Screening for Breast Cancer

Breast cancer is the most common cancer in Australian women. About 1 in 7 women will be diagnosed during their lifetime. Around 20,000 Australians are diagnosed each year and 5-year survival is approximately 93%.

  1. Average-risk screening
    • Mammogram every 2 years from age 50–74 years through BreastScreen Australia.
    • Women aged 40–49 years may self-refer for free screening but are not routinely invited.
    • Women aged ≥75 years can access BreastScreen, but routine screening is not generally recommended because evidence of net benefit is insufficient.
    • Screening applies to asymptomatic women. A breast symptom requires diagnostic assessment, not routine screening.
    • For expanded detail: Mammograms and Breast Augmentation
  2. Moderately increased familial risk
    • Think:
      • 1 first-degree relative diagnosed <50 years, or
      • 2 first-degree relatives on the same side of the family, or
      • 2 second-degree relatives on the same side, with ≥1 diagnosed <50 years.
    • Consider mammographic screening from age 40–74 years, at least every 2 years.
    • Some women may warrant annual mammography from age 40.
  3. Potentially high familial / genetic risk
    • Think multiple cancers on one side of the family plus red flags:
      • breast cancer <40 years
      • bilateral breast cancer
      • breast and ovarian cancer in the same person
      • male breast cancer
      • Ashkenazi Jewish ancestry
      • known pathogenic familial variant such as BRCA1/BRCA2.
    • Also remember paternal family history counts just as much as maternal history.
    • Refer to a familial cancer service / genetics service for formal risk assessment, genetic counselling and consideration of testing.
    • High-risk surveillance may include MRI plus mammography, rather than simply “more frequent BreastScreen”.
    • For expanded detail: Genetic Counselling
  4. BRCA and other hereditary cancer testing
    • Do not simply order BRCA testing as routine GP screening.
    • Current MBS germline testing items for hereditary breast/ovarian cancer are restricted to testing requested by a specialist or consultant physician in patients meeting defined criteria.
    • A GP’s role is to recognise the family-history pattern and refer for genetic assessment.
    • Testing now commonly involves a multigene panel, not just BRCA1/BRCA2; relevant genes can include PALB2, TP53, PTEN, CDH1 and STK11.
    • Public familial cancer services generally arrange testing without charge where criteria are met.
    • Private genetic testing is available, but cost varies by laboratory and panel; there is no useful single national price to quote.
    • For expanded detail: Genetic Counselling
  5. Family history changes risk
    • 1 first-degree relative: about 2× risk
    • 2 first-degree relatives: about 3× risk
    • ≥3 affected relatives: about 4× risk
    • Second-degree relative(s): about 1.5× risk
    • Risk rises further when relatives are diagnosed young, particularly <50 years.
  6. Clinical breast examination and self-examination
    • Routine clinical breast examination is not recommended for screening average-risk asymptomatic women.
    • Formal scheduled breast self-examination — eg “every 3 months” — is not the current recommendation.
    • Instead teach breast awareness: know what is normal and report a new or unusual change promptly.
    • Important changes include:
      • new lump or lumpiness
      • nipple inversion, crusting or discharge
      • change in breast size or shape
      • skin dimpling or redness
      • persistent unusual breast pain.
    • There is no preferred technique or interval for checking the breasts.
  7. What not to use for average-risk screening
    • MRI alone is not a screening test for average-risk women.
    • Thermography is not recommended.
    • Supplemental ultrasound or MRI solely for dense breasts remains an area where evidence of benefit versus harm is insufficient.
    • High-risk women are different: MRI may form part of specialist surveillance.
  8. Benefits and harms
    • Mammography reduces breast cancer mortality through earlier detection.
    • Harms include:
      • false positives
      • unnecessary biopsies
      • anxiety
      • overdiagnosis and overtreatment.
    • The balance of benefit is strongest in the 50–74 year target group.