MD; p2p e-Health Newsletter Assistant Editor
October is breast cancer awareness month and I wanted to briefly discuss breast cancer detection in this article. Breast cancer is the most common cancer among women in the United States. Annual screening mammogram beginning at age 40 has been shown to reduce mortality from breast cancer by 40%1. This is the current screening recommendation for average risk women from the American College of Radiology (ACR). For women who are at higher risk, such as those with strong family history of breast cancer, genetic predisposition, history of chest radiation at a young age and personal history of breast cancer, supplemental screening with breast MRI or breast ultrasound may be indicated. Digital breast tomosynthesis (3D mammogram) is available in most imaging centers in the US. One benefit of tomosynthesis is that it increases cancer detection rate compared to digital mammography (2D mammogram)2. To estimate the risk of breast cancer, one can use risk assessment tools such as the Gail model or Tyrer Cuzick risk calculators which are available online.
While routine self-breast exam may not be effective for early detection of breast cancer, a woman who feels a palpable breast or axillary lump should bring this to her doctor’s attention as soon as it is discovered. Additional evaluation may include clinical breast exam, imaging and/or biopsy, if indicated. Other symptoms that require further investigation include clear or bloody nipple discharge and nipple retraction/discoloration.
Screening mammography is performed for women who are asymptomatic. While 90% of women will be told that their mammogram is normal, approximately 10% will be called back for additional imaging. According to the ACR, 6/10 of these women will have normal mammograms and can return to routine screening. About 2/10 of the women will be asked to return for follow up in 6 months for breast ultrasound or mammogram. Only 1-2% of the women who are called back for additional imaging will need a biopsy2. However, if a patient has symptoms such as breast pain, lump or is returning for follow up, then the patient will have a diagnostic mammogram. This means that a radiologist will review the images and perform additional imaging, if necessary, during the same visit.
While mammography does not find all cancers, it is the best screening tool currently available. For those who haven’t had a mammogram this year, now is a good time to schedule one.
Tabár L, Dean PB, Chen TH, et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2019;125(4):515–523.
Conant EF, Barlow WE, Herschorn SD, et al. Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density. JAMA Oncol. Published online February 28, 20195(5):635–642.