Every year, approximately 9,000 new cases of breast cancer are diagnosed in Portugal, that is, about 11.6% of all cancer diagnoses in the country. Breast cancer is the most common oncological disease and the leading cause of cancer-related deaths in Portuguese in women. In our country, more than 2,000 women still die per year due to this disease. National breast cancer screening program Portugal has had an organized breast cancer screening program since the 1990s, coordinated by the Liga Portuguesa Contra o Cancro and the Serviço Nacional de Saúde (SNS). Since 2025, the program has been extended to women aged 45 to 74 , following new European guidelines, and is conducted every two years through mammography. Between 1990 and 2024, more than 6 million mammograms were performed, identifying approximately 36,000 women with suspicious lesions and referring them for medical evaluation. Screening saves lives and also improves quality of life Regular screening is important for the early detection of breast cancer , allowing for less aggressive treatments with a higher success rate. It allows for a reduction of up to 40% in breast cancer mortality. Earlier breast cancer diagnoses mean less invasive surgeries and lower chemotherapy rates. When diagnosed at stage 0 or 1, breast cancer has a cure rate of over 95%. In Portugal, the 5-year survival rate is over 85%, among the best in Europe. What are the international recommendations for breast cancer screening? Current recommendations for breast cancer screening vary somewhat between major North American and European scientific societies. For the general population with no known family or genetic history : The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) recommend starting screening at age 40, with annual mammograms, and with no upper age limit, as long as health permits. The United States Preventive Services Task Force (USPSTF) recommends mammography every two years between ages 40 and 74, based on new evidence of benefit in this age group. The European Society of Breast Imaging (EUSOBI) and the European Society of Radiology (ESR) recommend biennial mammography screening between ages 50 and 69, which can be extended to ages 73-75. Screening between ages 40 and 49 may be considered, especially with annual or biennial screening, depending on resources and preferences. For women with dense breasts (BI-RADS C or D) : EUSOBI recommends that women are informed about the impact of breast density on mammography sensitivity and consider additional tests such as ultrasound, contrast-enhanced spectral mammography (CESM), or MRI, even when they do not have additional risk factors. In situations of high genetic risk (e.g., BRCA1 or BRCA2 mutations) : ACR and EUSOBI recommend starting screening around age 25-30, with annual MRI and interim mammography. Breast imaging is more sophisticated than ever Digital mammography with tomosynthesis Increases sensitivity in dense breasts and in the detection of microcalcifications, reducing false positives and unnecessary biopsies. Intravenous contrast-enhanced mammography (CESM) Innovative technique that combines intravenous contrast media with digital mammography. It may be indicated for women with dense breasts or in cases where diagnostic uncertainty persists after conventional mammography. Breast ultrasound A complementary method to mammography. It is ideal for young or pregnant women and useful for characterizing nodules not visible on mammography. Breast magnetic resonance imaging High sensitivity (>95%) in the early detection of breast cancer. It is the standard test for screening women at high genetic risk. It is also useful for women with dense breasts or for assessing tumor extent and response to therapy. And self-examination and clinical examination: do they still have a role? Yes, they do, but as a complement . A monthly breast self-examination allows women to better know their bodies and, by knowing them well, they can detect changes that may occur. Clinical examinations performed by professionals remain relevant, especially in settings with limited access to imaging tests. Invest in your protection Early screening is not just a clinical act; it is a protective gesture , a personal and collective investment in women's lives and quality of life. Imagine your body as a home. A home you know well, where everything seems in its right place. But what if, one day, a silent intruder hid in a seldom-used room, leaving no trace? No doors broken down. No noise. No signs. This intruder could be breast cancer, a disease that can begin slowly, silently, without symptoms, without leaving any trace. And if discovered too late, it has already taken over the entire house. Screening is the light that goes on before the scare. Don't wait for the alarm. Follow the recommended screenings. Enter the dark room, find out early, and live longer. Breast cancer screening can change everything. Science is on women's side. Technology is too. Now, every woman needs to be on her own side, too. References American College of Radiology (ACR), Society of Breast Imaging (SBI). ACR and SBI continue to recommend annual breast cancer screening starting at age 40. ACR.org. 2024. US Preventive Services Task Force (USPSTF). Breast Cancer: Screening Recommendation Statement. JAMA. 2023;329(20):1740–1749. EUSOBI Recommendations for Breast Cancer Screening 2023. European Society of Breast Imaging; European Society of Radiology. Insights Imaging. 2023. Authors : Paulo Brandão , with the collaboration of Cândida Ventoso Castineira The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
