Early Detection Saves Lives!
October is breast cancer awareness month and with this in mind the importance of screening for breast cancer is front and center for many women. Breast cancer is the second deadliest cancer in women with 1 in 8 women being diagnosed with breast cancer during their lifetime. Worldwide, in 2013, we saw over 464,000 breast cancer deaths. Undoubtedly, this is an important health topic for women and one that generates some degree of anxiety.
It’s important to note that the majority of breast cancers in the United States are diagnosed as a result of an abnormal mammogram study, although a significant number are also first brought to the attention of a physician by a patient being aware of anatomic changes of her breast.
Differences in opinion surround breast cancer screening, however. Specifically, opinions vary with regard to who should be screened, when to start screening, how to screen, how frequently to screen and when to stop screening.
The concern from specialist is that if we over screen we may over biopsy, over diagnose, and maybe even over treat. “Overdoing it” carries its own psychological and physiologic side effects. In some cases, we may be looking at a “False-Positive”, i.e. looks like cancer but not cancer.
When considering breast cancer screening we should always include in the equation an individual woman’s risks of breast cancer, her personal preferences, and the benefits and harms of screening. The most important point being that women should make an informed decision with their physician about breast cancer screening.
While recommendations vary from specialty to specialty, I’d like to throw my hat into the ring and give you recommendations from a primary care, internal medicine physician viewpoint. Generally speaking these are my recommendations for breast cancer screening in women and for the most part coincide with recommendations from the American College of Radiology, the American College of Obstetrics and Gynecologists and the American Cancer Society.
1. Begin at 40
In average risk women, breast cancer screening should begin at age 40. Screening before age 40 is reserved for women at higher risk of breast cancer. High risk includes a positive family history of breast cancer, personal or family history of positive BRCA1 or BRCA2 genetic mutation, or strong family history of ovarian, tubal or peritoneal cancer. Keep in mind that less than 1% of women in the general population are estimated to be at high risk for breast cancer.
2. Mammography is the Standard
The tried and true method for breast cancer screening and the current standard of care is mammography. Other options, including MRI of the breast are reserved for high-risk individuals or women with a history of breast cancer.
3. How Often You Get Screened Depends on Age
Screening should occur annually for women age 40 to 54 and then every two years for women 55 years of age and older.
4. Screening Should Continue to 75-80
Screening should be continued as long as a woman has a life expectancy of at least 10 years. Most thought leaders recommend that screening for breast cancer should end around 75 to 80 years of age.
5. Physician Breast Exams Matter of Opinion
As far as clinical breast exams performed by your physician in the office, these have fallen out of favor as they have the potential of false positive findings and no scientific evidence that these exams result in better outcomes. As a general rule I don’t recommend these unless a patient has identified an area of concern and would like further evaluation. The American College of Obstetrics and Gynecologists does recommend clinical breast exams every one to three years for women ages 20 to 39, and annually thereafter.
6. Cannot Rely on Self-Exams
With regard to breast self-exams performed at home, these exams have also fallen out of favor and generally are not recommended except for patients who are high risk. It is my experience however that the yearly breast self-exam assist women in self-awareness of anatomy and in many cases may be beneficial in identifying abnormal anatomy of the breast. Examples of concerning anatomic changes of the breast include: lumps, bumps, dimpling, changes in the appearance of the nipple, fluid leakage from the nipple, or skin changes or redness that do not go away.
7. Genetic Testing is Helping
Genetic testing for breast cancer is indicated in very few women. When considering genetic testing, patients should work directly with a breast care specialist and undergo genetic counseling in order to make an informed decision. Specifically, women should consider genetic testing if they are diagnosed with breast cancer early in life, have a strong family history of breast and/or ovarian cancer, are of Ashkenazi Jewish descent, or have a family history of male breast cancer.
Appropriate breast cancer screening is our best defense in early identification of breast cancer. As in most cases, knowledge is power. Take time to discuss screening options with your physician in order to have a clear strategy for early detection.