is present and a patient prefers a female examiner, a nurse can perform it. But the general practice, in her words, should be to make breast examination a standard part of any consultation with a woman, not something reserved for a dedicated visit.
From 40: an annual mammogram
From age 40, a mammogram once a year becomes the recommended imaging. Below 40, ultrasound is generally preferred over mammography, though a mammogram can still be added if there is high clinical suspicion, as it was in the 35-year-old case in this series. If there is any doubt on clinical examination in a woman under 40, an ultrasound should be done immediately; if the woman is 40 or older, a screening mammogram is the right next step.
High-risk screening looks different
This standard-risk schedule is not the same for everyone. Women with a proven genetic mutation, or a strong family history of breast or ovarian cancer, fall into a high-risk category that changes the screening plan. Dr. Raizada's advice for these patients is to have a direct conversation with an oncologist about personal history, family history and other risk factors such as smoking. Based on that discussion, additional tests may be recommended, including a breast MRI, or a blood test to check for a hereditary mutation if suspicion is strong enough.
The clinical takeaway
The three-tier schedule, self-examination from 18, clinical examination from 30, mammography from 40, is meant to function as a safety net regardless of symptoms. Any GP or internal medicine physician can and should be trained to deliver the clinical examination tier themselves, rather than referring every woman to a specialist for a check that does not require one.
This guide is based on a live Jivo Masterclass — Dr. Niti Raizada taught doctors across Africa on February 1, 2026.
FROM THE LIVE Q&A
Dr. Stefan
Between MRI and CT scan, which is the better imaging modality for staging this cervical cancer case?
Dr. Niti Raizada
MRI of the pelvis is excellent for local pelvic structures, but the upper abdomen and chest still need to be assessed, which is better done on CT. The recommendation is CT of the thorax combined with CT of the abdomen and pelvis with contrast, or alternatively MRI of the abdomen and pelvis with contrast combined with a CT of the chest. The chest is generally better seen on CT, and the pelvis is generally better seen on MRI.
Frequently Asked Questions
I am seeing a Stage III breast cancer patient currently on filgrastim 300 micrograms for 3 days. What further treatment plan would you initiate for this patient?▼
Treatment depends on the patient's oestrogen receptor, progesterone receptor and HER2 status, and on whether she is receiving neoadjuvant chemotherapy followed by surgery, or surgery followed by adjuvant chemotherapy. Filgrastim is supportive care only, a white blood cell growth factor given to prevent a drop in counts after chemotherapy; it is not the primary cancer treatment. Its use depends on which chemotherapy protocol is being followed, but the treatment plan for the cancer itself is a separate, biology-driven decision.
Can the HPV vaccine still be given to a patient who has already tested positive for HPV?▼
Yes. If a nine-valent vaccine is given and the patient is positive for one strain of HPV, the vaccine still confers protection against the remaining eight strains it covers.
Are there any specific concerns in monitoring chronic liver disease, for example the frequency of ultrasound and the skill set of the radiographer?▼
Ultrasound should be done once every 6 months for a chronic liver disease patient, along with alpha-fetoprotein testing every 6 months. The skill of the radiographer matters because ultrasound is a subjective, operator-dependent test. If there is any doubt on ultrasound, a triple-phase CT scan or a multiphasic MRI should be done immediately.
We had a case where a gentleman with no history of alcohol or hepatitis could not get preliminary triple-phase CT staging done. The plan was hepatectomy, but he developed a crisis from bile build-up and passed away during the consultation and visa process. How could such cases be managed by a local doctor with limited information?▼
The key is always the right diagnosis at the right time. Liver cancer carries a real risk of coagulopathy and bleeding, so any patient with chronic liver disease should have regular PT, PTT and INR testing. If there is any bleeding diathesis, it needs to be treated, including with vitamin K and blood products if needed. Chronic liver disease patients also commonly have low white cell counts and low platelets, so basic blood counts should be checked regularly alongside liver and kidney function tests.
Could you recap the management of leukemia, including the case you discussed earlier?▼
Leukemias are broadly acute or chronic. Acute leukemias have a short history with low hemoglobin, white cell count and platelets, presenting with fever and bleeding. Chronic leukemias, chronic myeloid leukemia (CML) or chronic lymphocytic leukemia (CLL), generally occur in older age groups and are often managed with tablets alone. Acute leukemias are either AML or ALL. Genetic testing subcategorises each: CML needs confirmation of Philadelphia chromosome or BCR-ABL positivity; CLL needs a FISH panel to check p53 status and risk category; AML is categorised as good, intermediate or high risk. ALL is the most common leukemia in children and young adults and is treated with steroids followed by chemotherapy based on T-cell or B-cell type. AML M3, acute promyelocytic leukemia, is rare but very curable with ATRA or arsenic trioxide tablets; non-M3 AML needs chemotherapy.
At what age should women begin breast self-examination, and how should it be performed?▼
Self-examination should begin at age 18 and be repeated monthly. The technique uses the opposite hand to examine the opposite breast with three fingers held flat against the tissue, extending the examination to the axilla and the neck rather than the breast alone.
What imaging is recommended for women under 40 compared with those 40 and older?▼
Women under 40 are generally offered an ultrasound, while a mammogram can still be added if clinical suspicion is high. From age 40 onward, an annual mammogram becomes the standard recommended imaging.
How does the screening plan change for a woman with a known genetic mutation or strong family history?▼
These women fall into a high-risk category with a different plan. The recommended step is a direct conversation with an oncologist about personal and family history, which may lead to additional tests such as a breast MRI or a blood test for a hereditary mutation if suspicion is strong enough.
What should prompt an immediate ultrasound rather than waiting for a scheduled screening?▼
Any doubt found during a clinical breast examination warrants an immediate ultrasound. If the woman is 40 or older and there is doubt, a screening mammogram is the appropriate next step rather than waiting for the next routine visit.
In This Series: Diagnosing Common Cancers & Blood Disorders
- 1.Diagnosing Common Cancers and Blood Disorders
- 2.Breast Cancer in Young Women: Reading the Red Flags Beyond Age
- 3.Breast Cancer Screening: What to Do at 18, 30 and 40
- 4.When a Persistent Cough Isn't Tuberculosis: Diagnosing Lung Cancer
- 5.Colon Cancer, Lynch Syndrome and the Case for Cascade Testing
- 6.Ovarian Cancer: The Silent Killer and Its Diagnostic Trail
- 7.Cervical Cancer: From Diagnosis to Concurrent Chemoradiation
- 8.HPV Vaccination: Who Needs It and What It Prevents
- 9.Hepatocellular Carcinoma: Diagnosing Liver Cancer in Chronic Liver Disease
- 10.Oral Cancer: Recognizing a Non-Healing Ulcer Early
- 11.Acute Promyelocytic Leukaemia: A Bleeding Emergency Hiding in Plain Sight
- 12.The Basic Blood Panel: A GP's First Line of Defence Against Missed Cancers