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Home What is Breast Cancer Diagnosis Understanding Breast Cancer Screening

Understanding Breast Cancer Screening

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Understanding Breast Cancer Screening

By Ella Starobinska, MD Candidate, Class of 2017, UofA COM- Phoenix

 

 

What is breast cancer screening?

 

Screening is a way of identifying early signs of breast cancer in women that do not exhibit any symptoms. Doing so allows physicians to catch cancer in the early stages before cancer has a chance to cause significant harm by spreading to other organs. Numerous studies have shown that breast cancer screening decreases the risk of death.

 

Main screening tools for breast cancer include mammography in combination with clinical breast exams. 8

 

 

What are the risk factors predisposing women to breast cancer?

 

Major risk factors include age, family history, and exposure to estrogen. 2

 

Are there tools for identifying individual’s risk of breast cancer?

 

There are several prediction tools that have been created in order to categorize women based on their risk of developing breast cancer. These tools are used in order to optimize screening strategies as well as the guidelines for possible therapies.

One of the most commonly used tools that your physician will use is called the Breast Cancer Risk Assessment Tool (BCRAT). This tool was created by the National Cancer Institute and is also known as the Gail Model. To use this tool, the physician will need to know the following information about you:

race

ethnicity

age

family and personal history of breast disease

age at the time of first menstrual period

history of childbirth

This tool is available online for public use, as well http://www.cancer.gov/bcrisktool/

 

These tools are very helpful in estimating in which risk group you belong. However, it is important to note that this tool is not very accurate in predicting your individual risk of having breast cancer. 2

 

 

What are the current screening tools?

 

There are 3 main tools used to screen for breast cancer.

These include:

mammogram

clinical breast exam performed by your health provider

self exam

 

 

What is mammography?

 

Mammography is a breast Xray, which allows doctors to detect breast cancer before clinical symptoms develop. Mammography allows physicians to detect various abnormalities in the breast. These include different masses - cysts, cancer, other tumors. Another important sign on breast imaging that doctors look for is calcification. Calcifications are tiny mineral deposits within your breast. These appear as dense white spots on the image. Calcifications may sometimes indicate presence of breast cancer. 4

Nevertheless, it is important to note that mammography does not prove that a breast abnormality is indeed cancer. Instead, it determines whether further testing is necessary. 4

 

 

What types of mammograms are there? What is the difference?

 

There are 2 types of mammography: screening and diagnostic.

Screening mammography is used to identify breast cancer and other breast abnormalities in women who do not have any signs or symptoms. Finding these abnormalities early means a potentially better outcome for the patient because the earlier the stage of breast cancer, the more likely it can be cured.

Diagnostic mammography is done if a patient has symptoms or has an abnormality that was found by screening mammography. It allows doctors to determine the type of the abnormality. 3

 

One of the main differences between screening and diagnostic mammograms is that diagnostic mammography requires more X-RAY images of the breast from different angles, and thus requires more time. 5

These days most institutions will add breast ultrasound to diagnostic mammography.

 

How to prepare for your mammogram?

 

Schedule the test one week after your period. At this time of your menstrual cycle, your breasts are less likely to be tender, which will minimize the discomfort you might experience. 9

Do not wear deodorant, cream, or body powder. These contain metallic particles which will show up on imaging and will make it difficult to interpret the image. 10 If you can’t go without these items all day, you can schedule the mammogram in the morning or applying them right after your visit. 9

Wear a 2 piece outfit on the day of mammogram. You will be required to wear a hospital gown during the procedure. Wearing a pants or a skirt under it will make you feel less exposed and more comfortable. 9

 

What to expect during the procedure?

By Alan Hoofring [Public domain], via Wikimedia Commons https://upload.wikimedia.org/wikipedia/commons/2/2d/MammographyinprocessGraphic.jpg Original Source: National Cancer Institute (NCI): http://visualsonline.cancer.gov/details.cfm?imageid=4361

This procedure is done while you are standing with your arms extended forward.

The machine has 2 plates. The bottom one is fixed and the top plate is adjustable. Your breasts will be placed on a fixed plate, one at a time. The technician will adjust the top plate to compress your breast from the top to make sure that it does not move. 6

Compressing the breast may feel uncomfortable and for some women may even cause pain, but this only lasts a few seconds. At the end of the procedure, a black and white picture of your breast is produced, which is then analyzed by a radiologist. 6

After the images are captured, they will be send to a doctor to be analyzed.

The law in the United States requires that the images will be send to you within 30 days. However, it usually takes less time. 10

Ask your technician when you should be expected to receive the results.

 

 

 

 

What are the current guidelines for screening by mammography?

 

Currently, there is a debate in medicine about what is the optimal age to start screening women with mammography

The most recent guidelines from the American Cancer Society published in October 2015 include the following recommendations:

- 40 years- Women should start talking to their healthcare provider about screening and they can start screening, if they want to.

- 45- 54 - Start annual screening

- 55 years and older- Screen every 2 years as long as your health is good with life expectancy of more than 10 years. 7

 

 

How often should mammography be performed?

 

Once again, there is no clear consensus on the frequency of screening with mammography. However, most professional groups agree that women with low risk of breast cancer should be screened every 2 years. More frequent mammograms can be performed for women with higher risk of breast cancer. 1

 

 

What is a clinical breast exam?

Clinical breast exams are performed by your healthcare provider as a part of breast cancer screening. The physician carefully looks at your breasts and examines them by touch. During this, they will be looking for any lumps, nipple discharge, or changes in skin and texture of the breast. 8

However, it is important to note that experts do not recommend clinical breast exams as a sole screening method. These must be performed as adjunct to mammography. 2

 

 

What is a breast self exam?

 

Breast self exam is an exam performed by women on their own breasts. Currently, experts do not encourage self exams because studies have not shown their effectiveness in lowering the risk of breast cancer. However, if you are interested in doing breast self exams, it is important to perform them correctly. 8

 

To learn how to perform breast self-exams properly, click here

 

 

 

References:

 

1. Elmore J. Patient information: Breast cancer screening (Beyond the Basics). UpToDate Web site. Jan 28, 2015. Available at: http://www.uptodate.com/contents/breast-cancer-screening-beyond-the-basics Accessed June 15, 2015

2. Elmore J. Screening for breast cancer: Strategies and recommendations. UpToDate Web site. Feb 3, 2015. Available at: http://www.uptodate.com/contents/screening-for-breast-cancer-strategies-and-recommendations?source=search_result&search=Screening+for+breast+cancer%3A+Strategies+and+recommendations&selectedTitle=1~150 Accessed June 15, 2015

3. Gaillard F. Mammography. Radiopaedia Website. Available at: http://radiopaedia.org/articles/mammography Accessed June 15, 2015

4. Imaging (Radiology) Tests. Cancer.Org Web site. March 16, Available at: 2015 http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/imagingradiologytests/imaging-radiology-tests-mammogram Accessed June 15, 2015

5. Mammograms Fact Sheet. Cancer.gov Web site. March 25, 2014. Available at: http://www.cancer.gov/types/breast/mammograms-fact-sheet#q2 Accessed June 15, 2015

6. Mammograms and Other Breast Imaging Tests. Cancer.Org Web site. April 9, 2015 Available at: http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-having-a-mammogram Accessed June 15, 2015

7. Oeffinger KC, Fontham EH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783.

8. Patient information: Breast cancer screening (The Basics). UpToDate Web site. Jun 15, 2015. Available at: http://www.uptodate.com/contents/breast-cancer-screening-the-basics?source=see_link. Accessed June 15, 2015

9. Preparing for your first mammogram. U by Kotex. http://www.kotex.com/na/articles-info/preparing-for-your-first-mammogram/50109 Accessed July 11, 2015

10. Tests and Procedures: Mammogram. MayoClinic.Org http://www.mayoclinic.org/tests-procedures/mammogram/basics/what-you-can-expect/prc-20012723 Accessed July 11, 2015