Mammogram or Ultrasound? A Breast Screening Guide for Nigeria, Kenya and the UK

TL;DR: A mammogram is a breast X-ray and the main screening test from around 40 or 50. An ultrasound uses sound waves and is usually the first test for women under 40 or for checking a specific lump. The NHS invites women for mammograms every three years from 50 to 71. Kenya's guidelines recommend clinical breast exams from 25 and mammograms from 40. Nigeria has no national programme yet, so most screening is something you seek out yourself. Any new lump or change needs checking now, whatever your screening schedule.

Breast screening advice can feel like it was written for someone else. The leaflets talk about invitations in the post and appointments every three years, while you are trying to work out which hospital in your state even has a mammogram machine, or whether a scan your aunty had at a private centre "counts." The rules are different in Lagos, Nairobi and London, and so are the practical steps. This guide explains the main tests in plain language, then walks through how it works in each country.

What is the difference between a mammogram and an ultrasound?

A mammogram is an X-ray of the breast. An ultrasound uses sound waves to make a picture. Mammograms are the main tool for screening women without symptoms from middle age, while ultrasound is mostly used to look at a specific lump, to tell whether it is solid or filled with fluid, and as the first scan for younger women.

Mammogram. Your breast is placed on a plate and pressed firmly for a few seconds while X-ray images are taken. It can feel uncomfortable, but it is quick. The NHS explains that mammograms are used to look for cancers that are too small to see or feel. They work less well in younger women, whose breast tissue tends to be denser, which is why women under 40 are usually offered an ultrasound instead.

Ultrasound. A gel is put on your skin and a small probe is moved over the breast. It is a very safe test that does not involve radiation. It is very good at showing whether a lump is a fluid-filled cyst or solid tissue, but it is not recommended on its own for routine screening of women at average risk.

Clinical breast exam. A trained doctor or nurse looks at and feels your breasts and armpits. It is not as sensitive as a mammogram, but where imaging is scarce it is a valuable way to catch changes early, and both Kenya and Nigeria build it into their plans.

MRI and biopsy. MRI is mainly used for women at high genetic risk. A biopsy, where a needle takes a small sample of tissue, is the only test that can confirm whether a lump is cancer.

Which test should I have, and when?

It depends on two things: whether you have symptoms, and your age and risk.

• You have a lump or another change. This is not screening, it is diagnosis, and it should happen now. Doctors often call it triple assessment: an examination, imaging (usually ultrasound for younger women and a mammogram for older women), and a biopsy if needed.
• You have no symptoms and are at average risk. Follow your country's screening schedule, below.
• You have a strong family history. A mother, sister or daughter with breast cancer, especially before 50, or several relatives with breast or ovarian cancer, can mean earlier or more frequent checks. Tell your doctor and ask about a referral.

If you are not sure what feels normal for you, our breast self-exam guide is a good place to start, and breast lumps that are not cancer explains the common harmless causes.

Breast screening in the UK

The NHS Breast Screening Programme invites women from age 50 up to their 71st birthday. Your first invitation arrives sometime between 50 and 53, and then every three years. After 71 you are not invited automatically, but you can ask your local breast screening service for an appointment. Trans and non-binary people have specific eligibility rules on the same NHS page.

Practical points for the diaspora:

• Register with a GP. You need to be registered to be invited. If you have moved recently, update your address so the letter reaches you.
• Do not wait for your invitation if you notice a change. Screening is for people without symptoms. A lump at 32 or 48 goes straight to your GP, who can refer you to a breast clinic.
• Family history changes the rules. NICE guidance recommends annual mammograms from 40 for women at moderate risk, with earlier mammograms or MRI for some women at high risk. Ask your GP to assess your family history.

If you are also catching up on cervical screening, we wrote about the cervical screening gap in the UK.

Breast screening in Kenya

Kenya's Ministry of Health has a clear screening schedule for women at average risk, set out in the National Cancer Screening Guidelines and the Breast Cancer Screening and Early Diagnosis Action Plan 2021 to 2025:

• 25 to 34: clinical breast exam every one to three years, no mammogram
• 35 to 39: clinical breast exam, with an ultrasound or mammogram considered case by case, every one to three years
• 40 to 55: clinical breast exam plus mammogram every year
• 56 to 74: clinical breast exam plus mammogram every two years
• 75 and over: a decision based on your health and preference

Women with a close relative who had breast cancer are advised to start annual mammograms 10 years younger than that relative's age at diagnosis, but no earlier than 25 and no later than 40.

Where to go: through the Managed Equipment Service, digital mammography machines were placed in county referral hospitals across all 47 counties. The same plan admits the catch: there is no organised national screening programme yet, screening is mostly opportunistic, and uptake is held back by cost, a shortage of trained radiographers and radiologists, and many women not knowing the service exists. In practice, start at your nearest health centre or dispensary for a clinical breast exam and ask to be referred to your county referral hospital for imaging. Call ahead to check the machine is working and what it costs, and ask whether your health cover applies.

Breast screening in Nigeria

Nigeria's National Cancer Control Plan aims to provide clinical breast exams at primary health care level and mammography at secondary and tertiary level, and marks October as National Breast Cancer Awareness Month. But there is no national breast screening programme in place yet, so there is no letter in the post. You have to seek screening out.

Access is uneven. A 2023 study mapped 218 facilities offering mammography and 1,336 offering breast ultrasound across the country. Only 33 of the ultrasound sites also offered ultrasound-guided biopsy. About 83 percent of people lived within two hours' travel of an ultrasound or mammogram, but access to mammography and biopsy was noticeably worse in the North, especially the North East.

Practical steps:

• Start with a clinical breast exam. Ask at a primary health centre, general hospital or your gynaecologist's clinic.
• For imaging, go to a teaching hospital, federal medical centre or reputable private diagnostic centre. Ask whether a radiologist will read the scan, and how you will get the report.
• Look out for October screening drives. Hospitals, state ministries and charities may run free or subsidised clinical breast exams during awareness month. These are a good first step, as long as there is a clear plan for follow-up if something is found.
• Keep your reports. Bring previous scans to every new appointment so changes can be compared.

If you are also thinking about other checks, our guides to Pap smears in Nigeria and the women's health screening checklist cover the rest.

Does screening age matter if I am young?

Yes, because younger women fall outside most programmes, and that gap matters for Black and African women in particular. Across sub-Saharan Africa, women tend to be diagnosed younger and later, and more often with aggressive subtypes. We explain the research in breast cancer in young Black and African women. The takeaway is simple: if you are under the screening age, knowing your breasts and acting quickly on changes is your screening.

This post is education, not medical advice. Screening schedules are a guide for people without symptoms. A new lump, skin change, nipple change or bloodstained discharge at any age is a reason to see a clinician promptly.

Asele can help you stay on top of it. Cycle tracking and symptom logging let you note breast changes alongside your cycle, Amara can help you prepare questions in Yoruba, Hausa, Igbo, Swahili, French or English, and the Asele Health Brief gives you a summary to take to your appointment. You can find us at Asele. Whichever country you are in, the best screening plan is the one you know how to use.

References

1. NHS. Breast screening (mammogram). nhs.uk
2. NHS. Who breast screening is for. nhs.uk
3. NICE. Familial breast cancer (CG164): recommendations. nice.org.uk
4. Cancer Research UK. Breast ultrasound. cancerresearchuk.org
5. Breast Cancer Now. Fibroadenoma (diagnosis and imaging by age). breastcancernow.org
6. Kenya Ministry of Health. Breast Cancer Screening and Early Diagnosis Action Plan 2021 to 2025 (includes National Cancer Screening Guidelines 2018 recommendations). iccp-portal.org
7. Federal Ministry of Health, Nigeria. National Cancer Control Plan 2018 to 2022. iccp-portal.org
8. Nduka IJ et al. Cost-effectiveness analysis of mammography screening for early detection of breast cancer in Nigeria. PLOS One, 2026. pmc.ncbi.nlm.nih.gov
9. Population-Level Access to Breast Cancer Early Detection and Diagnosis in Nigeria. JCO Global Oncology, 2023. pmc.ncbi.nlm.nih.gov