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Home Prevention Screening for Breast Cancer

Screening for Breast Cancer

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The goal of screening is to look for the cancer before any symptoms develop.  This is helpful in detecting the cancer at an early stage, and thus improves the likelihood of starting treatment before it has spread. In many cases, by the time symptoms have appeared, the cancer has already spread.

Different tests are used for screening.

The best screening tests are those with the least amount of risk and the most benefits.  The best tests also detect the cancer early enough to decrease the chances of dying from the disease.  Trials for breast cancer screening focus on these two main points.  It is important to remember that for some types of cancer, the earlier they are discovered and treated, the better the chance of recovery.
Information about ongoing clinical trials is available from the NCI Web site. There has been a lot of discussion in the news over the last year as recent USPSTF guidelines have indicated a major change in screening recommendations.

 

There are two common, and one less common test traditionally used to screen for breast cancer:

  • Clinical breast exam (CBE): This is an exam performed by a physician. It is important for you to also perform these exams yourself at home so you know how your breasts look and feel.  If you feel any changes, you should talk to your physician.
  • Mammogram: An X-Ray of the breast that is able to find tumors that are too small to feel. Mammograms can detect ductal carcinoma in situ (DCIS), abnormal cells in the lining of the breast duct which can become invasive cancer in some. However the ability to detect breast cancer depends on the size of the mass, the density of the breast tissue surrounding the mass, and the skill of the radiologist operating the mammogram. This has not found to be a useful tool in women under the age of 50 as women in this age group have denser breast tissue.  Dense breast tissue and tumors appear white on mammograms, thus making them difficult to distinguish from each other.
  • Magnetic Resonance Imaging (MRI): this test is used less often. MRI uses magnet, radio waves, and a computer to create a series of detailed pictures of the inside of the body.  It does not use x-rays.

There has been a great deal of debate recently regarding breast screening guidelines. The following are the most up to date screening recommendations.

 

Screening Recommendations:

  • Yearly mammograms are recommended from age 50 to 74.  Previously it was recommended that screening start at age 40. Now, for women age 40-50 it is recommended that you speak with your physician and make the decision based on your personal and family medical history.  If you are over the age of 75, there is no current evidence that assesses the benefits and harms of performing screening mammograms in this age group.
  • Clinical breast exams (CBE) are no longer recommended as evidence is insufficient to assess the benefits vs harms.  It seems CBE add no benefit to the information gained from a mammogram.
  • The USPSTF no longer recommend teaching women self breast exams, however it is not forbidden in these recommendations.
  • MRI may be useful in screening for breast cancer in patients with higher risk of developing the disease. These include women who: have a known BRCA1 or BRCA1 gene mutation or have a first-degree relative (parents, sibling, child) with this gene mutation but they themselves have not been tested; have a lifetime risk of breast cancer of 20% or greater (these risk assessment tools are based mainly on family history and will be discussed later); had radiation therapy to the chest between the ages of 10 and 30; have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome or a first-degree relative with one of these syndromes.  MRI can also be used as a screening tool in women at moderately increased risk, this inclues women with a lifetime risk of developing breast cancer of 15-20%; women with a personal history of breast cancer, DCIS, LCIS, atypical ductal hyperplasia, or atypical lobular hyperplasia; women with extremely dense or unevenly dense breasts by mammogram.
  • If MRI is used, it should be used in addition to, not instead of, a screening mammogram.

If a lump or any other significant changes are discovered by mammogram or CBE, follow up tests may be needed.  AnUltrasound is useful to further evaluate any breast lump that is found. Ultrasound utilizes high-energy sound waves that bounce off internal tissues or organs and make echoes. Ultrasound is useful in elucidating whether the lump is more cystic or a solid mass.


Who should be screened early?

The American Cancer society recommends that some women be screened early based on family history, genetic tendency, or certain other factors.  The following women are at a higher risk for developing breast cancer and should be screened more frequently, or screening should be started at an earlier age depending on the risk factor.

  • I have had breast cancer before: You should see your physician regularly, and have a yearly mammogram.
  • I have had a breast disease, but it was benign (not cancer): You should be screened every year.
  • I have the breast cancer gene, or a strong family history of breast cancer: If you undergone genetic testing that revealed a mutation in the BRCA1 or BRCA2 gene, you have a high risk for developing breast cancer.  If this is the case, you should begin screening at age 25.You have a very strong family history if any of the following are true: you have two or more female relatives with breast or ovarian cancer (this is especially true if breast cancer was diagnosed before the age of 50, or if it was present in both breasts); or if at least one close male relative has breast cancer.  If you have a strong family history, you should also begin screening at age 25 for both breast and ovarian cancer, and follow up with your physician regularly.
  • I have a history of being exposed to high doses of radiation: You are at an increased risk for developing breast cancer if you have ever been exposed to high-dose radiation in your chest area.  You should begin having mammograms 10 years after the radiation exposure or at age 40 (whichever comes first).

There is no general guideline as to when women at higher risk should begin screening with MRI and mammogram. This decision should be made by you and your physician after discussing the pertinent medical and genetic history of yourself and your first degree relatives.

Shikha Jain, MD