women s health issues
Breast Cancer Screening and Prevention
Screening for Breast Cancer
Screening for breast cancer may include Yearly breast examination by a health care professional Mammography If women have an increased risk of breast cancer, magnetic resonance imaging (MRI) It can be challenging to keep up with the latest recommendations for breast cancer screening, such as when to start mammograms. Also, medical organizations may change their recommendations over time, or different organizations may have different recommendations. Some people think that more testing is better, but testing may also have disadvantages. For example, screening tests for breast cancer sometimes indicate a cancer is present when no cancer is present (called a false-positive result). When results of a breast screening test are positive, a Breast biopsy is usually done. Having a false-positive result means having a biopsy that is not needed and being exposed to unnecessary anxiety, pain, and expense. Because of these potential issues, organizations recommend that some people do not need to have a screening test. These people include those who are younger or older than a certain age (see sidebar Mammography is one of the most effective ways to detect breast cancer early. Mammography is designed to be sensitive enough to detect the possibility of cancer at an early stage, sometimes years before it can be felt. Because mammography is so sensitive, it may indicate cancer when none is present (a false-positive result). About 85 to 90% of abnormalities detected during screening (that is, in women with no symptoms or lumps) are not cancer. Typically, when the result is positive, more specific diagnostic procedures, usually a breast biopsy, are scheduled. Mammography may miss up to 15% of breast cancers. It is less accurate in women with dense breast tissue. Thus, these women may require additional tests, such as breast ultrasonography, 3-dimensional mammography ( Breast examination by a health care professional ), or magnetic resonance imaging (MRI). For mammography, x-rays are used to check for abnormal areas in the breast. A technician positions the woman’s breast on top of an x-ray plate. An adjustable plastic cover is lowered on top of the breast, firmly compressing the breast. Thus, the breast is flattened so that the maximum amount of tissue can be imaged and examined. X-rays are aimed downward through the breast, producing an image on the x-ray plate. Two x-rays are taken of each breast in this position. Then plates may be placed vertically on either side of the breast, and x-rays are aimed from the side. This position produces a side view of the breast. Breast tomosynthesis(3-dimensional mammography) may be used with mammography to produce a clear, highly focused 3-dimensional picture of the breast. This technique makes it somewhat easier to detect cancer, especially in women with dense breast tissue. However, this type of mammography exposes women to more radiation than traditional mammography. Recommendations for routine screening with mammography vary. Experts disagree about When it should start How often it should be done When (or if) it should be stopped Experts have different recommendations about Breast Cancer: When to Start Screening Mammography? . Most medical organizations recommend screening mammography for some women starting at between ages 40 to 49 and for all women starting at age 50. Recommendations to start at age 50 are because screening mammography is more accurate in women 50 or older. The reason is that as women age, fatty tissue replaces fibroglandular tissue in the breast. Abnormalities next to fatty tissue are easier to detect with a mammogram. The benefit of screening is not as clear in women aged 40 to 49. Experts are concerned about anxiety, false positives, and also about starting screening too soon or screening too often because exposure to radiation would be increased. Women with Risk Factors for Breast Cancer are more likely to benefit from starting mammography before age 50. They should discuss the risks and benefits of screening mammograms with their doctor. Whenever it is started, mammography is then repeated every 1 or 2 years. Routine mammography may be stopped at age 75, depending on the woman's life expectancy and her wish for continued screening. Only about 10 to 15% of the abnormalities detected during routine screening with mammography turn out to be cancer. The dose of radiation used in mammography is very low and is considered safe. Mammography may cause some discomfort, but the discomfort lasts only a few seconds. Mammography should be scheduled at a time during the menstrual period when the breasts are less likely to be tender. Deodorants and powders should not be used on the day of the procedure because they can interfere with the image obtained. The entire procedure takes about 15 minutes. Experts sometimes disagree about when regular screening with mammography should be started. Because screening identifies cancer and cancers can be fatal, people might think that screening should be started sooner (at age 40) rather than later (at age 50). However, screening has some disadvantages, and the benefits for younger women are not as clear as those for older women. The following are some reasons for the controversy: Screening, particularly in younger women, detects abnormalities that may not be cancers. Finding an abnormality often results in a biopsy to determine what it is. Thus, screening results in many more breast biopsies, sometimes causing women unnecessary anxiety and expense, as well as possibly resulting in scar tissue in the breast. Some breast cancers, such as in situ breast cancers (cancers that have not spread), are not fatal. Some breast cancers grow slowly and would not cause death in a woman's lifetime. However, other breast cancers continue to grow and invade other tissues. How many of the cancers detected by screening would eventually be fatal is unclear. Nonetheless, all cancers are treated because currently, health care professionals do not have enough evidence to determine which ones should be treated and which ones should not be treated. Mammography is less accurate in younger women. Thus, screening may miss cancers, possibly including those that could be fatal. Mammography is more accurate in women over age 50 partly because, with aging, fibroglandular tissue (composed of fibrous connective tissue and glands) in the breasts tends to be replaced with fatty tissue. Abnormalities next to fatty tissue are easier to detect with a mammogram. Many women must be screened to save one life. When women are older, fewer women need to be screened to save a life. For women 50 and over, screening saves lives and is recommended. Women should be familiar with how their breasts normally look and feel. Because breast cancer also affects men, men should be aware of changes in or around their nipples. If a woman notices a change, she may want to do a breast self-examination. Women should report any changes to a health care professional right away. In the past, most doctors recommended that women examine their breasts for lumps each month. Most medical organizations no longer recommend that people do monthly or weekly Breast self-awareness as a routine way to check for cancer. Doing these examinations when there is no lump or other change does not help detect breast cancer early in women who get screening mammograms. A breast examination may be part of a routine physical examination. However, as with breast self-examination, a doctor's examination may miss a cancer. If women need or want screening, a more sensitive test, such as mammography, should be done, even if a doctor's examination did not detect any abnormalities. Many doctors and medical organizations no longer require an annual breast examination by a doctor. During the examination, a doctor inspects the breasts for irregularities, dimpling, tightened skin, lumps, and a discharge. The doctor feels (palpates) each breast with a flat hand and checks for enlarged lymph nodes in the armpit—the area most breast cancers invade first—and above the collarbone. Normal lymph nodes cannot be felt through the skin, so those that can be felt are considered enlarged. However, noncancerous conditions can also cause lymph nodes to enlarge. Lymph nodes that can be felt are biopsied to see if they are abnormal. MRI is usually used to screen women with a high risk of breast cancer, such as those with aBRCAmutation. For these women, screening should also include mammography and breast examination by a health care professional. MRI may be recommended for women with dense breast tissue as part of an overall assessment that includes evaluation of risk. 