Frequently asked questions

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1. What is BreastScreen Australia?
2. When did BreastScreen Australia begin?
3. What is breast cancer?
4. What causes breast cancer?
5. What are the main risk factors for breast cancer?
6. What are some of the unproven risk factors associated with breast cancer?
7. How is a screening mammogram taken?
8. Does having a mammogram hurt?
9. Do mammograms cure cancer?
10. At what age does BreastScreen Australia encourage women to start having screening mammograms?
11. Why does BreastScreen Australia promote re-screening every two years for women aged 50-69 years?
12. What is the national BreastScreen Australia policy on screening women younger than 50?
13. What are the differences between a screening mammogram and a diagnostic mammogram?
14. Should women with a disability have a mammogram?
15. Where can I go and how do I book to have a mammogram?
16. Where can I find information on breast awareness?
17. Lately, I have noticed a change in one or both of my breasts. Is this cancer and what should I do?
18. Can I have a mammogram if I have breast implants?
19. I have a family history of breast cancer. Should I have a mammogram even though I am under 40 years of age?
20. How safe is the Pill?
21. How safe is hormone replacement therapy?
22. Is there any risk for my unborn child if I have a routine screening mammogram when pregnant?
23. Can I have a mammogram if I am breastfeeding?
24. How do I update my contact details?
25. Is thermography as effective as having a mammogram?

1. What is BreastScreen Australia?

BreastScreen Australia is the national breast cancer screening program. It provides free screening mammograms at two-yearly intervals for women aged 50-69 with the aim of reducing deaths from breast cancer in this target group, through early detection of the disease.

The state and territory governments have primary responsibility for the implementation of the Program at their local level. The Australian Government provides overall coordination of policy formulation, national data collection, quality improvement, monitoring and evaluation.

2. When did BreastScreen Australia begin?

Funding for the National Program for the Early Detection of Breast Cancer was announced in March 1990 and the Program began in 1991. The name BreastScreen Australia was adopted by the Program in 1996.

3. What is breast cancer?

Breast cancer occurs when cells in a woman's breast tissue start to grow abnormally. Breast cancer can be benign (staying within the breast) or malignant (able to spread outside of the breast).

There are several different types of breast cancer. The term 'breast cancer' usually refers to the most common type, which is called adenocarcinoma. Other types of breast cancer include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Treatment of the disease depends upon the type of breast cancer diagnosed in a woman (National Breast Cancer Centre 2003).

Breast cancer is usually a slow growing cancer. If the disease spreads it can invade the lymph nodes under the armpit, and can then invade other tissues such as the bones and the lungs. This is called metastatic disease (National Breast Cancer Centre 2003).

Outcomes for women with breast cancer are improving over time. This is probably due to early detection through screening and more effective treatments. For data on survival rates, you can view the AIHW’s publication – Breast cancer in Australia: an overview, 2006.

4. What causes breast cancer?

The cause of breast cancer is unknown.

5. What are the main risk factors for breast cancer?

Growing older

Age is the biggest risk factor in developing breast cancer. Around 75% of all breast cancers occur in women over the age of 50. Current research shows that breast cancer screening is most effective in detecting early breast cancer in women aged 50-69 years.

Family history

Family history can be a strong indicator of women who are likely to benefit from screening. Having a mother, sister, daughter, father, son, brother, aunt or cousins who developed breast cancer before the age of 50 increases a woman’s risk of developing breast cancer. Staff at BreastScreen Australia services can assist women in working out their family history.

However, nine out of ten women who develop breast cancer do not have a family history of breast cancer.

If you are concerned about your family history of breast cancer, you may wish to go to the National Breast Cancer Centre's website for more information.

Being overweight

Overweight women are at an increased risk of developing breast cancer, particularly after menopause. The level of risk increases with increasing body weight. (National Breast Cancer Centre)

Alcohol

Having more than two standard drinks per day increases a woman’s risk of developing breast cancer. This risk increases with each additional standard alcoholic drink. (National Breast Cancer Centre)

Hormone replacement therapy (HRT)

Use of combination hormone replacement therapy by postmenopausal women for five or more years is associated with increased risk of breast cancer. This risk is not evident for oestrogen-only preparations. (National Breast Cancer Centre)

An individual woman’s level of risk in relation to HRT will vary according to her circumstances and medical history. Women who are considering starting or who are taking HRT should always discuss their risks and options with their GP.

Having a child late in age or not having any children

Women who have their first child at an early age have a lower risk of breast cancer. Women who never have any children or who have a child later in life have a slightly higher risk of developing the disease (Meister & Morgan 2000).

6. What are some of the unproven risk factors associated with breast cancer?

Smoking

Though smoking increases the risk of other cancers, it has not been shown to increase the risk of breast cancer. However, recent research raises the possibility that environmental tobacco smoke, or passive smoking, may increase the risk of breast cancer in some subgroups of women.

A bump or knock to the breast

There is no evidence that a bump or knock to the breast will increase a woman’s risk of developing breast cancer.

Stress

There is no evidence that psychosocial stress increases a woman’s risk of developing breast cancer

Wearing a bra

There is no evidence that wearing a bra will cause breast cancer. (American Cancer Society 2002)

Wearing deodorant

There is no evidence to support the view that wearing deodorant will increase the risk of breast cancer. (Meister & Morgan 2000)

Breast size

There is no evidence to suggest a link between the size of women's breasts and breast cancer. (Meister & Morgan 2000)

7. How is a screening mammogram taken?

A radiographer will position and compress each breast in turn between two flat plates for about 10-15 seconds while the X-ray is being taken.

8. Does having a mammogram hurt?

Pressing (compression) of the breast during a screening mammogram is vital to obtain the best possible picture and to minimise the amount of radiation that is used. If the breast is not compressed, the x-ray picture will appear blurred so that any changes which may have occurred will be harder to find.

Compression of the breast does not hurt for most women, although some women may find it uncomfortable or even painful. Occasionally the compression can result in breast tenderness or bruising but this does not last very long. If your breasts are generally tender, please let the radiographer know before your screening mammogram is taken. The compression will only last a few seconds and you can ask the radiographer to stop if necessary. There is no evidence that having a mammogram harms the breast.

9. Do mammograms cure cancer?

Screening mammograms do not cure cancer or prevent breast cancer from developing in the future, nor are they 100% accurate. However, in women aged 50-69 years, screening mammography is the best way of detecting unsuspected cancer at an early stage.

10. At what age does BreastScreen Australia encourage women to start having screening mammograms?

BreastScreen Australia is targeted specifically at women without symptoms aged 50-69 years where the evidence is that screening has the greatest potential to prevent mortality from breast cancer. Women aged 40-49 and 70 years and older, who have no breast cancer symptoms or signs, are also eligible for free screening mammograms.

11. Why does BreastScreen Australia promote re-screening every two years for women aged 50-69 years?

Two-yearly screening mammograms are the best way for women aged 50-69 years to detect breast cancer early, before there are any signs or symptoms. Early detection in this age group offers women a better chance of successful treatment and recovery.

12. What is the national BreastScreen Australia policy on screening women younger than 50?

Women 40-49 years

Age is the biggest risk factor in developing breast cancer. Around 75% of all breast cancers occur in women over the age of 50. Current research shows that breast cancer screening is most effective in detecting early breast cancer in women aged 50-69 years.

Current evidence indicates that the benefits of breast cancer screening for women aged 40-49 years are not strong enough to encourage all women in this age group to have regular breast cancer screening.

Women in their 40s who have no breast problems are able to have a free screening mammogram through BreastScreen Australia if they wish. However, they are not specifically targeted to attend.

BreastScreen Australia will continue to review this policy as new research becomes available.

Women 40 years and under

Regular screening mammograms are not recommended for women under 40 years. One reason is that the risk of breast cancer in young women is low compared to that of older women. Also, mammographic screening is not as effective in younger women. As women grow older and approach menopause, their breasts change and become less dense or solid. The tissue of younger women's breasts is usually more dense than that of older women and can show up as white areas on the x-ray. Breast cancers also show up as white areas on x-rays. This makes breast cancer more difficult to detect in young women. Women under 40 years of age are therefore more likely to have an unnecessary recall for assessment, with all the anxiety associated with this, and sometimes invasive investigations, when there was no cancer there in the first place.

Younger women who notice any unusual breast lumps, pain or nipple discharge should see their doctor immediately. Those who are concerned about their individual risk of developing breast cancer should also seek advice from their doctor.

13. What are the differences between a screening mammogram and a diagnostic mammogram?

The key difference is the purpose for which the mammogram is done.

A screening mammogram performed in the BreastScreen Australia program is a free breast x-ray test for women who do not have any symptoms (i.e. asymptomatic or well women). Screening mammograms do not require a doctor's referral.

A diagnostic mammogram is a more complex x-ray of the breast and is done for the following reasons:

• to evaluate abnormalities seen or suspected on a prior screening mammogram;
• to evaluate abnormalities in the breast such as a lump, pain, thickening, nipple discharge or a inexplicable change in breast size or shape; or
• in circumstances where it is difficult to obtain a clear x-ray by a screening mammogram, such as when a woman has breast implants.

A diagnostic mammogram may incur a cost and requires a doctor's referral to a private or public radiology practice. Diagnostic mammograms are not offered within the BreastScreen Australia program, except as part of further assessment following a screening mammogram that shows an abnormal area.

On occasions, it is necessary for women to be called back for additional x-rays, usually for technical reasons. Some women need to have additional tests at an assessment clinic because their x-rays show changes in their breasts. Such tests may include additional breast x-rays (diagnostic mammograms), an ultrasound and breast examination. Nine out of ten women who are asked to return for further tests do not have breast cancer.

14. Should women with a disability have a mammogram?

Women with a disability are as much at risk of breast cancer as other women. BreastScreen Australia services endeavour to ensure that services are acceptable to and appropriate for women with disabilities.

In all states and territories women have access to a telephone helpline (13 20 50) for the cost of a local call. This provides further information on breast cancer screening, including access issues. Each woman’s individual requirements in relation to longer appointments and equipment needs are recorded by BreastScreen Australia for their subsequent visits.

BreastScreen Australia’s National Accreditation Standards require services to meet the needs of women with a disability by:

• offering longer appointments;
• ensuring there is appropriate access to services;
• ensuring all staff of the Service are adequately trained and equipped to provide care to people with a disability;
• providing access to a nurse/counsellor;
• facilitating transport, where appropriate; and
• providing appropriate education materials.

For more information about access to BreastScreen Australia services ring 13 20 50 (for the cost of a local call). Alternatively, contact your state or territory BreastScreen Australia Program.

We recommend that you talk to staff about any particular requirements you may have when you make your booking.

15. Where can I go and how do I book to have a mammogram?

In order to make an appointment for a mammogram, you can contact BreastScreen Australia by telephone on 13 20 50 (for the cost of a local call).

BreastScreen Australia services are provided in a wide range of centres, including mobile units (vans) in some areas.

16. Where can I find information on breast awareness?

The National Breast Cancer Centre's website has information for women on breast health. This material appears in a section targeting women under 40 years of age as mammograms are not recommended for women in this age group. However, the techniques described are suitable for older women as well.

17. Lately, I have noticed a change in one or both of my breasts. Is this cancer and what should I do?

From time to time you may find breast changes, such as:

• a lump or lumpiness;
• any change in the shape or appearance of the breast such as dimpling or redness;
• an area that feels different to the rest;
• a discharge from the nipple;
• any change in the shape or appearance of the nipple such as pulling in or scaliness (nipple inversion or retraction); or
• pain.

Many women are concerned that a breast change might be breast cancer. Even though this will not be true in most cases, it is very important that all breast changes are carefully investigated. If it is cancer, finding it early will mean a much better chance of effective treatment.

If you notice a breast change or experience a breast symptom you should see your doctor without delay. A doctor will do a clinical breast examination and refer you for further tests such as a diagnostic mammogram or ultrasound if needed. These tests require a doctor's referral and may be performed in a private radiology practice or a public hospital.

18. Can I have a mammogram if I have breast implants?

Mammographic screening is generally safe for women with implants. There is an extremely small chance that the pressure placed on the implant by the mammography machine could cause the implants to rupture or break.

In women who have implants which have already ruptured or started to leak, it is possible that having a mammogram could increase the amount of silicone or saline (depending on the type of implant) spreading into the breast tissue.

In some women with implants, very small amounts of silicone or saline (depending on the implant) pass through the pores of the implant shell. This is sometimes called 'bleeding' of the implant. At present it is not known whether mammography increases 'bleeding' of implants.

There is a small chance that mammography will change the shape of the breasts by dispersing the fibrous capsule that often grows around the implant. The breast may feel softer after mammography. However, it cannot be guaranteed that both breasts will be affected equally.

You should discuss with your GP as to whether screening mammography is suited to your particular circumstances. Should you decide to attend for a screening mammogram, please advise the staff when you make the appointment that you have implants.

19. I have a family history of breast cancer. Should I have a mammogram even though I am under 40 years of age?

While having a family history of breast cancer can increase your risk, it is important to note that nine out of ten women who develop breast cancer do not have a family history of breast cancer.

The National Breast Cancer Centre has developed guidelines entitled Do you have breast cancer in your family? to help you work out if you have an increased chance of developing this disease.

See your general practitioner to discuss any further concerns regarding your family history of breast cancer. If you require a further examination your general practitioner will refer you to a specialist.

20. How safe is the Pill?

Very safe. Prolonged, uninterrupted exposure (5 to 10 years or more) may slightly increase the risk of breast cancer.

21. How safe is hormone replacement therapy?

Hormone replacement therapy (HRT) carries an increased risk of breast cancer. The risk increases with the duration of treatment. Short periods of HRT for relief of menopausal symptoms increase risk only slightly and the increase reverses after HRT is stopped.

22. Is there any risk for my unborn child if I have a routine screening mammogram when pregnant?

It is advised that you wait until after pregnancy to have a screening mammogram. This is because there would be scattered radiation to the foetus. Also the breast tissue is very dense during pregnancy (and breastfeeding) which significantly reduces the sensitivity of mammography.

23. Can I have a mammogram if I am breastfeeding?

You should generally wait six months after you have stopped breastfeeding to have a mammogram, as the image can be harder to read and you may also experience increased discomfort. If you think you have any symptoms of breast cancer you should see your GP who may refer you for diagnostic procedures.

24. How do I update my contact details?

In order to update your contact details, please contact BreastScreen Australia on 13 20 50 for the cost of a local call.

25. Is thermography as effective as having a mammogram?

The BreastScreen Australia Program does not recommend the use of thermography for the early detection of breast cancer.

Studies have shown that a tumour has to be large (several centimetres in diameter) before it can be detected by thermography (Homer 1985). Screening mammograms have the ability to detect breast cancer at a much smaller size, and therefore to reduce deaths from breast cancer. Less than 50% of breast cancers detected by mammography screening have an abnormal thermogram (Martin 1983).

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Page currency, Latest update: 03 July, 2007