No Lump? Why Breast Cancer Screening Still Matters

Every October, pink ribbons remind us of Breast Cancer Awareness Month, also known as Pink October. But breast health deserves attention all year round, even when everything feels normal.

One common belief is: “If I can't feel a lump, I don't need a breast check.” Unfortunately, breast cancer can develop without noticeable symptoms. That is why screening matters: it can detect changes before you feel them.

Here's what you should know about when to start screening, which tests are available, and how to prepare.

Why you shouldn't wait for a lump

Breast cancer is the most common cancer among women in Thailand and worldwide. Early breast cancer often causes no pain or obvious changes. A lump may not appear until the cancer has been developing for some time.

Finding cancer early can make a significant difference. According to the American Cancer Society, the five-year relative survival rate is over 99% when breast cancer is confined to the breast. For cancer that has spread to distant parts of the body, it is about 32%. These figures describe groups of patients, not an individual's prognosis.

The purpose of screening is to find cancer earlier, when treatment is often more effective.

When should you start breast cancer screening?

In its 2024 guidance, the US Preventive Services Task Force (USPSTF) recommends a mammogram every two years for women aged 40 to 74 who are at average risk of breast cancer.

Some people may need a different screening plan. Speak with your doctor if you have:

• A mother, sister, or daughter with a history of breast or ovarian cancer
• An inherited genetic change, such as BRCA1 or BRCA2
• Received radiation treatment to the chest at a young age
• A personal history of breast cancer or certain abnormal breast biopsy results

Your doctor can help you decide when to begin and how often to be screened based on your individual risk.

Mammogram vs breast ultrasound: what's the difference?

A mammogram uses low-dose X-rays to look for changes inside the breast. It is the main recommended screening test for women at average risk. It can detect small cancers and tiny calcium deposits that cannot be felt.

A breast ultrasound uses sound waves to create images. Doctors may recommend it alongside a mammogram, particularly when breast tissue is dense.

Dense breasts contain more glandular and fibrous tissue than fat. Both dense tissue and some cancers appear white on a mammogram, making suspicious areas harder to identify.

In the Japanese J-START study of women aged 40 to 49, adding ultrasound to mammography increased the proportion of cancers detected by screening, from about 77% to 91%. However, it also led to more callbacks and additional tests for women who did not have cancer.

It is not yet clear whether adding ultrasound reduces breast cancer deaths, so it is not routinely recommended for everyone. If you have dense breasts, ask your doctor whether additional imaging would be useful for you.

Does a mammogram hurt?

During a mammogram, each breast is briefly compressed between two plates to obtain a clear image. You may feel pressure or discomfort, and some people experience short-lived pain. The compression usually lasts only a few seconds per image.

To make your appointment more comfortable:

• If you menstruate, consider scheduling the test for the week after your period, when your breasts may be less sensitive.
• Avoid deodorant, antiperspirant, powder, or lotion on your breasts and underarms on the day of the test.
• Wear a two-piece outfit so you only need to remove your top.
• Bring previous mammogram reports or images, if available, for comparison.

Called back after a mammogram? Here's what it means

Being asked to return for additional imaging can feel worrying, but it does not necessarily mean you have cancer. According to the American Cancer Society, fewer than one in ten women called back after a screening mammogram are diagnosed with cancer.

Sometimes the radiologist simply needs a clearer image, another view, or an ultrasound to understand what appeared on the first scan. Follow the recommended next steps rather than assuming the worst.

Know what is normal for your breasts

Screening is important, but you should also be familiar with how your breasts usually look and feel. Contact a doctor if you notice a new or unusual change, including:

• A lump or thickening in the breast or underarm
• Swelling in part or all of the breast
• Dimpling or puckering of the skin
• A nipple that has recently turned inward
• Redness, scaling, or thickening of the nipple or breast skin
• Nipple discharge other than breast milk
• Breast or nipple pain that does not go away

Many breast changes are not caused by cancer. Still, any new or persistent change deserves medical attention, even if your next routine screening is months away.

Getting a mammogram in Thailand

Hospitals and clinics across Thailand offer breast screening services, including mammograms and breast ultrasounds. Some private hospitals may also provide a doctor's consultation and results on the same day, depending on the facility and tests required.

If you are visiting Thailand and plan to get screened:

• Arrange your appointment early in your trip in case follow-up tests are needed.
• Ask when your results will be ready and who will explain them.
• Request copies of your imaging report and images.
• Share the results with your regular doctor for future follow-up and comparison.

Frequently asked questions

At what age should I start breast cancer screening?
The USPSTF recommends mammograms every two years from ages 40 to 74 for women at average risk. If you have a higher risk, ask your doctor about an individual screening plan.

Is breast ultrasound better than a mammogram?
Not necessarily. Mammography remains the main screening test. Ultrasound may provide additional information, particularly for dense breasts, but it can also lead to more follow-up tests.

Does a mammogram hurt?
You may feel pressure or brief discomfort while your breast is compressed. The compression lasts only a few seconds per image.

Should I worry if I'm called back?
A callback means more information is needed, not that cancer has been diagnosed. Most women called back after screening do not have breast cancer, but it is important to complete the recommended tests.

What breast changes need medical attention?
See a doctor about a new lump, swelling, skin dimpling, nipple changes, unusual discharge, or persistent breast pain. Do not wait for your next scheduled mammogram if you notice a change.

This Pink October, take the next step

Wearing a pink ribbon helps raise awareness. Knowing when you need breast screening, and following through with it, can make that awareness meaningful.

If you are 40 or older, ask your doctor when your next mammogram should be. If you have a family history or other risk factors, discuss a screening plan that fits your needs. And if you notice a breast change, seek medical advice without waiting for October.

Explore hospitals and clinics in Thailand on ArokaGO and contact a provider to ask about available breast screening services.

References

1. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. 2024;331(22):1918–1930.
2. Giaquinto AN, et al. Breast cancer statistics 2024. CA Cancer J Clin. 2024.
3. Ohuchi N, Suzuki A, Sobue T, et al. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial. Lancet. 2016;387(10016):341–348.
4. International Agency for Research on Cancer. CanScreen5 country fact sheet: Thailand (GLOBOCAN 2022).
5. American Cancer Society. Mammogram basics and breast cancer signs and symptoms.
6. Breast Cancer https://www.arokago.com/en/health-library/breast-cancer

This article is for educational purposes only and does not replace advice from a qualified healthcare professional. If you notice any change in your breasts, please see a doctor.