Breast Cancer Screening: Mammography Guidelines and How to Prepare Patients

Tumour markers can be used, but it is important to understand the patient's age, family history and smoking status first. At a basic level, a mammography for women, an ultrasound of the whole abdomen for endometrial or ovarian cancer, a serum PSA blood test for men with suspected prostate cancer, and a CT scan of the chest for smokers can be recommended. The frequency varies: colon cancer screening can be a colonoscopy every ten years, or a sigmoidoscopy with a faecal occult blood test.

This is a real issue even in India, where processing time for biopsies can be high in some regions. One workaround is relying more on FNAC, which is not the best strategy but can guide treatment decisions in select situations where a diagnosis is otherwise delayed. A second option is a frozen section facility, which gives some confirmation quickly but is resource-intensive and usually only available at high-volume cancer centres. Short of that, it is best to refer to an oncologist who can guide where a biopsy should be taken from for the best results.

The most important myth is patients' hesitancy to get a biopsy done, fearing it will cause the cancer to spread. A biopsy is one of the most crucial tests a cancer patient needs, and if planned and performed correctly it will not cause the cancer to spread. Another myth is that patients believe cancer is their own fault, from dietary habits or indulgences like tobacco or alcohol. More cases are now understood to happen because of environment or genetics rather than a patient's own fault, and it is important to destigmatise patients suffering from cancer, since stigma is what keeps them from seeking timely treatment.

Definitely. Breast conservation surgery is one of the advanced techniques for treating early breast cancer and is routinely discussed as a possibility with patients. It offers a definite cosmetic advantage, but it needs to be followed up with radiotherapy, and there are strict criteria on imaging and family history that must be met before it is offered. It is now combined with oncoplasty, which improves how the scars are closed for a better cosmetic outcome.

This is a tricky situation where metastatic deposits are seen without knowing where they are coming from. A PET scan is needed to confirm there is no other site of disease in the body, and immunohistochemistry on the biopsy can give clues to where the cancer is arising from, guiding directed and targeted imaging afterward. Many times the primary is never found. If there are only liver metastases, treatment starts with a palliative intent, and depending on how the patient responds and their performance status, a curative approach involving surgery may later be attempted, though nothing can be assured to the patient in advance.

Digital mammography or digital breast tomosynthesis is recommended every one to two years for women aged 50 to 74.

Avoid scheduling it the week before or during a period, avoid deodorant, powder or perfume on the day of the scan since these can show up as artefacts, wear a top with a skirt or trousers rather than a dress, and wait four to six weeks after any recent vaccination.