Benefits Of Mammographic Screening
The ACS systematic review also examined the effect of screening mammography on life expectancy. Although the review concluded that there was high-quality evidence that mammographic screening increases life expectancy by decreasing breast cancer mortality, the authors were not able to estimate the size of the increase 23.
American Cancer Society Screening Recommendations For Women At Average Breast Cancer Risk
The COVID-19 pandemic has resulted in many elective procedures being put on hold, and this has led to a substantial decline in cancer screening. Health care facilities are providing cancer screening during the pandemic with many safety precautions in place. Learn how you can talk to your doctor and what steps you can take to plan, schedule, and get your regular cancer screenings in;Cancer Screening During the COVID-19 Pandemic.
These guidelines are for women at average risk for breast cancer. For screening purposes, a woman is considered to be at average risk if she doesnt have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer , and has not had chest radiation therapy before the age of 30.
Women between 40 and 44 have the option to start screening with a mammogram every year.
Women 45 to 54 should get mammograms every year.
Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
All women should understand what to expect when getting a mammogram for breast cancer screening what the test can and cannot do.
Clinical breast exams are not recommended for breast cancer screening among average-risk women at any age.
Using Your Family History
You should certainly share your family history with your medical team. Your doctors might advise genetic counseling or genetic testing if your family history suggests that you could be carrying a breast cancer gene.
Some red flags include:
- Cancer of;any;kind before the age of 50
- More than one relative with the same type of cancer
- One family member who has more than one type of cancer
- A family member who has cancer not typical for that gender, such as breast cancer in a male
- Certain combinations of cancer, such as the combination of breast cancer with ovarian cancer, uterine cancer, colon cancer, prostate cancer, pancreatic cancer, or melanoma
- Cancer in both of one organ, for example, bilateral breast or ovarian cancer
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Harms Of Early Detection And Treatment
Primary Screening With Conventional Mammography
Screening mammography has several potential harms. The most common is a false-positive result, which can lead to psychological harms, as well as additional testing and invasive follow-up procedures. Studies show a fairly consistent association between a false-positive screening mammogram and increased breast cancerspecific distress, anxiety, and apprehension, particularly in women who have an associated procedure, such as fine-needle aspiration or breast biopsy. These effects improve over time for most women.2, 4Table 5summarizes BCSC data on the cumulative probability of a woman receiving at least 1 false-positive mammogram or a recommendation for what turns out to be a false-positive biopsy over a 10-year period.39
Primary Screening With DBT
Currently, DBT is most frequently performed in combination with conventional digital mammography; this practice essentially doubles the resulting radiation exposure to the patient. The U.S. Food and Drug Administration has approved a method to generate synthetic reconstructions of 2-dimensional images from 3-dimensional views, which reduces the total radiation dose emitted. However, study data on the performance of DBT in isolation is limited to 1 mammography reading study that compared sensitivity and specificity and 1 prospective clinical trial,42 and the method is not yet thought to be in widespread clinical use.
Adjunctive Screening in Women With Dense Breasts
Guidelines For Genetic Testing For Breast Cancer
About 10% of breast cancers are related to inheritance of damaged genes. BRCA1 and BRCA2 are the genes most frequently implicated, but there are many other genes, such as PALB2, ATM, and CHEK2, that need to be considered as well.; Genetic testing usually starts with a family member who has already developed a breast or ovarian cancer.; If this individual is positive for a mutation then all of the other family members can be tested for the same mutation to determine who is high risk and who is not.; If no one in the family is known to carry a mutation then the test is considered non-informative.; That means the test was unable to tell us which relatives in the family are high risk. ;People who have inherited a damaged gene are at increased risk for breast and other cancers.; The risk may be as high as 80% depending on the specific gene and family history.;Guidelines for determining whether an individual should get genetic testing or not are constantly evolving. General criteria include:
- Someone in your family is known to carry a mutated gene
- Ashkenazi Jewish ancestry
- You were diagnosed with breast cancer before age 50
- A man in your family has been diagnosed with breast cancer
- You were diagnosed with ovarian cancer
- There are multiple breast cancers on one side of your family
- Cancer was diagnosed in both breasts
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Should You Be Tested For The Breast Cancer Gene
Most of the more than 232,000 cases of breast cancer that will be diagnosed in the United States this year are not due to a faulty gene passed down through families. As with most other cancers, they happen because of genetic mutations that happen as we age.
But about 15% of women with breast cancer have at least one relative who has also had the disease, and 5% to 10% have specific inherited mutations in one of two genes that have been linked to breast cancer, known as BRCA1 and BRCA2.
These mutations are serious. Women with a BRCA1 or BRCA2 mutation face a dramatically increased lifetime risk of breast cancer — 55% to 85%, compared with about 13% for women with no inherited genetic risk. Ovarian cancer risk is higher, too — about 39% of women with BRCA1 and 11% to 17% of women with BRCA2 will get ovarian cancer. BRCA-linked breast cancers also tend to develop at a younger age than other breast cancers.
Women diagnosed with these mutations sometimes choose to have preventive surgery to remove their breasts and/or ovaries before they can get cancer.
Angelina Jolie and Christina Applegate both underwent double mastectomies after testing positive for a BRCA mutation. Jolie lost her mother to ovarian cancer, and Applegateâs mom developed both breast and ovarian cancer.
But you may want to consider testing if your family tree includes these signs:
How Do I Know If I Am At High Risk For Breast Cancer
Some women have a higher than average risk of developing breast cancer. You may be at a higher risk if you have:
- strong family history of breast cancer
- certain gene mutations, such as the BRCA1 or BRCA2 mutation
- a personal history of lobular carcinoma in situ , ductal carcinoma in situ , invasive breast cancer or atypical hyperplasia
- dense breast tissue
- received radiation therapy to the breast or chest
Talk to your doctor about your risk. If you are at higher than average risk, you may need a personal plan for testing. This may include:
- mammography at a younger age
- more frequent mammography
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Myth #: I Had A Normal Mammogram Last Year So I Dont Need Another One This Year
Fact: Mammography is detection, not prevention. Having a normal mammogram is great news, but it does not guarantee that future mammograms will be normal, says Dr. Zeb.;”Having a mammogram every year increases the chance of detecting the cancer when it is small and when it is most easily treated which also;improves survival.”
How Often Should I Schedule Breast Exams
A person aged 25 to 40 with an average risk should have a clinical breast exam every one to three years, but individuals over 40 years and those with risk factors are recommended to have them more frequently, possibly annually.
Mammograms, the best way to detect early signs of breast cancer, are recommended every two years for persons aged 50 to 74 with an average risk. However, the topic of when to start mammograms and how often to do them is still debated by many organizations. Most groups advocate in favor of having mammograms beginning at age 40, “however, I think it should be an individualized, informed decision-making process between the patient and doctor,” says Abe.
Breast cancer is often detected when it presents as a new finding on breast imaging equipment like mammograms, ultrasounds, and magnetic resonance imaging . This indicates that screening exams identify breast cancers “when they are very, very early and extremely treatable and curable,” says Fishman.
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Stay Away From Tobacco
There is no safe form of tobacco. If you smoke cigarettes or use other types of tobacco products, it’s best to stop. It’s also important to stay away from tobacco smoke . Both using tobacco products and being exposed to tobacco smoke can cause cancer as well as many other health problems. If you don’t use tobacco products, you can help others by encouraging the people around you to quit. Call us at 1-800-227-2345 for help, or see;How to Quit Smoking or Smokeless Tobacco;to learn more about quitting.
What To Ask Your Doctor About Starting Mammogram Screening
Dr. Onalisa Winblad, a radiologist at the University of Kansas Cancer Center, says other forms of assessment may be helpful for women under 40.
By the time a woman is 30, she should meet with her doctor and have a discussion about breast cancer risk to assess whether early or additional breast cancer screening may be indicated. Clinical breast exam by a trained medical professional may begin at age 20 as well, she said.
At this time, no country or organization has guidelines recommending mammography for women under 40, except in the case of having a personal history of breast cancer or other risk factors that would put them at very high risk.
Mammography simply does not work well in younger women, primarily due to the density of the breast tissue, Dr. Deanna Attai, an assistant clinical professor at the UCLA David Geffen School of Medicine, told Healthline. In women with a family history of breast cancer, we often start screening 10 years before the youngest relative was diagnosed, but in younger women dont only rely on mammography.
Attai says for patients with increased risk due to genetics or the BRCA gene, theyll start screening earlier and often use other scans, like an MRI or ultrasound device, in addition to mammography.
She recommends that women who are concerned about their breast cancer risk should speak with their physician and conduct their own breast exams regularly.
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Colon And Rectal Cancer And Polyps
For people at average risk for colorectal cancer, the American Cancer Society recommends starting regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a persons stool , or with an exam that looks at the colon and rectum . Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage. No matter which test you choose, the most important thing is to get screened.
If youre in good health, you should continue regular screening through age 75.
For people ages 76 through 85, talk with your health care provider about whether continuing to get screened is right for you. When deciding, take into account your own preferences, overall health, and past screening history.
People over 85 should no longer get colorectal cancer screening.
If you choose to be screened with a test other than colonoscopy, any abnormal test result needs to be followed up with a colonoscopy.
Guidelines For Elective Surgical Options
Women with BRCA1 or BRCA2 mutations face a significant risk of breast and ovarian cancer. Prophylactic removal of the fallopian tubes and ovaries is recommended by about age 40.; Many women with BRCA1 or BRCA2 mutations will also elect to have their breasts removed. Nipple-sparing mastectomy is an effective option for these women.;
Making the decision to have an elective preventive double mastectomy and removal of the ovaries is personal and should be based on many life factors. You must balance where you are in your childbearing years, what your future choices may be, and whether you would prefer to follow a rigorous screening schedule instead of making such a life-altering choice.
Whatever your decision, we encourage you to make an informed choice. If you do elect to have a preventive double mastectomy, our breast specialists will guide you in the appropriate breast surgery reconstruction to help restore your body image after treatment.
If you are interested in discussing ovary removal surgery , we will refer you to one of our gynecological oncologists.
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Dbt As A Primary Screening Strategy
The USPSTF found insufficient evidence to assess the balance of benefits and harms of DBT as a primary screening method for breast cancer.
Background
Evidence on DBT is limited; a single study on the test characteristics of DBT as a primary screening strategy for breast cancer met the inclusion criteria of the systematic evidence review.13
Potential Benefits
From the limited data available, DBT seems to reduce recall rates and increase cancer detection rates compared with conventional digital mammography alone.13 However, current study designs cannot determine whether all of the additional cases of cancer detected would have become clinically significant or whether there is an incremental clinical benefit to detecting these cancers earlier than with conventional digital mammography. In addition, no studies of DBT looked at clinical outcomes, such as breast cancer morbidity or mortality or quality of life.13
Potential Harms
Who Is Breast Screening For
BreastScreen Australia is the national breast screening program and actively invites women aged 5074 to have a free two yearly mammogram. Women aged 4049 and those aged over 74 are also eligible to receive a free mammogram but do not receive an invitation.
It is important to continue to attend screening when you are invited to do so.
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What Is A Mammogram
A mammogram is an x-ray picture of the breast. Mammograms use a very low level of x-rays, which are a type of radiation. The risk of harm from this radiation is very low.
Mammograms can be used to screen for breast cancer in women with no signs or symptoms. They can also help doctors figure out if cancer is causing a particular symptom like a;lump;or another change in the breast.
When you get a mammogram, a technician will place your breast;between 2 plastic plates and press it flat to get a clear picture. Getting a mammogram can be uncomfortable, but it doesn’t last long.
Screening For Breast Cancer With Methods Other Than Conventional Mammography
| Screening Method | Primary screening with DBT | Adjunctive screening with breast ultrasonography, MRI, DBT, or other methods in women who have dense breasts |
|---|---|---|
| Recommendation | ||
| Benefits | From the limited data available, DBT seems to reduce recall rates and increase cancer detection rates compared with conventional digital mammography alone. | Limited data suggests that ultrasonography or MRI will detect additional breast cancer in women who have dense breasts. DBT also detects additional breast cancer in the short term. |
| Harms | As currently practiced in most settings, DBT exposes women to about twice the amount of radiation as conventional digital mammography. Current study designs cannot determine the degree to which the additional cases of cancer detected would have become clinically significant . | Most positive adjunctive breast cancer screening test results are false positive. |
| Balance of Benefits and Harms | Evidence is insufficient, and the balance of benefits and harms cannot be determined. | Evidence is insufficient, and the balance of benefits and harms cannot be determined. |
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to .
- View the Clinician Summary in PDF
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What If I Just Dont Want To Know
Like Khloe, many women worry that a positive test result will feel like a death sentence, and create unwanted anxiety about the future. Freivogel suggests that you should think about whether a positive result would change what you are currently doing to protect your health, as it did for Applegate. If I had a patient that said, Ive already had my ovaries removed for some other reason, I would not consider a preventative mastectomy, even if I had a BRCA mutation, and my family history puts me at enough risk that Im already getting screened very carefully, Im getting mammograms.’ Would that person do anything differently if she got a BRCA result? Maybe not.
But if there are preventative steps that you’re not already taking, knowing your BRCA status could literally save your life. And if you’re thinking about getting pregnant in the future, the test could potentially help protect your baby too. Dr. Klugman explains that a procedure performed during an IVF cycle can help doctors identify the embryos that don’t carry the treacherous mutation.
Like Freivogel, Dr. Klugman also recommends talking to a health care providerlike a genetic counselor or an oncologistto help you understand the pros and risks of analyzing your DNA. But ultimately, she points out, “any genetic testing is up to the patient.”