BREAST CANCER DETECTION
Breast cancer cases have been steadily increasing in the United States with 252,710 women being diagnosed in 2017 according to Cancer.org. About one in eight women will be diagnosed with breast cancer in their lifetime. Mortality has been decreasing due to early diagnosis due to breast cancer detection through mammographic examinations. The size of the tumor and the stage of cancer at diagnosis are the most important factors. This determines prognosis and survival rates.
Breast cancer is a wide spectrum of disease, some breast cancers are slow growing and have longer survival than others. Tissue samples of cancer tissue obtained during a biopsy are routinely subjected to a series of tests. These tests look for the presence of certain types of receptors in cancer cells. An Oncologist uses this information and the stage of cancer to tailor a treatment plan for each patient to optimize patient survival.
Some breast cancers are aggressive and fast growing while others are slow growing. Annual screening with mammography leads to potential early breast cancer detection. When cancer is small, it may grow faster than others. Younger women tend to have cancers that grow faster. This makes screening every year in women in their forties is very important to provide the benefit of early diagnosis.
SYMPTOMS OF BREAST CANCER
Women should be aware of the signs and symptoms of breast cancer such as:
- unexplained breast infection (mastitis)
- skin changes
- itching nipples
- one-sided nipple discharge
Such symptoms should prompt diagnostic mammogram and breast ultrasound. Breast Ultrasound accurately characterizes breast lumps and is useful to determine the need for a biopsy of solid tumors of the breast. Not all solid tumors of the breast are cancerous, about 75% or higher are non-cancerous produced by Fibrocystic changes in the breast. Fibrocystic changes formerly called fibrocystic changes are a result of the estrogen effect on the glandular tissue and the stroma in between the glands of the breast. It is a common condition of the breast seen in over 50% of women.
Risk Factors & Assessment
There are several breast cancer risk assessment models that are in use that help doctors determine an individual woman’s risk factor for breast cancer. One great tool can be found on Cancer.com. Based on an individual risk screening for breast cancer can be tailored to match the degree of risk. Only 5% of breast cancers occur in women with a genetic susceptibility for breast cancer. However, 75% of women diagnosed with breast cancer have no known risk factors.
Modifiable risk factors include:
- High BMI
- Consumption of alcohol
- Smoking
- Post-menopausal hormone replacement therapy
Non- modifiable risk factors include:
- Genetic predisposition
- Menstrual and reproductive history
- Family history of breast cancer.
3D Mammography – Breast Cancer Detection
3D Mammography is superior to 2D mammography for breast cancer detection while simultaneously reducing the false positive. The increased radiation dose is well within the safe limit required by the FDA. Breast cancer prognosis and survival is dependent on the size of the tumor at initial diagnosis. Breast cancer screening using mammography finds cancers when small and before they manifest as breast lumps. This provides a window of opportunity to treat when small and confined to the breast.
Mammography utilization rates have increased from 29% in 1987 to 66% in 2013. Resulting in a 33% reduction in deaths from breast cancer from 33 deaths per 100,000 women in 1989 to 22 deaths per 100,000 women in 2011. Many clinical trials conducted in the USA and Europe have shown breast cancer mortality being reduced in women who undergo regular mammography. 30-40% reduction has been documented in large scale clinical trials. Breast cancer screening with mammography should commence at age 40 and most benefit is achieved when done annually. Screening mammography should continue until there is a life expectancy of 5-7 years.
When to get a breast cancer screening
Women with a first degree relative with breast or ovarian cancer should start screening with mammography ten years prior to the age of diagnosis of the family member or at age 35 years whichever is earlier. Patients who have received chest radiation at a young age are at increased risk for developing breast cancer and should start screening at a younger age. Women under the age of thirty years, pregnant and lactating women with breast symptoms and complaints are evaluated with a breast ultrasound initially.
Breast cancer management and treatment is a multidisciplinary and involves a close consultation from qualified specialists. Breast imager, breast pathologist, breast surgical oncologist, medical oncologist, or radiation oncologist are all qualified specialists. These specialists discuss cases during a tumor board in order to come to a consensus plan for optimal treatment for a patient.