Early Detection

Screening Methods for Breast Cancer

  1. Breast self-exam  (BSE)
    1. Breast examination is a tactile skill.  Our fingers must learn what to feel for.  Learning to perform BSE well requires training the sense of touch.
  2. Clinical Breast exam (CBE) - Examination by doctor
  3. Mammography
    1. is a special type of X-ray of the breasts
    2. use  ionizing radiation to create images.
    3.   can show tumors long before they are big enough for you or your health care provider to feel.
    4. They are recommended for
      1. who have symptoms of breast cancer
      2. or who have a high risk of the disease.  .
    5. Mammograms are quick and easy.
    6. Type
      1. screening mammogram
        1. used to check for breast cancer in women who have no signs or symptoms
      2. diagnostic mammogram
        1. to check for breast cancer after a lump or other sign or symptom

Preparation for mammogram

  1.   Try to avoid making your mammogram appointment   the week before your period.
  2. Inform if you have  implants, .
  3. Wear a shirt with shorts, pants, or a skirt.
    1.  Easy ton undress from the waist up 
  4. Don’t use any deodorant, lotion, perfume, or powder under your arms or on your breasts 
    1.  These things can make shadows  on your mammogram.
  5. Bring old mammogram for comparison

What is the best method of detecting breast cancer as early as possible?

A high-quality mammogram plus a clinical breast exam, an exam done by your doctor, 

What can mammograms show?

Doctor compare  past mammograms with  most recent one to check for changes. The doctor will also look for lumps and calcifications.

  1. Lump or mass.
    1. The size, shape, and edges of a lump . 
      1. benign often looks smooth and round with a clear, defined edge.
      2. cancer often has a jagged outline and an irregular shape.
  2. Calcification. A calcification is a deposit of the  calcium . Look as small white spots on a mammogram. There are two types:
    1. Macrocalcifications are large calcium deposits often caused by aging. usually are not a sign of cancer.
    2. Microcalcifications are tiny specks of calcium that may be found in an area of rapidly dividing cells.

What if screening mammogram shows a problem?

  1. If screening test result  suggests cancer,
  2. Doctor must find out whether it is due to cancer or to some other cause.
  3. Evaluate  your personal and family medical history.
  4. Need a physical exam.
  5. Diagnostic mammogram, to focus on a specific area of the breastUltrasound  Exam
  6. Magnetic resonance imaging (MRI), may be helpful
  7. FNAC /Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer.

NBCCEDP Screening Recommendations

  1. Women age 50 and older
    1. BSE monthly
    2. CBE yearly
    3. Mammography yearly
  2. Women age 40 to 49
    1. BSE monthly
    2. CBE yearly
    3. Mammography as advised by provider
  3. Women under age 40
    1. BSE monthly starting at age 20
    2. CBE every 3 years or as advised by provider
    3. Routine mammography not advised

Advantages of Mammography

  1. Average-size lump found by women untrained in BSE  :
  2. 36mm

  1. Average-size lump found by women practicing occasional BSE  :
  2. 25mm

  1. Average-size lump found by women practicing regular BSE
  2. 20mm

 

  1. Average-size lump found by first mammogram
  2. 5mm

  1. Average-size lump found by getting regular mammograms
  2.  3mm

  1. Mortality Reduction
    1. mortality reduction from the randomized trials is calculated to range between 15 and 30%
    2. Other authors, however, attribute mortality reduction predominantly to improved therapy

Improved Treatment of Early Disease

    1. the rates of chemotherapy, mastectomies, and axillary dissection drop with mammography screening 

Potential harms of screening mammograms

  1. Early detection does not mean cure for all
    1.  .A fast-growing or aggressive cancer may spread /may have already spread to other parts of the body before it is detected. .
  2. False-negative results. 
    1.  mammograms appear normal even though breast cancer is present.
    2.    miss about 20 percent of breast cancers 
  3. False-positive results.
    1.   mammograms are abnormal but no cancer is actually present.
    2. All abnormal mammograms should be followed up with additional testing 
    3. False-positive results are more common for
      1.  younger
      2.  who have had previous breast biopsies,
      3.  with a family history of breast cancer,
      4.  e taking estrogen 
      5.  lead to anxiety and other forms of psychological distress in affected women.
      6. The additional testing required to rule out cancer 
  4. Overdiagnosis and overtreatment. 
  5. Radiation exposure.
    1. very small doses of radiation.
    2. The risk of harm   is extremely low,
    3. but repeated x-rays have the potential to cause cancer
    4. The benefits  however, nearly always outweigh the potential harm 
    5. Tell if there is any possibility pregnancy, because radiation can harm a growing fetus.

Interval Cancers

By definition, interval cancers are cancers which become palpable between 2 screening-rounds

represent a limitation of screening and not a side effect.

Can diagnose a cancer which never needed treating

    1. for every 200 women who have breast screening, one will have treatment that may not be needed

Breast Imaging Reporting and Database System (BI-RADS®)

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels.

Breast Imaging Reporting and Database System (BI-RADS)

Category

Assessment

Follow-up

0

Need additional imaging evaluation

Additional imaging needed before a category can be assigned

1

Negative

Continue regular screening mammograms (for women over age 40)

2

Benign (noncancerous) finding

Continue regular screening mammograms (for women over age 40)

3

Probably benign

Receive a 6-month follow-up mammogram

4

Suspicious abnormality

May require biopsy

5

Highly suggestive of malignancy (cancer)

Requires biopsy

6

Known biopsy-proven malignancy (cancer)

Biopsy confirms presence of cancer before treatment begins

 

 
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