BREAST CANCER RISK ASSESSMENT AND SCREENING

Breast cancer risk

A collage of women with various ethnicities showing overall breast cancer risk of 1 in 7 women.

The National Screening Program

One in 7 women will develop breast cancer in their lifetime. Therefore, breast cancer screening has been running in many countries for more than 30 years as an important preventative health program. BreastScreen Australia actively invites women aged 50 to 74 for free two-yearly mammographic screening. Women aged 40-49 and those ≥ 75 are also eligible for this program, however they will need to proactively contact BreastScreen.

Following screening your mammogram will be independently examined by two expert radiologists. If there are no signs of cancer your results will be sent to you within 2-4 weeks. However sometimes you may be called back for more assessment. Naturally being recalled is anxiety provoking, but please note that most women who are called back for further tests do not have cancer!

It is important to note that BreastScreen is designed for cancer detection in asymptomatic women only. It does not provide you or your doctor with a comprehensive report of all findings on your imaging. If you have a breast symptom you should see your GP and receive an appropriate imaging referral based on your history and physical examination. 

Breast Density and Mammographic Screening

No screening program is 100% accurate and there is always a small chance your screening mammogram will look normal even if a small cancer is present. An important factor in the accuracy of mammographic screening is ‘breast density’ – a radiological term that shows the amount of glandular tissue relative to the fat in your breast.  The breast is composed of glandular tissue with a variable amount of fat interspersed between the glandular tissues, together held on the chest wall with a complex ligamentous network. Breast density is often classififed A to D, with A being the least dense breast which is almost entirely fatty, and D being extremely dense breast which is almost completely fibroglandular tissue with minimal fat. The higher the breast density the lower is the accuracy of mammographic screening.

Mammographic breast Density ranging from A to D with increasing density obscuring breast cancer shown with a star. Much easier to see the start in fatty breast and much harder in dense breast.

Blog: Demystifying Breast Density: Key Facts and Considerations

Generally younger women have a higher breast desity and as they go through menopause their glandular breast tissue is replaced by fat reducing their mammographic density. Another important factor in breast density is the body mass index (BMI) with overweight and obese women having a lower breast density compared to slim women.  

While BreastScreen Australia still uses the traditional 2D mammograms, there are newer technologies widely available in Melbourne through both private radiology practices and public hospitals that can significantly improve the accuracy of breast cancer screening. These technologies including 3D mammography (tomosynthesis), contrast enhanced mammogram (CEM) and breast MRI, maybe preferred in premenopausal women, those with higher breast densities and those with a higher risk of breast cancer. For further information and action plans check out my dedicated blog on breast density. 

Personalised Breast Screening

As mentioned above the national screening program follows an age-based screening protocol irrespective of the women’s risk factors and breast density. However we now understand that one size does not fit all. Every woman’s risk of breast cancer is influenced by a combination of factors — including family history, genetics, reproductive history, breast density, lifestyle, and more. This means that two women the same age can have very different risk profiles and therefore may benefit from different screening strategies. 

As mentioned above the national screening program follows an age-based screening protocol irrespective of the women’s risk factors and breast density. However we now understand that one size does not fit all. Every woman’s risk of breast cancer is influenced by a combination of factors — including family history, genetics, reproductive history, breast density, lifestyle, and more. This means that two women the same age can have very different risk profiles and therefore may benefit from different screening strategies.

Two women sit on cushioned chairs in a sunlit room, discussing breast screening, surrounded by plants and papers.

A personalised breast cancer screening approach moves beyond the “one size fits all” model by tailoring screening recommendations to an individual’s risk profile. This allows screening to be more targeted, more effective, and better aligned with a woman’s actual risk, rather than relying solely on population-based guidelines.

To address this, Melbourne Comprehensive Breast Care (MCBC) was established as Australia’s first personalised, risk-based breast cancer screening program. It was founded by Dr Saam Tourani following years of clinical research and collaboration with national and international experts in breast surgery, genetics, and breast imaging, with the aim of moving beyond the traditional “one size fits all” screening model.

MCBC offers an individualised approach to breast cancer screening by combining validated risk assessment tools with personal health information, including breast density and family history. This allows screening recommendations to be tailored to a woman’s true level of risk, rather than based on age alone.

For women seeking a more personalised assessment of their breast cancer risk and screening options, further information is available through Melbourne Comprehensive Breast Care.

Breast Cancer Risk Factors

Person wearing pink ribbon on shirt, breast cancer awareness symbol.

Blog: Breast Cancer Risk Factors

The risk factors for breast cancer can be widely divided into non-modifiable factors such as age, sex and family history, and modifiable factors such as obesity, alcohol use, high fat diet and sedentary lifestyle. We encourage you to refer to our dedicated blog on Breast Cancer Risk Factors for a more detailed discussion. 

Familial Breast Cancer Risk Assessment

Genetic family tree diagram illustrating familial breast cancer risk, with pink circles and blue squares representing family members.

Blog: Familial Breast Cancer and Genetic Testing

As mentioned above 1 in 7 Australian women will develop breast cancer in their lifetime. Therefore, it is very common for women to have a relative with breast cancer diagnosis and naturally become worried if they are at increased risk due to their family history. Based on their family history women are devided into average, moderate, or high risk of breast cancer which has implications in recommendation for screening, genetic testing and preventive therapies. We have a dedicated blog on Familial Breast Cancer and Genetic Testing which we encourage you to read.

Additional Resources