Breast cancer screening could be expanded to younger women

The National Screening Centre is working to bring screening for breast cancer down to the age of 45, irrespective of a rise in the incidence of the disease among younger women.

The initiative builds on a government pledge to reduce the starting age of breast cancer screening down from 51 and is also being strongly spearheaded by a breast cancer lobby group.

Action for Breast Cancer Foundation is on a mission to lower the screening age on the basis of what it claims is an increase in the incidence of the disease among younger women, who have been seeking out their services.

However, according to the latest data from the National Cancer Screening Register, no discernible change in incidence rates of breast cancer has been noted in the 40-49 age group between 2008-2022.

Sascha Reiff, a consultant in Public Health Medicine and Clinical Lead of the National Screening Centre since 2020, said that even though there was no rise in the incidence in the 40-49-year age group until 2022, the rationale for expanding the screening ages was not related to this, but “because of evidence there is benefit in screening this age group too”.

He said that now that Malta was “nearly up to EU standard – the target is 50-69, and we have arrived at 51-69 – we can now plan for further expansion”.

The next two to three years will see the National Screening Centre move to the ex-Boffa Hospital, as well as an additional mammogram machine, more radiographers and the use of AI to assist radiologists in interpreting the mammograms- Sascha Reiff, consultant in Public Health Medicine and clinical lead of the National Screening Centre

Based on recent international scientific reports, the European Commission and Council also suggest that screening is started at the age of 45 due to the incidence of breast cancer in this age group, Reiff said.

“It is still far more cost-effective to screen the 50-69 age group, but there is now sufficient evidence to justify decreasing the starting age,” he continued, quoting the report, which does not delve into any increases.

According to the European Cancer Information System website, which gives cancer incidence and mortality rates across the EU, breast cancer in 35-49-year-olds in Malta was higher than the EU average in 2024.

Reiff said the next two to three years will see the National Screening Centre move to the ex-Boffa Hospital, as well as an additional mammogram machine, more radiographers and the use of AI to assist radiologists in interpreting the mammograms.

“These will all support the drive to screen a higher number of women,” he said.

‘Can we save more women with screening?’

ABCF, which has been at the forefront of significant steps in breast cancer awareness and the battle against the disease, remains convinced that breast cancer cases can be caught earlier and is on a drive to broaden national screening from 45.

Its chairperson and co-founder Esther Sant, a breast cancer survivor diagnosed at 36, when this was considered “unheard of”, pointed out that screening was “tricky” among younger women who had denser breast tissue.

A “super case of remission” from 2000-2023, Sant said that, today, being diagnosed early was not a novelty.

“We just had two young ladies with young children come to us for support,” she said, adding that younger patients were likely to have more aggressive cancers that spread quickly.

Younger patients were likely to have more aggressive cancers that spread quickly- ABCF chairperson and co-founder Esther Sant

Committee member Ruth Guillaumier, from the university’s biology department, was diagnosed with breast cancer at 42, she said of her own experience, adding “you do not need to have a family history”.

The foundation was being approached “mostly” by women in their 30s, setting alarm bells ringing, she said.

“We are a small voluntary NGO, but we care. Can we save more women with screening?”

Among its milestones, the foundation recently got the VAT on mastectomy bras it supplies to hospital knocked off and received a rebate of €10,000 that has now returned to their kitty for more initiatives to support cancer patients.