It is strongly recommended by the American Cancer Society, for women without breast symptoms age 40 and older, to stay alert to detecting breast cancer early. A mammogram should be performed every year. It is very important that they commit to this annual examination to stay on top of their condition.
Today, stronger than ever before, the evidence supporting mammograms is positive. The recent evidence regarding these examinations show how women in their 40s gain substantial benefits in their efforts to find cancer early. One should be aware that there are limitations attached to mammograms as well. It is possible that some cancers might be missed by the testing.
It is critical that women be told, and understand, both the limitations and the benefits of the annual mammograms. They should also understand that in spite of any limitations they may have, mammograms are truly valuable and effective tools. Regardless of whatever age the woman might be, these tests should continue going on unless she has other chronic and serious health issues and problems. Health issues and problems such as moderate to severe dementia, chronic obstructive pulmonary disease, end-stage renal disease, and congestive heart failure. The reason to halt having regular mammograms should never be age alone. Women with short life expectancies, or with extremely serious health problems, should consult with their physician whether or not they should continue having mammograms or not.
As part of a regular health examination, ladies in their 20s and 30s should seek out a clinical breast examination(CBE), performed at least every three years by a health professional. When they reach the age of 40, the CBE performed by the health professional should occur every year.
Performed along with mammograms, the CBE allows women and their medical professional the opportunity to talk about early detection testing. Any changes in their breasts, and any factors that could lead to the likelihood of obtaining breast cancer, should be the topics of these discussions. Having the CBE shortly before the mammogram could be of some benefit. Instruction for becoming more familiar with one’s breasts should be included in the exam. Also, information about both the limitations and the benefits of breast self-exam(BSE), and CBE should also be offered to the women involved. For women in their 20s, the chance of breast cancer occurring is rather limited, but it does increase as one grows in age. It is important that women understand that any new breast symptoms are promptly reported to a health professional.
For women starting in their 20s, breast self-exam(BSE) is a useful detection option. It is important that they are versed on both the limitations and the benefits of BSE. And again, they should be reminded that they need to report any changes to their breasts to their health professional immediately.
Research has shown that BSE plays a small role in discovering breast cancer when the women are not aware of what they should be looking for. Doing BSE on a consistent basis(usually after their monthly period) can be used to schedule exams for some women. Examining the look and feel of one’s breasts in a systematic, step-by-step approach is what BSE involves. Very often, some women become overly stressed dealing with the technique. Their concerns usually arise when regarding if they are “doing everything right.” It is often a good technique for women to regularly monitor the feel of their breasts, and determine if there are any changes occurring. With or without BSE, the goal is to be aware of any changes that happen, and if there are any, report them immediately to a health professional.
It is important for those women employing a BSE step-by-step approach, to review their technique with their health professional during their physical exam. Women should know the proper techniques, what to feel for, and they should check frequently. The truth is that those who do conduct the exam consistently, get a good idea for what their breasts should feel like. Should any changes occur such as: a discharge other than breast milk, scaliness or redness of the breast skin or nipple, nipple pain or retraction(turning inward), skin irritation or dimpling, or development of a lump or swelling, it is vital to see your health professional as soon as possible to get an evaluation. You should keep in mind that most of the time these breast changes are not cancer.
An MRI and mammogram annually are vitally important for all women with an increased risk of breast cancer.
Included in this are women who:
- Have a known BRCA1 or BRCA2 gene mutation
- Had radiation therapy to the chest when they were between 10 and 30 years of age
- Have a breast cancer lifetime risk 20%-25% greater than normal according to risk assessment tools. Usually based predominately on the history of their family(such as the Claus model-see below)
- Have a first-degree relative(child, sister, brother or parent)with a gene mutation BRCA1 or BRCA2, and have not themselves had genetic testing
- Have Bannayan-Riley-Ruvalcaba syndrome, Cowden syndrome, or Li-Fraumeni syndrome, or with one of these syndromes, have a first-degree relative
For those women with a 15% or less lifetime risk of breast cancer, the American Cancer Society recommends against MRI screening.
For women with a moderately increased breast cancer risk, there is simply not enough evidence available to make a recommendation for or against an annual MRI screening.
The same applies to those at risk for breast cancer, based on certain factors like:
- A personal history of breast cancer, atypical lobular hyperplasia(ALH), atypical ductal hyperplasia(ADH), lobular carcinoma in situ(LCIS), or ductal carcinoma in situ(DCIS).
- Having dense breasts(“heterogeneously” or “extremely” dense) as seen on a mammogram.
An MRI should not be used instead of a screening mammogram, but in addition to it. The reason for this is that even though it is more likely to detect cancer than a mammogram is, it still can miss certain cancers that the mammogram will find.
Screening with mammograms and MRI should start at age 30 for women at high risk, and as long as the woman remains in good health, screenings should continue. This decision should be made by the patient and their health care provider, taking into account personal preferences and circumstances, because the evidence is still limited to just what age is the best to begin screening.
To estimate a woman’s breast cancer risk, professionals use several risk assessment tools with names like the Tyrer-Cuzick model, the Claus model, and the Gail model. These tools estimate breast cancer risk approximately, rather than precisely, based on different data sets and different combinations of risk factors.
Because different factors are used to estimate risk by, the same woman can get different risk estimates. An example of this would be a risk estimate based on certain personal risk factors of the Gail model. Included in these factors are first-degree relatives and any history of breast cancer with them, history of prior breast biopsies, age at menarche (first menstrual period), and current age. On the other hand, a risk in the Claus model is based only on breast cancer family history in relatives both first and second degree. For the same person, these two models could very easily give different estimates.
A woman should consult with her health professional and discuss the usage and results of any risk assessment tools.
It is suggested that women getting an MRI screening do so at a facility where at the same time they can do an MRI-guided breast biopsy. Otherwise, when she does have the biopsy at another facility, she will also need a second MRI examination.
For women at average risk, the evidence doesn’t exist that an MRI is an effective screening tool. It has a higher false positive rate than mammograms, and this can often lead to many other tests and unneeded biopsies, causing the women involved anxiety, unnecessary worry and concern.
Women have the best chance to lower the risk of dying from breast cancer, according to the American Cancer Society, by the use of clinical breast exams. MRI(in women at high risk), mammograms, and early breast change reporting, according to the outlined above recommendations, are certainly better than any one test or examination alone.
There is no question that both mammograms and MRI exams are highly recommended for women at high risk of breast cancer. The bottom line is you want to deal with any problems before they get worse.
