An experienced nurse listens for three decision-changing details: whether the person has symptoms, whether risk is average or increased, and what question the person expects the test to answer. A person with a new breast lump, bloody nipple discharge, a newly inverted nipple, or a concerning skin change is not simply requesting routine screening. The finding requires clinical assessment through a diagnostic pathway, even if the person is within a usual screening age range. Routine screening is designed for people without such findings. For breast screening, ask about: - personal history of breast cancer; - a strong family history of breast cancer; - a known BRCA1 or BRCA2 mutation; and - radiation to the chest before age 30. These findings can move a person out of the average-risk pathway. Do not apply a routine population schedule simply because the person’s age appears to fit it. Increased risk may call for individualized counselling, earlier imaging, or an alternative imaging strategy. Risk assessment also includes practical factors that affect whether screening can occur safely and usefully: previous abnormal results, access to follow-up,...