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 The Study Found
In this latest study, Lee and colleagues evaluated three specific risk factors: a family history , a personal history of breast cancer, or dense breasts.
Dense breasts can obscure the underlying mammographic abnormalities, including breast cancers. Having more fibroglandular breast tissue is also itself associated with increased breast cancer risk, Lee told Healthline.
But experts not associated with the study have advised caution when considering mammography at age 30, particularly on the basis of dense breasts.
Dense breasts are common in younger women. Research estimates 74 percent of women ages 40 to 49 have dense breasts compared with just 36 percent of women in their 70s. Most women aged under 40 have dense breast tissue.
Breast density in mammography refers to the amount of parenchymal tissue relative to the amount of fatty tissue in a breast. Parenchymal tissue looks white on mammography and so are cancerous masses. Cancers can therefore be harder to detect in those with dense breasts.
Diana Miglioretti, PhD, a professor of biostatistics at the UC Davis School of Medicine, says that given most women in their 30s have dense breast tissue, the benefits of mammography for women without a personal history of breast cancer may not outweigh the risks.
Miglioretti points out that under current guidelines, all women with a personal history of breast cancer should be screened annually , regardless of age.
Treatment Options For Breast Cancer
According to the American Cancer Society, early-stage breast cancer has a five-year survival rate of about 99 percent.
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A Word Of Caution Regarding Home Genetic Tests For Breast Cancer
The idea of a home genetic test for breast cancer is exciting to many people, as these tests might help them avoid the clinic while being their own advocate in their health. It’s important to thoroughly understand the limitations of these tests, however, if you choose to do one.
For example, a popular at-home genetic test identifies three breast cancer genes that are more common among Ashkenazi women but are rare in other ethnic populations. While the company is transparent in admitting that the test only checks for 3 out of a potential 1000 BRCA mutations, not everyone reads the small print. The bottom line on this test is that for Ashkenazi Jewish woman, a positive test might let them know they should see their healthcare provider . For most women the test is relatively meaningless, and actually be harmful if they trusted the results and did not have formal testing.
Personal History Of Breast Disease
Females who have previously had breast cancer are at risk of developing a second breast cancer, either in the other breast or in a different part of the same breast. This is not the same as the first cancer returning.
Having a personal history of certain noncancerous breast conditions can also increase a persons risk of breast cancer. This can include conditions such as atypical hyperplasia, lobular carcinoma in situ, and ductal carcinoma in situ.
People with a history of breast, ovarian, fallopian tube, or peritoneal cancer should ask their doctors about .
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Breast Cancer Risk Increases Over Time
The older a person gets, the more likely they are to develop breast cancer. In general, children and teens dont get breast cancer. About 90 percent of breast cancer diagnoses occur in women aged 45 or older. Additionally, about half of women with breast cancer are at least 63 years old when they are diagnosed.
According to the NCI, during each decade of life, a womans breast cancer risk increases.
- A 30-year-old woman has a 0.49 percent chance of developing breast cancer in the next 10 years.
- A 40-year-old woman has a 1.55 percent chance of developing breast cancer in the next 10 years.
- A 50-year-old woman has a 2.4 percent chance of developing breast cancer in the next 10 years.
- A 60-year-old woman has a 3.54 percent chance of developing breast cancer in the next 10 years.
- A 70-year-old woman has a 4.09 percent chance of developing breast cancer in the next 10 years.
These numbers account for all women across the United States. Many other risk factors affect whether any individual will develop breast cancer, so each persons risk may be higher or lower than what these numbers show. It is also unclear whether these figures are affected by a difference in access to health care resources between individuals.
Clinicopathologic Features Biology And Prognosis
The comparison of clinicopathologic and prognostic features of breast cancer arising in younger women with those in their older counterparts has been the subject of published studies for decades.- Traditionally, breast cancer arising in a younger host is characterized by a more aggressive phenotype. Among 185 premenopausal women carrying a diagnosis of invasive breast cancer, referred for surgery at the European Institute of Oncology from April 1997 to August 2000, those aged less than 35 years had a higher percentage of ER-negative , progesterone receptor -negative , vascular or lymphatic invasion and pathologic grade 3 tumors compared with women aged 35-50 years. Differences in tumor size, lymph node involvement, and Her2/neu status between younger and older women diagnosed with breast cancer have been less clear.-
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Early Detection Saves Lives
The chance of a woman up to age 85 developing breast cancer is one in eight.
Approximately 17,000 women are diagnosed with breast cancer every year in Australia. When breast cancer is detected early, women have a much greater chance of being treated successfully and for most women the cancer will not come back after treatment.
Types Of Breast Cancer
There are several different types of breast cancer, which develop in different parts of the breast.
Breast cancer is often divided into either:
- non-invasive breast cancer found in the ducts of the breast which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
- invasive breast cancer where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.
Other, less common types of breast cancer include:
- invasive lobular breast cancer
- inflammatory breast cancer
It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland.
If this happens, it’s known as secondary, or metastatic, breast cancer.
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What’s The Best Way For Younger Women To Screen For Breast Cancer
The American Cancer Society recommends that all women know how their breasts look and feel and report any changes to their doctor. The ACS states that research has not shown a clear benefit of performing regular breast self-exams. Talk with your doctor about the pros and cons of breast self-exam.
Regular breast exams done at least every 3 years by your doctor are recommended for women beginning at age 20. Expert groups donât all agree when women should start getting mammograms and you should discuss with your doctor whatâs right for you. The U.S. Preventive Services Task Force recommends screening every 2 years from ages 50 through 74 and also that the decision to start yearly screening mammograms before age 50 should be an individual one..
Talk to your doctor about when you should begin to have mammograms. For younger women, digital mammography may be an alternate to a standard mammogram. Digital mammography is better able to see abnormalities in dense breast tissue.
Detection And Diagnosis Of Breast Cancer In Young Women
Organised breast cancer screening aims to detect breast cancers at an early stage in women. In Australia, population-based screening is performed by BreastScreen Australia and involves mammograms . As there is currently insufficient evidence that mammography is an effective nation wide breast cancer screening strategy for young women, routine breast screening for under 40s is not offered.
An effective method for early detection of breast cancer in young women is breast awareness. Women of all ages should become aware of how their breasts normally look and feel, and to report any new or unusual changes) to their general practitioner without delay.
Young women classified as being at high risk of developing breast cancer should discuss an individual routine screening program with their general practitioner. Breast imaging use to investigate breast symptoms or for surveillance of young women may include breast ultrasounds, breast mammograms and breast MRIs.
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How Is Breast Cancer Diagnosed
Tests to find breast cancer
To find the cause of a breast change, your doctor will typically use an approach called the ‘triple test’, which includes:
- a medical history and clinical breast examination
- imaging tests, such as a diagnostic mammogram or ultrasound
- a biopsy, which involves taking a sample of tissue cells from the breast and testing them for signs of cancer.
Most women dont show any abnormal results in these tests.
Staging and further tests
If breast cancer is confirmed, you will be referred for further tests, such as a CT scan, blood tests, bone scans or a PET scan, to see what stage your cancer is at.
Your healthcare team may use a 4 stage system:
- Stage 0 refers to pre-invasive breast cancer thats only in the milk ducts or lobules of the breast.
- Stage I to IIB refer to early breast cancer of a small size .
- Stage IIB to Stage IIIC cancers have spread to nearby lymph nodes in the breastbone or armpit.
- Stage IV cancer have spread to other parts of the body.
There may also be further tests for hormone receptors , HER-2 or other genetic markers. These tests help decide the best treatment for your type of breast cancer.
Genetics And Family History
Up to 1 in 10 breast cancer cases may be caused by gene changes that are passed down within families. Usually, gene changes that cause breast cancer affect the BRCA1 or BRCA2 genes. When these genes dont work properly, damage can build up within breast cells, making them grow out of control.
People who have changes in their BRCA genes have a higher risk of developing some types of cancer, including both breast and ovarian cancer. They are also likely to develop these cancers at a younger age.
For people without BRCA gene changes, the average age at which breast cancer develops is 63. Studies have shown that women with BRCA1 gene mutations are most likely to develop breast cancer between the ages of 41 and 50. Women with BRCA2 gene mutations most often develop breast cancer between the ages of 51 and 60.
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Warning Signs Suggestive Of Breast Cancer
OLYMPUS DIGITAL CAMERA
If a doctor says, Teens dont get breast cancer, find another doctor. Though this statement is no reason to panic, it is medically FALSE.
Remember, if just ONE person on the planet of a particular age group has a certain medical condition, then its FALSE to state, People in that age group dont get that condition.
The lump seems fixed in place does not move around.
Its harder than just rubbery. 17
It may be painful, but not usually.
Absence of nipple discharge or puckering does NOT rule out a malignancy.
If youre still panicking, even though your doctor has assured you that youre in perfect health, then turn that fear into a full-force commitment to healthy lifestyle habits.
Do not smoke or drink. Avoid illegal drugs. Snack on natural foods like fruits, vegetables, green salads, nuts and seeds. EXERCISE
Dr. Johnson performs lumpectomies, and skin-sparing and nipple-sparing mastectomies, breast ultrasounds, needle core biopsies, infusaport placements, genetic testing and counseling, plus works with radiation oncologists to treat breast cancer using intraoperative radiation therapy.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. Shes also a former ACE-certified personal trainer.
What Are The Breast Cancer Symptoms I Need To Look Out For
People of all ages should be familiar with the normal look and feel of their breasts. If you notice any of the following changes please see your doctor immediately:
- a lump, lumpiness or thickening of the breast
- changes in the skin of a breast, such as puckering, dimpling or a rash
- persistent or unusual breast pain
- a change in the shape or size of a breast
- discharge from a nipple, a nipple rash or a change in its shape.
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What Is Best For You
A key reminder: These recommendations are for screening mammograms, not diagnostic mammograms. Screening mammograms are scheduled to detect breast cancer whether or not you have a lump or other symptom. Diagnostic mammograms are scheduled after finding some possible evidence of breast cancer, such as a lump or abnormal findings from a screening mammogram. Mammograms are recommended at almost any age if a lump is found. The mammography recommendations also do not apply to all women, but are meant for women with average risk of breast cancer. Experts agree that women at especially high risk of breast cancer, such as those with mothers or sisters who had breast cancer, may want to start mammograms between the ages of 40 and 50 or in rare cases, even earlier.
The bottom line is that mammograms have the potential to help detect breast cancer earlier. However, like most medical procedures, there are risks as well as benefits. Whether to start at age 50, age 40, or earlier or later or never depends on several different factors.
For most women who are not at especially high risk of breast cancer, regular mammograms do not need to start before age 50. Or, to be cautious, a woman can get one mammogram earlier , and then if it is normal, wait until she is 50 for her next mammogram. This is the advice that the National Center for Health Research and their Cancer Prevention and Treatment Fund have been giving since 2007.
Living With Breast Cancer
Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.
How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.
Forms of support may include:
- family and friends, who can be a powerful support system
- communicating with other people in the same situation
- finding out as much as possible about your condition
- not trying to do too much or overexerting yourself
- making time for yourself
Find out more about living with breast cancer.
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At What Age Should I Begin Screening
Screening guidelines are currently evolving towards screening less women in their 40s. These newer guidelines recommend beginning mammography at age 45 or 50. Some suggest every other year rather than every year. The new guidelines have not been widely adopted and are quite controversial and confusing.
The Breast Cancer School for Patients recommends continuing annual screening mammograms for women age 40 and older. We provide an overview of both the wisdom and risks of these controversial recommendations. Consult with your physician to see what mammographic screening program will suit your unique situation. Screening mammograms are now covered by all health insurance plans, including Medicare and Medicaid.
How Has The Risk Of Being Diagnosed With Breast Cancer Changed In Recent Years
For a woman born in the 1970s in the United States, the lifetime risk of being diagnosed with breast cancer, based on breast cancer statistics from that time, was just under 10% .
The last five annual SEER Cancer Statistics Review reports show the following estimates of lifetime risk of breast cancer, all very close to a lifetime risk of 1 in 8:
- 12.83%, based on statistics for 2014 through 2016
- 12.44%, based on statistics for 2013 through 2015
- 12.41%, based on statistics for 2012 through 2014
- 12.43%, based on statistics for 2011 through 2013
- 12.32%, based on statistics for 2010 through 2012
SEER statisticians expect some variability from year to year. Slight changes may be explained by a variety of factors, including minor changes in risk factor levels in the population, slight changes in breast cancer screening rates, or just random variability inherent in the data.
Howlader N, Noone AM, Krapcho M, et al. . SEER Cancer Statistics Review, 19752017, National Cancer Institute. Bethesda, MD, , based on November 2019 SEER data submission, posted to the SEER web site, April 2020.
- Reviewed:December 16, 2020
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