It is said that all women, once they turn 20, should do breast screening regularly. During the procedure, the woman herself has the opportunity to get to know her body better and find out what breast condition is considered normal, so she can detect any changes more easily. Nevertheless, examples show that not many women do this, and sometimes breast screening is postponed to a later date (this is especially true for younger women).

"I am 21 years old. Even though I have heard about nasty breast diseases, I have never done breast screening. Having read some tragic stories, I realize that I should not delay this procedure, but I’m just not thinking about it at the moment," said Patricija (name changed, actual name known to DELFI), who lives in Vilnius.

Patricija understands that she – and every woman – should be responsible for her health.

"I know that breast cancer kills not only older, but also young women, and I’m definitely not indifferent towards my health, but it is obvious that I could do more to maintain it," she said.

According to Patricija, even though today there’s plenty of information online about breast cancer and other diseases and their symptoms, she started thinking about possible risks after a conversation with her mother.

"I asked mom if she undergoes preventative breast screening. She said she used to, but it was quite a while ago. I immediately wondered – why? Now I’m a little bit worried about my mother and myself, especially when I know that some symptoms can be unnoticeable. I think that both of us should pay more attention to breast cancer, especially because such diseases have a major negative effect on the person’s emotional state," she said.

Her mother Inga (name changed, actual name known to DELFI) is 48 years old. Inga said that she had only done preventative breast cancer screening twice.

"It was about seven years ago. I had some health issues at the time and went to a gynaecologist, who prompted to test the breasts. Just to be safe. Sure, while waiting for the results I was anxious because I had read about the frequency of this disease in women. Gynaecologist’s determination to see my breast test results also added to the frustration – I thought she might be suspecting something," Inga explained.

Thankfully, the results put her at ease.

"They were good, so I carried on with my life and I have not done another screening," she said.

She understands, though, that breast cancer screening should become a habit.

"When you think about it in greater detail, you realize you should be doing it, but you just don’t seem to find the time due to the other life stuff. I don’t have anyone in the family with breast cancer, but who knows where the evil gene lurks – my mother died from cancer in internal organs. I agree that breast cancer screening should become routine and I should encourage my daughter to care for her health because she has entered that particular age when you kind of have to start doing it," Inga added.

Although she does not like going to doctors and does not see them too often, this conversation made her think.

"I promise myself that, encouraged by this discussion, I and my daughter will book an appointment for breast cancer screening," she admitted.

Breast cancer is one of the most common oncological diseases in women, but, according to Gudaviciene, there are various breast diseases.

"A wide variety of benign diseases, conditions, and just medical terms exist. There used to be a disease called mastopathy. Today, this term is usually used to describe all kinds of benign changes in the breasts with no tumours present," she said.

"There are conditions like breast pain, which is typically caused by hormones and cyclic changes. Sometimes the pain is not even related to the breast, but more to the thoracic wall and changes in the spine, for example, compression of nerve roots. We also have various benign tumours that sometimes have to be removed surgically due to their size or unclear development. But the majority of such small changes can be safely monitored because now we have great diagnostic tools," Gudaviciene continued.

The plastic and reconstructive surgeon’s explanation is somewhat comforting, i.e., not all breast changes are malignant and not necessary mean a horrible disease. But it is important to know about the bad ones.

"When it comes to the bad diseases, again, there are several types. Usually, they are gland tissue tumours (in lobules, ducts, etc.): various carcinomas and connective tissue tumours like sarcomas, which are also malignant. Also, metastases can appear in breasts from other cancers. For example, melanoma metastasis, ovarian cancer metastasis. Obviously, such cases are rarer, but we do see them sometimes," she noted.

Gudaviciene says that these are the most common types of breast-related illnesses, but the list does not end here.

"You can also get Paget’s disease of the nipple, which causes sores and other changes in the nipple. Sometimes the skin just flakes or burrs. If a woman who is not breastfeeding or a man has a damaged nipple, they should see a doctor", she continued.

When we talk about breast diseases, we usually have only women in mind, but men should stay vigilant as well.

"It is a burning issue because men, too, can get benign tumours, for example, lipomas (lumps of fatty tissue), glandular tissue hyperplasia, or breast enlargement due to excess glandular and fatty tissue," Gudaviciene said.

According to her, in Lithuania cases of breast cancer in men are registered every year.

"The thing is that men and their partners find it very difficult to detect the symptoms. Sometimes even the general practitioner dismisses the possibility that the male patient may have breast cancer. So if you feel some formation by touching your breasts or notice nipple dimpling, sores, do not hesitate and have it checked," she recommended.

The doctor insists that the symptoms should not be ignored.

"We basically don’t see men with stage 1 breast cancer. They come only when the changes have become more pronounced. Perhaps at first they don’t believe its breast cancer or maybe are ashamed of going to the so-called women’s doctor. But it can happen, that is why men, too, should consider the possibility," she said.

Radiological and Nuclear Medicine Centre doctor Lekiene added that in certain cases this problem should be treated even more seriously: "The men whose first-degree relatives had breast cancer should pay more attention to their breasts, touch them more frequently, or see a specialist from time to time."

According to Lekiene, the range of methods to confirm a breast disease is very wide.

"That’s something to boast about. Even though our country is relatively small, we can provide quality diagnostic services. First of all, I would like to stress that in Lithuania all women aged 50 through 69 are invited to participate in a special programme which includes a mammogram every two years. Also we have noticed that more women come for a screening, but not the majority of them, the numbers are still too little," she lamented.

Lekiene added that when such women are asked why they do not come for regular screening, they answer that they had come once.

"I would like to stress that women should get a mammogram every two years, unless their doctor recommends shorter intervals," she noted.

Unfortunately, experience shows that today younger women are diagnosed with breast cancer.

"Younger women who notice something strange with the breasts should see a doctor and do an ultrasound scan of the breasts. This test is more suitable for younger women and, of course, for women with the glandular tissue dominating in the breasts (found during a mammography)," the Radiological and Nuclear Medicine Centre doctor suggested.

The risk of developing breast cancer may also increase if there were such cases in the family or among first-degree relatives.

"The women who have a BRCA mutation, first or second, or first-degree relatives that were diagnosed with breast cancer by the age of 50 should do a screening test. Lithuania is the only country in East Europe with a screening programme for such women – a preventative MRI yearly because, according to various literature, their risk of getting breast cancer increases to about 70%," Lekiene informed.

If you have noticed or felt something strange in the breasts, Gudaviciene first of all recommends seeing your GP.

"The GP should refer the woman who complains about breast-related symptoms to a breast care specialist for a consultation. Such women who already feel that there’s something wrong with their breasts should not be told to join the aforementioned programme – their situation is much more urgent. The programme is for women who don’t feel anything, and their GP does not suspect anything. Similarly, the programme was not created for women who had already been treated for breast cancer," Gudaviciene explained.

According to her, other misleading situations happen as well.

"A woman comes for a check-up and states: "I’m not 50 yet, so I can’t get a mammogram as part of the screening programme." It’s not like that. The programme is oriented towards the peak age with the greatest number of cases to decrease mortality since that is the main goal. The programme is for women aged 50 through 70, but younger women also get sick. For example, in families with breast cancer cases, especially among young women, or for women who have a lot of fatty tissue in their breasts, we suggest getting a mammogram much sooner than the programme-relevant age," she elaborated.

Gudaviciene revealed that once you reach the programme-relevant age or feel some of the symptoms, it’s a different scenario. However, a large group of women are not qualified for the programme yet or already are past the indicated age. The doctor suggested that such people should be referred for preventative tests by their GP.

"For young women, the main test is ultrasound. Later, at the age of 40–45, ultrasound should be combined with mammography. But if you have family members with early onsets of breast cancer, we recommend doing an ultrasound test 10 years before the earliest case in your family was detected. It should be warranted, though, because you don’t want to suggest a mammogram to a young woman whose breast tissue is glandular, so as not to provoke cancer because mammography is a radiological, rentgenological test. We try to use it sparingly and avoid when possible," Gudaviciene said.

As Lekiene puts it, before doing a mammography, the risks and benefits are assessed.

"Actually, the doses of radiation aren’t as huge as they used to be. Some women are definitely worried about the radiation, but the doses are safe, everything has been scientifically tested, proved, and calculated. The radiation doses are permissible and not harmful," she ensured.

During the interview, Gudaviciene stressed time and again that upon having noticed any symptoms, one should not ignore them. She also pointed out that currently as many as 30–40% of cancer cases that are being treated present no symptoms.

"Preventative screening is key here because the sooner you identify the type of cancer, the less aggressive treatment is needed. For instance, if we diagnose breast cancer at stage 0, chemotherapy is out of the question. If its stage 1, the prognosis is much better than the later stages," she said.

Gudaviciene also told how to notice certain breast cancer symptoms or breast changes.

"Examine yourself in front of the mirror. You can do this by putting your hands to the sides or raising them. In the mirror, you can clearly see all skin cracks, indentations, and changes in breast symmetry. You should feel your breasts with your hands once a month. It doesn’t matter how – laying down or standing upright, in the shower or in the bed – what matters is feeling the entire surface area. Every woman knows what her breasts should feel like to the touch. Their partners, too, often notice changes. We have all kinds of strange examples, including cases when people come with fist-sized formations and say that they hadn’t noticed them," she shared.

According to the doctor, a particularly nasty type of cancer is inflammatory breast cancer.

"If the woman is breastfeeding and has mastitis – this can happen, it is not rare – the condition should be treated with antibiotics. If there’s no fever, no inflammation indicators, but the breast is swollen, inflammatory breast cancer should be considered. It is quite aggressive, so seeing the doctor as soon as possible is vital," she warned.

Regarding the changes that you can feel by touch, Lekiene instructed on when to do a self-exam.

"Women should feel their breasts by touch after a menstruation cycle. Women often ask, when to do it. Well, it should become a habit, just check your breasts on the last day of the cycle," she advised.