Benefit And Harms Of Screening And Early Treatment
The USPSTF found adequate evidence that mammography screening reduces breast cancer mortality in women aged 40 to 74 years. The number of breast cancer deaths averted increases with age; women aged 40 to 49 years benefit the least and women aged 60 to 69 years benefit the most. Age is the most important risk factor for breast cancer, and the increased benefit observed with age is at least partly due to the increase in risk. Women aged 40 to 49 years who have a first-degree relative with breast cancer have a risk for breast cancer similar to that of women aged 50 to 59 years without a family history. Direct evidence about the benefits of screening mammography in women aged 75 years or older is lacking.
The USPSTF found adequate evidence that screening for breast cancer with mammography results in harms for women aged 40 to 74 years. The most important harm is the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to a womans health, or even apparent, during her lifetime . False-positive results are common and lead to unnecessary and sometimes invasive follow-up testing, with the potential for psychological harms . False-negative results also occur and may provide false reassurance. Radiation-induced breast cancer and resulting death can also occur, although the number of both of these events is predicted to be low.
Mammography Is The Most Common Screening Test For Breast Cancer
A mammogram is a picture of the inside of the breast. Mammography may find tumors that are too small to feel. It may also find ductal carcinoma in situ . In DCIS, abnormalcells line the breast duct, and in some women may become invasive cancer.
There are three types of mammograms:
- Film mammography is an x-ray picture of the breast.
- Digital mammography is a computer picture of the breast.
- Digital breast tomosynthesis uses x-rays to take a series of pictures of the breast from many different angles. A computer is used to make 3-D pictures of the breast from these x-rays.
DBT was approved by the U.S. Food and Drug Administration in 2018 and is now used in 3 out of 4 facilities. One study found that DBT reduced false-positive test results and was likely to reduce breast cancer deaths. More studies are being done to provide information on digital mammography compared to DBT.
Mammography is less likely to find breast tumors in women with dense breast tissue. Because both tumors and dense breast tissue appear white on a mammogram, it can be harder to find a tumor when there is dense breast tissue. Younger women are more likely to have dense breast tissue.
Many factors affect whether mammography is able to detect breast cancer:
Women aged 50 to 69 years who have screening mammograms have a lower chance of dying from breast cancer than women who do not have screening mammograms.
What Is Breast Cancer Screening
Screening can help find breast cancer early, when it is easier to treat.
Breast cancer screeningexternal icon means checking a womans breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for youand if so, when to have itthis is called informed and shared decision-making.
Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.
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What Are The Risks Of Breast Cancer Screening
False positives:;Unfortunately, mammography is not a perfect science;and all breast cancers dont always look really obvious, Dr. Philpotts says. In those cases, women undergo more tests, which can provoke a lot of anxiety. A lot of women automatically think they have breast cancer, but of course the majority of them do not, says Dr. Philpotts.
Yale Medicine has found that its use of 3-D mammography has reduced the number of false alarms. Though 3-D mammography is not yet widely available throughout the region , women seeking the most accurate screening are choosing to come to us.
Over diagnosis:;Women may hear that breast cancer screening leads to over-diagnosing the disease. ;With improved;cancer detection,;doctors may be;finding early-stage cancers that would never harm a woman or affect her life.;This is a controversial topic in radiology.;
The advanced screening techniques used by Yale Medicine help to limit overdiagnosis.
With mammography, we cannot tell the difference between a really bad cancer and a not-so-bad cancer, Dr. Philpotts says. They often look the same. At Yale Medicine its a matter of finding them, biopsying them, diagnosing them, and then, not over-treating them.
There is no data to suggest that cancers regress if left untreated, says Dr. Philpotts, adding that most women will choose to have their cancers treated appropriately.
Benefits Of Breast Screening
Breast cancers found by screening are generally at an early stage. Very early breast cancers are usually easier to treat, may need less treatment, and are more likely to be cured.
The current evidence suggests that breast screening reduces the number of deaths from breast cancer by about 1,300 a year in the UK.
Almost all women diagnosed with breast cancer at the earliest possible stage survive for at least 5 years after diagnosis and are likely to be cured.
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Outside The Obsp Screening Population
Women in their 40s are encouraged to make a personal decision about breast cancer screening in consultation with their healthcare provider.
Women over age 74 can be screened within the Ontario Breast Screening Program; however, they are encouraged to make a personal decision about breast cancer screening in consultation with their healthcare provider. The Ontario Breast Screening Program will not recall women over age 74 to participate in the program. To continue screening through the OBSP, a referral is required from a womans healthcare provider.
Where To Get Screened
Women ages 50 to 74 can call the nearest Ontario Breast Screening Program location to make an appointment .
Women in the North West and Hamilton Niagara Haldimand Brant regions may be eligible for screening in one of our mobile screening coaches.
If you think you may be at high risk for breast cancer, talk to your doctor about a referral to the;High Risk Ontario Breast Screening Program;based on family or medical history.
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Where Can I Go To Get Screened
You can get screened for breast cancer at a clinic, hospital, or doctors office. If you want to be screened for breast cancer, call your doctors office. They can help you schedule an appointment.
Most health insurance plans are required to cover screening mammograms every one to two years for women beginning at age 40 with no out-of-pocket cost .
Are you worried about the cost? CDC offers free or low-cost mammograms. Find out if you qualify.
What Do Lumps In My Breast Mean
Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.
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High Risk Screening Program
We offer a screening and prevention program for women at high risk of developing breast cancer. Our team of medical oncologists, surgical oncologists, and staff members works with you to help you gain a clear understanding of your breast cancer risk factors, how your risk of developing the condition evolves as your life changes, and what you can do to manage your risk.
Our screening and prevention program is tailored to healthy women who are at high risk of developing breast cancer.
Through this program, each woman receives a thorough physical examination, a review of her medical history by an oncologist, and routine and advanced screening examinations that may consist of clinical breast exams, mammograms, ultrasounds, and MRIs.
Who Is Most At Risk Of Breast Cancer
While breast cancer can affect men and women, it is largely women over the age of 50 who are most susceptible to breast cancer.
In the UK, 1 in 7 women will experience breast cancer in their lifetime and 400 men are diagnosed every year.
Other factors which can increase your likelihood are:
- Age the risk increases as you get older
- Family history of breast cancer
- Previous diagnosis of breast cancer
- Previous non-cancerous breast lump
- Being tall, overweight or obese
- Drinking alcohol
More than three-quarters of people survive breast cancer for a decade or more after their diagnosis, however 11,400 people die of breast cancer in the UK every year.
Thats 31 people every day.
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Implant Rupture With Mammography Is Rare
Worried that your implant might burst under compression? Its not a common occurrence.
A 2004 study in the Journal of Womens Health examined problems with mammography for women with breast implants. When researchers reviewed adverse events reported to the U.S. Food and Drug Administration , they identified just 44 incidents involving breast implant rupture with mammography.
In a separate review of published studies, FDA researchers identified another 17 cases involving breast implant rupture during compression.
Yet there are almost 300,000 women who undergo breast augmentation each year, says the American Society of Plastic Surgeons.
In many rupture cases, Dr. Baker suspects the implant was already compromised and the compression just helped it along.
For Women At High Risk
Women who face a higher risk of getting breast cancer;will likely be advised to undergo screening earlier, more often or using more thorough tests.However, like the guidelines for average-risk women, different organizations offer different recommendations for the high-risk group.
According to the ACS, youre high risk if you:
- Have a 20 to 25 percent higher lifetime risk of getting breast cancer based on risk assessment tools
- Had genetic testing;that found a mutation known to increase the risk of breast cancer in the BRCA1 or BRCA2 gene
- Have not had genetic testing, but have an immediate family member with a BRCA1 or BRCA2 gene mutation
- Had radiation therapy in your chest area between ages 10 to 30
- Have or have an immediate family member who has Li-Fraumeni;syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome
The ACR;recommends that women be assessed for breast cancer risk by the age of 30, so that those at high risk may be evaluated to determine whether screening should begin before the age of 40. For women with dense breasts, the ACR recommends that, in addition to mammograms, they undergo contrast-enhanced breast MRI, and if they can’t undergo an MRI, that they consider an ultrasound.
You and your doctor can go over all factors that define your risk and the various recommendations to help you make an informed and shared decision on when to start screening, which tools to use and how frequently to have it done.
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Expect To Have Extra Images Taken
The standard mammogram is two views of each breasta total of four pictures. But women with breast implants typically require a couple of additional views of each breast. The extra views are gathered to detect cancers that might be obscured by the implants.
Theyre called implant displacement views, says Dr. Patel, a member of the National Comprehensive Cancer Networks Guidelines Panel for Breast Cancer.
The breast is drawn out, pushing the implant toward the chest wall so more of the breast tissue is visualized with the mammogram, he explains.
Implant displacement views involve relatively little compression, just enough to keep the breast still, Dr. Baker notes.
In An Era Of Precision Medicine Testing New Approaches To Breast Cancer Screening
A doctor examines mammograms on a view box.
A goal of precision medicine for cancer is to match patients with the most appropriate treatments based on information about the genetic and molecular changes in their tumors. This approach can also help patients avoid treatments that would be unlikely to help and could cause harm.
In the field of cancer screening, individualized approaches could help doctors identify individuals at risk of cancer who need to be screened with tests and testing intervals that are appropriate for each person’s level of risk. Those who are not at risk could avoid the potential harms of screening, such as false-positive test results and overdiagnosis.
Interest in bringing precision to cancer screening has increased in recent years, particularly in the area of breast cancer.
Last year, for example, researchers in California launched a clinical trial to test a new approach to breast cancer screening. The Women Informed to Screen Depending on Measures of Risk clinical trial is using several measures, such as safety, to compare annual mammography with a more individualized approach called risk-based screening.
We are trying to bring precision medicine into the arena of screening. The idea is to learn how we can do a better job of screening for breast cancer.
Laura Esserman, M.D.
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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
When To Get Screened
Breast cancer was expected to be the most common cancer diagnosed in Ontario women in 2018. Screening mammography can find breast cancers when they are small, less likely to have spread and more likely to be treated successfully. Your age and family medical history help determine when you should get screened:
- If you are age 50 to 74, the Ontario Breast Screening Program recommends that most women in your age group be screened every 2 years with mammography. Find your nearest OBSP site by calling 1-800-668-9304 or visiting Ontario Breast Screening Program locations.
- If you are age 30 to 69 and meet any of the following requirements, talk to your doctor about referral to the High Risk Ontario Breast Screening Program:
- You are known to have a gene mutation that increases your risk for breast cancer
- You are a first-degree relative of someone who has a gene mutation that increases their risk for breast cancer
- You have a personal or family history of breast or ovarian cancer
- You have had radiation therapy to the chest to treat another cancer or condition before age 30 and at least 8 years ago
For every 200 women screened in the Ontario Breast Screening Program, about 18 are referred for further tests and 1 will have breast cancer.
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Molecular Breast Imaging Gives An Inside Look At Cancer Cell Activity
Researchers are also exploring the possibility of using molecular breast imaging to detect breast cancer. It may be used together with a mammogram or ultrasound for women who have dense breast tissue or are at higher risk of developing breast cancer.;
This form of imaging works by injecting small amounts of radioactive material into the arm. Then, small cameras record the tracer for about 40 minutes to create images of each breast. Cancer cells absorb the tracer faster than regular cells, so areas that show the most tracer will appear highlighted in the image. This technology may help doctors get a better look at breast tissue to determine whether a biopsy is needed, which can help you avoid unneeded procedures.
Molecular breast imaging is a new technology and is not yet widely available. You can learn more from Mayo Clinic.
Tools Used To Assess Breast Cancer Risk
Several risk assessment tools are available to help health professionals estimate a womans breast cancer risk. These tools give approximate, rather than precise, estimates of breast cancer risk based on different combinations of risk factors and different data sets.
Because the different tools use different factors to estimate risk, they might give different risk estimates for the same woman. Two models could easily give different estimates for the same person.
Risk assessment tools that include family history in first-degree relatives and second-degree relatives on both sides of the family should be used;with the ACS guidelines to decide if a woman should have MRI screening. The use of any of the risk assessment tools and its results should be discussed by a woman with her health care provider.
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Primary And Adjunctive Screening In Women With Dense Breasts
The USPSTF found insufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
Epidemiology of Dense Breasts
In the United States, the most commonly used classification system for breast density is the American College of Radiologys Breast Imaging Reporting and Data System 4-category scale . Data from the BCSC indicate that about 25 million women aged 40 to 74 years are classified as having heterogeneously or extremely dense breasts. The proportion of women with dense breasts is highest among those aged 40 to 49 years and decreases with age.14
Increased breast density is a risk factor for breast cancer. Data from the BCSC indicate that, compared with women with average breast density, women aged 40 to 49 years with heterogeneously or extremely dense breasts have a relative risk of 1.23 for developing invasive breast cancer. For women aged 50 to 64 years with heterogeneously or extremely dense breasts, the RR is 1.29, and for women aged 65 to 74 years, it is 1.30.7 However, women with dense breasts who develop breast cancer do not have an increased risk for dying from the disease, after adjustment for stage, treatment, method of detection, and other risk factors, according to data from the BCSC.15
Primary Screening Test Performance Characteristics
Primary Screening Frequency