
Come summer, community activist Eutha Prince likes to give herself a present before going on vacation: a mammogram. It was during one such mammogram that doctors found something suspicious on her right breast. She was diagnosed with breast cancer following a biopsy and ultrasound. The doctors recommended a tailored treatment plan that included a course of immunotherapy before surgery.
After undergoing a mastectomy, the doctors asked her to undergo radiation treatment and chemotherapy before breast reconstruction. About eight months after the final radiation therapy session, she underwent the procedure. Much has changed since. Eutha has resumed her job as the district manager for the community board in New York City’s West Harlem neighborhood. She lives her life to the fullest, jubilant about the second chance she got. Eutha is among many women who are lucky enough to beat this cancer because it was detected early. However, not everyone has a similar story to tell. The rising prevalence of breast cancer for decades has become a source of concern. Across the world, every 14 seconds, a woman is diagnosed with this cancer. What is more alarming is that approximately half of those diagnosed have no other risk factors other than sex and age. In 2022, almost 2.3 million women were diagnosed with breast cancer and nearly 670,000 died of it.
Furthermore, the prevalence and mortality rates widely differ between countries with high and low human development indexes, with the latter seeing higher deaths. In 2023, altogether there were more than two lakh cases and over 82,000 deaths in India. Early detection is the most potent tool for reducing the burden.
Over time, guidelines for breast cancer screening have undergone a major shift as research and technology have transformed the way it is detected, and risks are assessed. These guidelines have changed, adapting to the changing epidemiology. Hence, patients, caregivers, and policymakers must be aware of these changes to make critical decisions effectively.
A mammogram or low-dose X-rays of the breast, form the cornerstone of screening. In the past, mammograms were only meant for women past 50 years of age. For instance, the guidelines issued by the US Preventive Services Task Force (USPSTF) in 2016 recommended that women (≥ 50 years) undergo screening twice a year. In 2024, the revised guidelines recommended that women begin mammogram-based screening at 40 years of age. Similarly, the American Cancer Society provides the following recommendation for women at average risk of breast cancer:
Option to initiate yearly mammograms for women between 40 and 44
Yearly mammogram for women between 45 and 54 years
An annual mammogram for women 55 years and older
Women need to undergo an MRI and mammogram every year from 30 years of age if the following exist: a history of breast cancer, genetic factors that may hasten its development, radiation therapy on the chest before 30 years of age, and specific conditions.
Early-stage breast cancer is often treatable, and routine screening is essential to ensure its timely detection. Studies show that screening as early as 40 years of age can reduce breast cancer-related mortalities by 40%. Furthermore, compared to biennial screenings in women between 50 and 74 years of age, annual screening from 40 years onwards can save 13,000 more lives. Breast cancer can also be detected in women in the older age group with advanced imaging techniques such as digital mammography, breast MRI, and genetic testing.
A challenge of screening guidelines is balancing the risk of over-diagnosis and overtreatment with the benefits of early detection. While early detection can increase survival, it may also lead to unnecessary interventions such as biopsies or aggressive treatments. A study found that a significant number of women over 70 who undergo screenings are over-diagnosed. As a result, women may undergo treatment regimens that can negatively impact their quality of life. Today, with technological advancements and an increasing focus on personalisation, such instances can be prevented. For instance, 3D mammography (tomosynthesis) can significantly reduce the number of false positives. Similarly, artificial intelligence (AI) and machine learning are also aiding doctors to make more accurate diagnoses, allowing for a targeted approach. Hence, guidelines must take several factors into account including age and risk factors to ensure robust screening protocols that fully leverage newer screening methods.
The essence of cancer care is timely screening and early detection. If either fails, the prospects become poor. Advanced screening methods and an increased understanding of cancer risk factors are reshaping how and when screening is conducted. The adoption of digital and risk management tools help breast cancer care become more precise and patient-centric. These developments empower women and healthcare professionals to make more informed decisions while fostering better outcomes. As new research and tools emerge, breast cancer screening guidelines will continue to evolve, striking a fine balance between early detection and the need for personalised risk-based care.
Dr Jasmeet C Singh
breast medical oncologist
Memorial Sloan Kattering Cancer Center, New York