Risk Of Bias In Included Studies
Three studies have been included in this review. Two of these studies assessed regular breast selfexamination versus no regular breast selfexamination and one assessed a combination of clinical breast examination and instruction for breast selfexamination versus no regular breast selfexamination.
Regular breast selfexamination versus no regular breast selfexamination
The Russian Federation/World Health Organization Study a) Randomisation method
Women aged 40 to 64 years were invited to participate. In St Petersburg, 18 district polyclinics and 10 large enterprise healthcare services were randomised separately at WHO, Geneva, using a table of random sampling numbers, which ensured that there were 9 polyclinics and 5 enterprises in each group. According to one publication a total of 120,310 women were randomised in St Petersburg from 1985 to 1989: 60,221 women to the screening group and 60,089 to the control group. According to a later publication the numbers were 122,471 with 57,712 randomised to the screening group and 64,759 to the control group. This discrepancy has not been explained. Polyclinics with ‘occupational hazards’ and previously conducted breast selfexamination education programs were excluded. Screening by breast selfexamination had not been promoted in the Russian Federation before the implementation of the study. Because of the discrepancies in numbers, the outcome of the randomisation process is uncertain.
c) Quality of the screening programme
Reduce Your Risk For Breast Cancer
There are several healthy lifestyle choices you can make to reduce your risk of breast cancer and breast cancer recurrence.
- Stay lean after menopause. Keep a healthy weight and a low amount of body fat. Eating a healthy diet can help.
- Get active and sit less. Aim for at least 150 minutes of moderate or 75 minutes of vigorous physical activity each week. Do strength-training exercises at least two days a week.
- Avoid alcohol. If you drink, limit yourself to one drink per day if you are a woman.
- Choose to breastfeed. Try to breastfeed exclusively for six months after giving birth, and continue even when other foods are introduced.
- Manage hormones naturally. If you are going through menopause and trying to control the symptoms, try non-hormonal methods before turning to hormone replacement therapy.
The screening plans on this page apply to women expected to live for at least 10 years. Theyre not for women who have a health condition that may make it hard to diagnose or treat breast cancer. Your doctor can help you decide if you should continue screening after age 75.
Interpretation Of Screening Mammography Results
Clinicians receive screening mammography results for their patients in standardized lexicon using the American College of Radiology’s Breast Imaging Reporting and Data System .97 Screening mammograms interpreted as normal or benign correspond with a clinical management recommendation of continued routine screening, though the decision to continue screening should be based on the woman’s preferences. Almost all abnormal screening mammograms are interpreted as BI-RADS assessment category 0, which indicates an incomplete assessment and request for additional diagnostic mammographic views and/or ultrasound. Some radiologists will provide a probably benign assessment at screening and recommend short-term follow-up mammography in 6 months. This designation corresponds to a radiologist’s belief that the finding harbors < 2% of malignancy. Rarely, radiologists will provide a BI-RADS 4 or 5 category assessment, deeming an imaging finding as suspicious for malignancy these designations are usually reserved for after a complete diagnostic work-up has been completed.
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Clinical Considerations And Recommendations
How should individual breast cancer risk be assessed?
Health care providers periodically should assess breast cancer risk by reviewing the patients history. Breast cancer risk assessment is based on a combination of the various factors that can affect risk Box 1610111213. Initial assessment should elicit information about reproductive risk factors, results of prior biopsies, ionizing radiation exposure, and family history of cancer. Health care providers should identify cases of breast, ovarian, colon, prostate, pancreatic, and other types of germline mutation-associated cancer in first-degree, second-degree, and possibly third-degree relatives as well as the age of diagnosis. Women with a potentially increased risk of breast cancer based on initial history should have further risk assessment. Assessments can be conducted with one of the validated assessment tools available online, such as the Gail, BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancer Intervention Studies , or the Claus model 34.
Is screening breast self-examination recommended in women at average risk of breast cancer, and what should women do if they notice a change in one of their breasts?
Should practitioners perform routine screening clinical breast examinations in average-risk women?
When should screening mammography begin in average-risk women?
How frequently should screening mammography be performed in average-risk women?
Who Should Be Screened
Guidelines for who should undergo breast cancer screening vary within and among countries.1 In the United States, the U.S. Preventive Services Task Force recommends that breast cancer screening with mammography be offered to women 50 to 74 years of age and that starting screening before age 50 years should be based on the individual woman’s context, including her values regarding the benefits and risks.2 The American Cancer Society recommends screening starting at age 40.3 Screening women 40 to 49 years of age is more controversial than older ages, with less evidence available to determine the risk-benefit balance. Analyses using six different breast cancer simulation models of the National Cancer Institute-funded Cancer Intervention and Surveillance Modeling Network found that starting biennial screening at age 40 years with mammography, in comparison to age 50 years, was associated with reduced breast cancer mortality by an additional 3%, but at the expense of more false-positives and health care resources.4
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General Considerations For Screening
The goal of screening for cancer is to detect preclinical disease in healthy, asymptomatic patients to prevent adverse outcomes, improve survival, and avoid the need for more intensive treatments. Screening tests have both benefits and adverse consequences .
Breast self-examination, breast self-awareness, clinical breast examination, and mammography all have been used alone or in combination to screen for breast cancer. In general, more intensive screening detects more disease. Screening intensity can be increased by combining multiple screening methods, extending screening over a wider age range, or repeating the screening test more frequently. However, more frequent use of the same screening test typically is associated with diminishing returns and an increased rate of screening-related harms. Determining the appropriate combination of screening methods, the age to start screening, the age to stop screening, and how frequently to repeat the screening tests require finding the appropriate balance of benefits and harms. Determining this balance can be difficult because some issues, particularly the importance of harms, are subjective and valued differently from patient to patient. This balance can depend on other factors, particularly the characteristics of the screening tests in different populations and at different ages.
What Happens During A Breast Exam
Before your breast exam, your health care provider will ask you detailed questions about your health history, including your menstrual and pregnancy history. Questions might include what age you started menstruating, if you have children, and how old you were when your first child was born.
A thorough breast exam will be performed. For the exam, you undress from the waist up. Your health care provider will look at your breasts for changes in size, shape, or symmetry. Your provider may ask you to lift your arms over your head, put your hands on your hips or lean forward. They will examine your breasts for any skin changes including rashes, dimpling, or redness. This is a good time to learn how to do a breast self-exam if you don’t already know how.
As you lay on your back with your arms behind your head, your health care provider will examine your breasts with the pads of the fingers to detect lumps or other changes. The area under both arms will also be examined.
Your health care provider will gently press around your nipple to check for any discharge. If there is discharge, a sample may be collected for examination under a microscope.
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What To Do If You Find A Lump
Dont panic if you think you feel a lump in your breast. Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign . There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.
Dont hesitate to call your doctor if youve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor. The best healthcare provider to call would be one who knows you and has done a breast exam on you before for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor.
Make sure you get answers. Its important that your doctor gives you an explanation of the cause of the lump or other breast change and, if necessary, a plan for monitoring it or treating it. If youre not comfortable with the advice of the first doctor you see, dont hesitate to get a second opinion.
Increased Breast Cancer Risk
Some women have an increased risk of developing breast cancer. Having an increased risk doesnt mean that you will get cancer, but they must receive more frequent testing. Aging only adds to the increased risk. Risk factors for breast cancer include:
- Carrying a related genetic mutation
- Lobular carcinoma history
- Strong family history of breast cancer
- Having received radiation treatment to the chest
- Having had breast cancer already
Contact us if you believe you may be at an increased risk of breast cancer. We can offer personalized support and recommendations for your testing protocol. Women who have a high risk of breast cancer should begin mammogram testing before age 40. These women may also need an MRI in combination with mammograms.
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Pap Test And Human Papillomavirus Testing
These tests, which can be used both alone and in combination, can lead to both early detection and prevention of cervical cancer. They prevent the disease because they allow abnormal cells to be found and treated before they become cancer. Testing is generally recommended to begin at age 21 and to end at age 65 in women who have had adequate prior screening and are not otherwise at high risk for cervical cancer. For more information, see the Pap and HPV Testing fact sheet and the PDQ® Cervical Cancer Screening summary.
Screening Information For Breast Cancer
Mammography is the best tool doctors have to screen healthy women for breast cancer, as it has been shown to lower deaths from the disease. Like any medical test, mammography involves risks, such as the possibility of additional testing and anxiety if the test falsely shows a suspicious finding, called a “false-positive” result. Up to 10% to 15% of the time, mammography will not show an existing cancer, called a “false-negative” result.
Digital mammography may be better able to find breast cancers, particularly in women with dense breasts. A newer type of mammogram is called tomosynthesis or 3D mammography. It may improve the ability to find small cancers and reduce the need to repeat tests due to false-positives. However, there is also the risk of diagnosing problems in the breast that would otherwise go unnoticed and would not lead to any negative consequences. This is called “overdiagnosis” and may lead to overtreatment with a potential for harm. This method is approved by the FDA, though research on it is ongoing.
Other breast cancer screening methods
According to the American Cancer Society , women who have BRCA gene mutations, who have a very strong family history of breast cancer, or who had prior radiation therapy to the chest should consider mammography and MRI each year.
Women at moderate risk of breast cancer, such as women with precancerous changes on a biopsy, can talk with their doctor about whether MRI screening should be considered.
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How Close Are We To A Blood Test For Breast Cancer
- Researchers are looking at whether we can detect breast cancer via blood test.
- Were still years away from the test being available to the public.
- Early stage cancers shed very small amounts of most biomarkers into blood.
Theres a new blood test that aims to detect breast cancer. Its one of many attempts to create an effective early detection method.
The test could pinpoint breast cancer up to 5 years before a person shows clinical signs of the disease, according to researchers from the University of Nottingham in the United Kingdom.
The test evaluates the bodys immune response to the substances tumor cells produce.
Cancer cells make antigens that cause the body to make antibodies known as autoantibodies. The test looks for the presence of autoantibodies against tumor-associated antigens .
The team was able to make a panel that looked for autoantibodies against 40 antigens that are known to be associated with breast cancer.
Additionally, they looked at 27 antigens or TAAs that werent known to be linked with breast cancer.
The research was presented at the 2019 National Cancer Research Institute Cancer Conference.
To assess the test, the researchers collected blood samples from 90 people with breast cancer when they received their diagnosis. They then compared those samples with blood samples from 90 people without breast cancer.
How Often Should You Get Breast Exams
Breast exams are an essential part of a healthy routine for every woman. We understand that breast cancer can be a scary topic that many women dont want to think about. However, regular checkups at our Womens Center are the best way to maintain health and monitor any changes you may experience in your breasts. At Southside Medical Center in Atlanta, GA, we offer comprehensive gynecological and womens health services for our valued female patients.
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Stage Of Breast Cancer
When breast cancer is diagnosed, your doctors will give it a stage. The stage describes the size of the cancer and how far it has spread, and is used to predict the outlook.
Ductal carcinoma in situ is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:
- stage 1 the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
- stage 2 the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
- stage 3 the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
- stage 4 the tumour is of any size and the cancer has spread to other parts of the body
This is a simplified guide. Each stage is divided into further categories: A, B and C. If youre not sure what stage you have, talk to your doctor.
Regular Breast Exams To Detect Breast Cancer Early
Breast cancer is cancer that forms in the breast cells. Your chances of beating breast cancer increase when it is detected early. Survival rates of breast cancer are climbing because of early detection and advances in treatment. Regular breast exams play a significant role in detecting breast cancer.
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* You Are At Average Risk If You Have:
- no symptoms of breast cancer
- no history of invasive breast cancer
- no history of ductal or lobular carcinoma in situ
- no history of atypia
- no family history of breast cancer in a first-degree relative
- no suggestion or evidence of a hereditary syndrome such as a BRCA mutation
- no history of mantle radiation
For Women Who Have Had Mantle Radiation:
- a clinical breast exam every six months beginning at the time of your radiation treatment
- an annual mammogram starting eight years after your radiation treatment
- possible annual breast MRI
All women at above-average breast cancer risk should speak with their doctor about additional screening tests, perform a monthly self breast exam, and become familiar with their breasts so they are better able to notice changes.
MSK offers a comprehensive program for women at increased breast cancer risk, including regular breast exams and imaging. It allows any developments to be identified and dealt with right away.
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Whats The Difference Between A Breast Self
A clinical breast exam is performed by a healthcare professional who is trained to recognize many different types of abnormalities and warning signs. This in-office exam will most likely be completed by your family physician or gynecologist at your annual exam, whereas your breast self-exam is something every woman should do at once at month at home.
Blood Test For Early Detection Of Cancer: Final Study Results Support Screening Use
by European Society for Medical Oncology
Final results from a study of a blood test that can detect more than 50 types of cancer have shown that it is accurate enough to be rolled out as a multi-cancer screening test among people at higher risk of the disease, including patients aged 50 years or older, without symptoms.
In a paper published in the leading cancer journal Annals of Oncology today, researchers report that the test accurately detected cancer, often before any symptoms arose, while having a very low false positive rate. The test also predicted where in the body the cancer is located with a high degree of accuracy, which could help doctors choose effective diagnostic tests.
GRAIL, Inc. , the company developing and funding the research, has now made the multi-cancer early detection test available in the U.S. by prescription only, and to complement other, existing screening methods such as those for breast, cervical, prostate, lung and bowel cancers. Many of the cancers that the test is capable of detecting do not have screening tests available, such as liver, pancreatic and oesophageal cancers, which are among the most deadly and where early detection could make a real difference.
Sensitivity of the test was 67.6% overall across stages I-III in 12 pre-specified cancers that account for two-thirds of cancer deaths in the U.S. each year , and it was 40.7% overall in more than 50 cancers.
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