Breast cancer screening

Breast cancer examinationBreast cancer is the most common (noncutaneous) cancer in U.S. women, and about 61 000 cases of the disease, and 246 660 new cases of invasive disease, are expected this year.

Mammography is the most widely used screening method, and there is good evidence of benefit for women aged 40 to 74 years.

The most recent evidence based on randomized controlled trials (RCTs) shows that screening with mammography is linked with a 15% to 20% relative reduction in mortality from breast cancer, for women aged 40 to 74 years.  Although there is the risk of overdiagnosis and resulting treatment of insignificant cancer, it’s difficult to predict which cancer would never progress.

American Cancer Society (ACS)Recommendations  

The American Cancer Society (ACS) has recently published a breast cancer screening guideline updatein The Journal of the AmericanMedicalAssociation.

The ACS   strongly recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years. If you are 45 to 54 years old, you should be screened annually, and women 55 years and older should have biennial screening or have the opportunity to continue screening annually.

Clinical breast examination (CBE) for breast cancer screening among average-risk women at any age is not recommended. The ACS states, “This new recommendation should not be interpreted to discount the potential value of CBE in low- and medium-resource settings where mammography screening may not be feasible. Clinical breast examination also may have a role in some groups of women at very high risk.”

This study defines women at average risk as “women without a personal history of breast cancer, a confirmed or suspected genetic mutation known to increase risk of breast cancer (eg, BRCA), or a history of previous radiotherapy to the chest at a young age.’’   Thus, you should consider BRCA testing too to best help you detect breast cancer.  Note that 0.2% to 0.3% of the general population and 2% of Ashkenazi Jewish women are estimated to be carriers of the BRCA1 or BRCA2 mutation.

If you have one or more of the above risk factors, you need additional tests.

MRI testing is effective for high-risk women under 40

A new study shows that MRI testing is indicated for women who have risk factors such as breast cancer in first-degree relative(s), heterogeneous or extremely dense breast tissue on mammography, orare BRCA carriers.  This particular study showed that the cancer detection rate for mammography was 0 %.  MRI detected breast cancers that mammography wasn’t able to. This suggests that MRI is useful in screening high-risk women under 40.

False-Positive Findings

False-positive findings may occur with mammogram testing.  There’s a higher chance of false-positive results if it’s the first mammogram, if the patient has greater mammographic breast density, and if there’s use of postmenopausal hormone therapy. If too much time goes by between screenings, and if there’s a lack of comparison mammography images froma previous examination, then there could be higher levels of false-positive findings.

What to do

To determine if you are at high risk of breast cancer, it is essential you have a detailed check-up and evaluate your family and medical history, and undergo BRCA testing.

Dr. Gafanovich will then determine the frequency of your mammography testing, and if you need an MRI.

Genetic testing, mammographic and MRI testing are your rights, so don’t wait to get tested to help you detect breast cancer at an early stage.