Breast cancer screening: Getting better all the time
Research is continuing to improve our defenses against breast cancer.
A woman's fingers are met by a hard lump as she washes her left breast. Without a second thought, she finishes her bath and starts her day.
Today it's an unlikely scenario. But in 1933, it wasn't so strange. Before awareness campaigns and screenings became routine, many breast cancers first came to a doctor's attention when they were too large for surgical removal and had spread too far to be treated.
In recent years, doctors and researchers have found increasingly better ways to detect this disease in its earliest, most treatable stages.
The latest guidelines
The American Cancer Society (ACS) recommends these measures for the early detection of breast cancer:
Mammograms. Starting at age 40, all women should have a mammogram every year, says the ACS. In women at high risk for breast cancer, it may be best to start even sooner.
Though there was some recent controversy about mammograms for women younger than age 50, research has pretty much put this issue to rest, says Robert A. Smith, PhD, director of cancer screening for the ACS.
"The data supporting the value of screening mammography has gotten stronger and stronger," he says.
Though their exact guidelines vary slightly, the National Cancer Institute, the U.S. Preventive Services Task Force, the American College of Radiology and the American Medical Association all recommend regular mammograms for women 40 and older.
Mammograms are specialized x-rays of the breast that can reveal tumors before they can be felt. A recent study from Sweden showed that regular mammograms can reduce breast cancer deaths by more than 40 percent.
Ongoing research is exploring how computers can help make mammograms even more effective. For example, digital mammography uses a computer instead of x-ray film to store breast images. It allows a doctor to look at the x-ray image from different views or magnify sections for a closer look.
Computer-aided detection and diagnosis (CAD) uses a program that scans the x-ray for patterns that could be cancer. These areas are highlighted so the doctor can pay extra attention to them.
Clinical breast exams (CBE). Starting at age 20, the ACS says women should have breast exams by medical professionals at least every three years during a periodic health examination. After age 40, CBE should be done during periodic health examinations—preferably every year.
Breast self-exams (BSE). "In their 20s women should be told about BSE," Dr. Smith says. "They should be told about breast lumps and breast symptoms."
Though the ACS once recommended that women perform BSE every month, the exam is now optional. BSE was introduced decades ago, before any breast imaging was developed, Dr. Smith explains. Regular examination and awareness were the only available measures for detecting breast cancer as early as possible.
While awareness of breast changes is still very important, BSE is only one route to this awareness, Dr. Smith says. Recent research has shown that women who find their own breast cancers usually detect them at other times, such as while bathing or dressing, even if they perform regular BSE.
"We're not saying that BSE doesn't work and women shouldn't do it. We're saying that…heightened awareness is really what's most important," Dr. Smith says. Heightened awareness means knowing how your breasts normally feel, learning about breast cancer symptoms and reporting any possible symptoms to your doctor right away.
If a woman wants to perform BSE, she should learn how to do it properly, Dr. Smith says. However, according to the ACS, it's also OK if a woman chooses not to perform BSE, or to do it only occasionally.
Magnetic resonance imaging (MRI). Women at high risk for breast cancer should have an MRI, in addition to a mammogram, every year. Women with moderately high risk for breast cancer should discuss this screening test with their doctor.
MRIs use magnetic fields to image breast tissue, and may produce a clearer image than mammograms. They can reveal some cancers that a mammogram would miss, but are also more likely to reveal unusual tissue growth that isn't cancer. In women at average risk for breast cancer, this is more likely to lead to follow-up procedures for growths that aren't cancer, which carries its own risks. That's why screening with MRI is not recommended for all women.
A woman is at high risk for breast cancer if she has:
* A known BRCA1 or BRCA2 gene mutation.
* A first-degree relative (mother, father, brother, sister or child) with a BRCA1 or BRCA2 gene mutation.
* A history of chest radiation therapy between ages 10 and 30.
* Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome, or a first-degree relative with one these syndromes.
* A 20 percent or greater lifetime risk of breast cancer because of other factors (usually family history).
A woman is at moderately high risk for breast cancer if she has a 15 to 20 percent lifetime risk of breast cancer, a personal history of breast cancer or a precancerous breast condition, or breast tissue that appears dense on mammograms.
A doctor can help a woman determine her breast cancer risk.
Breast ultrasound. If something unusual shows up on a mammogram, a breast ultrasound test may show if the mass is solid or filled with fluid. A solid mass could be cancer. Breast ultrasound may also be helpful in addition to mammograms for younger women who have an increased risk of breast cancer, says the ACS.
Ultrasound can also be helpful if a woman's breasts are very dense, Dr. Smith says, which can make it difficult to get a clear mammogram picture. Some doctors also use ultrasound to see if the edges of a tumor are smooth or ragged. Cancerous tumors more commonly have ragged edges.
For your health's sake
Even though more women are developing breast cancer, death rates from the disease have been dropping for more than a decade, Dr. Smith says. The single most important factor in this trend is that cancers are being found earlier. When breast cancer is found early, a woman has the greatest likelihood of successful treatment, and the greatest range of treatment options.