Screening for Breast Cancer
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Screening is a way to evaluate people without symptoms to determine if they are at risk for cancer or have already developed cancer.
Screening Guidelines for Breast Cancer
After considerable debate about the merits of mammogram screening in women 40-49 years old, most professional organizations including the American Cancer Society, National Cancer Institute, and the US Preventative Services Task Force recommend the following:
- Women in their 40s should be screened every 1–2 years with mammography.
- Women aged 50 and older should be screened annually.
- Women who are at higher than average ]]>risk]]> of breast cancer should seek expert medical advice about whether they should begin screening before age 40, and the frequency with which they should be screened.
While this is certainly reasonable advice, research evidence regarding screening in average-risk women less than 50 remains mixed. A recent study, for example, involving 160,921 women recruited at age 39-41 showed that annual screening mammograms up to age 48 did decrease breast cancer mortality over an average of 10.7 years. This reduction, however, was not statistically significant, meaning it could have been due to chance. According to these findings, about 2,500 women would need to be screened to prevent one breast cancer death during this time period. ]]>*]]>
Screening Tests for Breast Cancer
The success of breast cancer treatment lies in detecting and treating breast cancer in the earliest stages. The following practices may help promote early detection of breast cancer:
Traditionally, women have been strongly encouraged to perform monthly breast self-exams beginning at age 20 to look for breast lumps or changes that might signal breast cancer. Although this practice can be beneficial to many women, and may help in detecting changes between annual clinical breast exams, recent research draws different conclusions as to its ultimate effectiveness. Talk to your doctor about breast self-exams to see if they are right for you. If you would like to perform breast self-exams, learn how to do them accurately, and perform them monthly. However, this type of examination is not a substitute for a clinical breast exam.
For more information on breast self-examination, ]]>click here]]> .
Clinical Breast Examination
During your routine physical exam, your doctor or health care professional may do a clinical breast examination (CBE). During a CBE, your doctor will look for any changes in the skin, such as dimpling, scaling, or puckering; any discharge from the nipples; or any difference in appearance between the two breasts, including differences in size or shape. Then your doctor will carefully feel your breasts and under your arms while you are sitting up and lying down to check for lumps or other unusual changes. This test is especially important for younger women to have, as their breast tissue may be dense, and abnormalities may not be detected by a mammogram.
Clinical breast examination has not been formally tested against an unexamined control group. Its role may be most important in younger women where mammography is less accurate. It is unclear when clinical breast examination should be advised, but it is reasonable to consider having an annual examination by age 40. Talk with your doctor about the best clinical exam schedule for you.
A mammogram is a special x-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Mammograms are usually done in a clinic or special radiology center; the test itself will only take about 15 minutes to complete. The ability of mammography to detect cancer depends on such factors as the size of the tumor, the age of the woman, breast density, and the quality of the imaging center.
During a mammogram, you will remove all clothing above the waist, and will sit upright in front of a mammography machine. You will be provided with a lead vest to cover and protect your reproductive organs. A technician will position and compress each breast between two plates on the x-ray machine so an accurate picture can be taken. A radiologist will examine the x-ray for any potential abnormalities.
The results of your mammogram should be reported to you and to your doctor. If for some reason you are not contacted, call your doctor to request the results. If the test results are suspicious or inconclusive, you may be asked to have other testing procedures, such as an ultrasound.
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast . Philadelphia: Lippincott Williams and Wilkins; 1999.
National Cancer Institute website. Available at: http://www.cancer.gov/ .
* Updated Screening Guidelines for Breast Cancer section on 12/21/2006 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet . 2006 Dec 9;368(9552):2053-60. ]]>
Last reviewed February 2003 by John Erban, MD]]>
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