Breast cancer screening checking the breasts for early signs of cancer in women who have no symptoms of breast cancer.

The goal of breast cancer screening is to detect cancer early, before it has a chance to grow, spread or cause problems.

The death rate from breast cancer has declined about 20 percent over the past decade. This is due in part to increased screening as well as earlier and improved treatment for breast cancer. Screening usually detects the disease at an earlier stage when the chances of successful treatment are higher. Early detection and treatment of breast cancer improve survival because the breast tumor can be removed before it has a chance to spread (metastasize).

Traditionally, breast cancer was known to be almost associated with elderly people but with the increased screening, it is gradually being detected in younger populations.

According to WHO, breast cancer is the most common cancer in women both in developed and developing countries. The incidence of breast cancer is increasing in the developing world partly due to increased life expectancy, increased urbanization and adoption of western lifestyles. Majority of deaths due to breast cancer in low income settings is greatly because these cancers are detected in late stages where treatment intervention is very limited.

Previously, and to a great extent presently, proper medical equipment for early detection of these breast cancers were not accessible in low to middle income settings. Medical equipment such a mammogram which is the best screening test for reducing the risk of dying from breast cancer were not easily available.

A mammography is a specific type of breast imaging that uses a low dose X-rays to detect cancer early, before women experience any symptoms when it is most treatable. A breast lump which is too small for the doctor to detect on physical examination can be seen during a routine mammography and this can be taken out during the procedure (called stereotactic breast biopsy) which is then taken to the laboratory for further testing to look out for possibility of a cancer.

However, not every abnormal mammogram result means that one has breast cancer, and in fact most of the abnormal results aren’t cancerous and hence more tests are carried out. There are other investigations which are usually helpful in the diagnosis of possible cause of breast swellings, such as breast ultrasound scan, MRI. A CT scan of the chest and abdomen is usually done to determine the extent of the cancer once breast cancer has been identified.

Screening with mammogram is recommended at the age of 45 years and to done annually until the age of 54years, after which it is done after every 2 years. In women at higher risk of breast cancer, mammogram screening can begin at 40years.

Routine clinical examination and self-examination should be done though these have many limitations. Self-breast examination to feel for any breast lumps, skin changes, nipple changes should be done monthly and preferably a week after menses, if one is still experiencing periods. Any breast lump felt should not be ignored.

Some hospitals and medical centers in Rwanda run breast screening programs routinely. Rwanda Military Hospital runs a breast clinic every Wednesday of the week, where patients get to be reviewed and assessed for any suspicion or presence of breast cancer by a breast specialist surgeon and a Cancer specialist. All these health care interventions have led to early detection of breast cancer leading to early medical intervention with the overall total reduction in death of breast cancer in the country at large.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.