For younger women, dense breast tissue makes mammography produce unclear images, so breast ultrasonography is the preferred examination. Besides, mammography delivers certain radiation damage to young breasts, hence ultrasound is recommended. Breast self-examination is another screening option. At present, there are several mainstream approaches for breast cancer screening.
Mammography, an X-ray imaging test, was recommended by the American Cancer Society for women aged 35 to 40 to take one baseline scan for future comparison.
Women aged 40 to 49 are advised to receive mammography every 1 to 2 years, while those over 50 need annual mammograms. The peak incidence age of breast cancer in China is earlier than that in Europe and America. Therefore, local guidelines recommend annual mammography screening for women above 40. As mentioned above, mammography is less suitable for younger women due to dense breast tissue and radiation risks.
Does mammography harm young women’s breasts?
Adolescent, unmarried or childless women have underdeveloped breast tissue that cannot tolerate high-dose X-rays, as radiation itself carries carcinogenic risks. Two drawbacks make mammography inadvisable for young females: first, thick dense glands lead to low diagnostic accuracy; second, ionizing radiation causes tissue damage. Routine annual mammography screening is thus not encouraged for young women. For older women, breast glands atrophy with age, resulting in clear mammogram images, making this test highly effective for this age group.
Opinions on breast self-examination remain controversial internationally, yet most Chinese medical scholars recommend regular self-checks for women.
The optimal timing for self-examination is 7 to 10 days after menstruation. At this stage, breast glands are soft and free of tenderness, ideal for inspection. The specific operation steps are as follows: stand in front of a mirror, straighten and press the palmar surface of fingers flat against the breast. Use the right hand to examine the left breast and the left hand for the right breast, moving in either clockwise or counter-clockwise order. Do not overlook the nipple and areola areas. Lumps felt between the palm and chest wall indicate abnormal lesions. Never squeeze or pinch breast tissue during examination, as this is an incorrect operation.
Women are not expected to make definitive diagnoses on their own. Monthly self-examination is advised within 7–10 days post-menstruation. Seek professional hospital examination immediately if any abnormal changes are noticed compared with previous checks. Menopausal women can pick a fixed date each month, such as the 1st day of every month, to complete self-examination.
Most Chinese scholars regard breast self-examination as a practical screening method adapted to domestic conditions. A large number of breast cancer patients treated in outpatient clinics first detected breast abnormalities accidentally while bathing, changing clothes or resting. While some developed countries with strong public cancer prevention awareness do not fully promote self-examination due to international debates, the method is widely valued in China. It requires no medical equipment, is safe, low-cost and easy to perform.
Comprehensive screening combines mass screening tools including mammography and ultrasound with regular self-examination. If self-examination or workplace physical check-ups detect abnormalities, clinical palpation by doctors will determine whether further diagnostic tests are needed. Final pathological confirmation can be achieved via needle puncture or surgical excisional biopsy. Cytological and histological analysis of samples can distinguish benign conditions such as breast hyperplasia from malignant breast cancer.