When Is Breast Ultrasound Used
Ultrasound is useful for looking at some breast changes, such as lumps or changes in women with dense breast tissue. It also can be used to look at a suspicious area that was seen on a mammogram.
Ultrasound is useful because it can often tell the difference between fluid-filled cysts and solid masses .
Ultrasound can also be used to help guide a biopsy needle into an area so that cells can be taken out and tested for cancer. This can also be done in swollen lymph nodes under the arm.
Ultrasound is widely available, easy to have, and does not expose a person to radiation. It also costs less than a lot of other options.
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.
Stages Of Breast Cancer
Banner MD Anderson knows each person is unique, and so is their breast cancer. While breast cancer staging helps doctors and patients understand the diseases progression, individual treatment options and results vary. Doctors use the results of your diagnostic tests to determine breast cancer stage, treatment options and prognosis.
- Stage 0: Cancer is contained within the breast milk ducts
- Stage I : Cancer is small and has started to spread to other breast tissue
- Stage II : Cancer has grown and/or spread to nearby tissue and/or up to three lymph nodes
- Stage III : Cancer has grown and/or spread to nearby tissue, chest wall, and/or four to nine lymph nodes
- Stage IV : Cancer has spread far away from the breast and lymph nodes to other parts of the body like the bones, lungs, liver and brain
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Your Insurance Should Cover Breast Cancer Screening
Thanks to the Affordable Care Act, all health insurance plans should cover yearly mammograms with no out-of-pocket costs for women 40 and older. If your doctor says youre at a higher risk of breast cancer because of family history, an inherited gene mutation or other risk factors, your screening should be covered even if youre under 40. CBEs and screening breast MRIs should also be covered if your doctor recommends them. Medicare and Medicaid also cover breast cancer screening. Check with your insurance provider to find out where you should go for screenings and make sure theyll cover whatever services you need.
What Are Screening Tests
The goal of screening tests for breast cancer is to find it before it causes symptoms . Screening refers to tests and exams used to find a disease in people who dont have any symptoms. Early detection means finding and diagnosing a disease earlier than if youd waited for symptoms to start.
Breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis of a woman with this disease.
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How Does The Breast Cancer Index Test Work
The Breast Cancer Index genomic test analyzes the activity of 11 genes that can influence how likely the cancer is to come back 5 to 10 years after diagnosis, as well as how likely a woman is to benefit from 5 additional years of hormonal therapy.
The Breast Cancer Index test returns two results:
- The BCI Prognostic result estimates how likely the cancer is to come back 5 to 10 years after diagnosis . The result is given as a percentage. So a prognostic result of 2.2% means that you have a 2.2% risk of the cancer coming back 5 to 10 years after diagnosis.
- The BCI Predictive result is reported as “yes” or “no.” A yes result means you’re likely to benefit from 5 more years of hormonal therapy. A no result means you’re not likely to benefit from 5 more years of hormonal therapy.
If You Have A Family History Of Breast Cancer
UK guidelines recommend;that women with a moderate or high risk of breast cancer because of their family history should start having screening mammograms every year in their forties.
If you are younger than 40 and have an increased risk of breast cancer, you should be offered yearly;MRI scans;from the age of 30 or 40. This depends;on your level of risk.
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When And How Often To Get Screened
The decision of when and how often to have breast cancer screening is up to you, based on discussions with your doctor about your personal risks for breast cancer and the benefits of screening.
Breast cancer screening guidelines are generally divided into two groups:
- Guidelines for women at average risk of getting breast cancer
- Guidelines for women at high risk of developing breast cancer
Breast cancer risk is determined based on a combination of your risk factors for breast cancer and other data sets or models, but it is only an estimate. It can vary depending on the assessment tools used.
If You Have A Higher Risk Of Breast Cancer
Routine breast cancer screening is important for anyone with breasts, but even more so for those at higher risk. Work with your doctor to look at your individual risk factors and discuss what screening tests are right for you. If you and your doctor find that you have a higher risk of breast cancer, you may need to be screened earlier and more often than average. You might also benefit from breast MRI screening along with regular mammograms.
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Breast Cancer Screening Health Professional Version
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Note: Separate PDQ summaries on Breast Cancer Prevention, Breast Cancer Treatment , Male Breast Cancer Treatment, and Breast Cancer Treatment During Pregnancy are also available.
Mammography is the most widely used screening modality for the detection of breast cancer. There is evidence that it decreases breast cancer mortality in women aged 50 to 69 years and that it is associated with harms, including the detection of clinically insignificant cancers that pose no threat to life . The benefit of mammography for women aged 40 to 49 years is uncertain. There are randomized trials in India, Iran, and Egypt that have studied the use of clinical breast examination as a screening test. Some of these studies have suggested a shift in late-stage disease; however, there is still insufficient evidence to conclude a mortality benefit. Breast self-exam has been shown to have no mortality benefit.
Technologies such as ultrasound, magnetic resonance imaging, and molecular breast imaging are being evaluated, usually as adjuncts to mammography, and are not primary screening tools in the average population.
Informed medical decision making is increasingly recommended for individuals who are considering cancer screening. Many different types and formats of decision aids have been studied.
Digital Mammography And Computer
Digital mammography is more expensive than screen-film mammography but is more amenable to data storage and sharing. Performance of both SFM and DM for cancer detection rate, sensitivity, specificity, and positive predictive value has been compared directly in several trials, with similar results in most patient groups.
The Digital Mammographic Imaging Screening Trial compared the findings of digital and film mammograms in 42,760 women at 33 U.S. centers. Although DM detected more cancers in women younger than 50 years , there was no difference in breast cancer detection overall. A second DMIST report found a trend toward higher AUC for film mammography than for DM in women aged 65 years and older.
Another large U.S. cohort study also found slightly better sensitivity for film mammography for women younger than 50 years with similar specificity.
The use of new screening mammography modalities by more than 270,000 women aged 65 years and older in two time periods, 2001 to 2002 and 2008 to 2009, was examined, relying on a Surveillance, Epidemiology, and End Results Medicare-linked database. DM increased from 2% to 30%, CAD increased from 3% to 33%, and spending increased from $660 million to $962 million. CAD was used in 74% of screening mammograms paid for by Medicare in 2008, almost twice as many screening mammograms as in 2004. There was no difference in detection rates of early-stage or late-stage tumors.
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How Does The Endopredict Test Work
The EndoPredict test analyzes the activity of 12 genes in breast cancer cells. These genes are linked to the likelihood that the cancer will come back in a part of the body away from the breast within 10 years after diagnosis.
The EndoPredict test also includes the size of the cancer and whether or not cancer is in the lymph nodes when calculating the risk score.
EndoPredict test results are given as an EPclin Risk Score, a number between 1.1 and 6.2 that maps to a percentage risk of recurrence. The scores are considered either low-risk or high-risk:
- an EPclin Risk Score higher than 3.3287 is interpreted as the cancer having a high risk of recurrence
- an EPclin Risk Score lower than 3.3287 is interpreted as the cancer having a low risk of recurrence
- each EPclin Risk Score is shown on a curve to clarify an individuals personal risk of recurrence
You and your doctor will consider the EPclin Risk Score in combination with other factors, such as the grade of the cancer, the number of hormone receptors the cancer cells have , and your age. Together, you can make a more informed decision about chemotherapy.
The EndoPredict test is performed on preserved tissue that was removed during the original biopsy or surgery.
Tests To Stage Breast Cancer
After youre diagnosed with breast cancer, the next step is identifying your stage. Knowing the stage is how your doctor determines the best course of treatment. Staging depends on the size and location of the tumor and whether it has spread outside your breast to nearby lymph nodes and other organs. The speed of growth and the likelihood that the growth will spread is another component of staging.
Cancer cells that spread to lymph nodes can travel to different parts of your body. During the staging process, your doctor may order a complete blood panel including, liver function and kidney function tests, and a mammogram of your other breast to check for signs of a tumor. A doctor may also test for breast cancer tumor markers, CA 27-29 and CA 15-3.
Your doctor may also use any of the following tests to determine the extent of your cancer and assist with diagnosis:
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Screening Letters Sent To The Public
Cancer Care Ontario sends letters to women turning 50 inviting them to get screened for breast cancer through the Ontario Breast Screening Program. Women ages 51 to 73 who have not been screened in at least 3 years also receive a letter inviting them to get screened.;
We also send letters to women ages 50 to 74 reminding them when it is time to return for screening and informing them of their results, if they are normal.;
What Do The Results Of Hormone Testing Mean
Breast cancer patients who test positive for both estrogen receptors and progesterone receptors usually have a better-than-average prognosis for survival and a complete recovery than those who have no receptors present. Also, the more receptors and the more intense their reaction, the better they respond to hormone therapy. Patients with one type of receptor but not the other may still reap benefits from this form of treatment, but likely not to the same degree. As mentioned earlier, if the cancer is both ER- and PR-negative, it probably wont respond to hormone therapy. Typical response rates to hormone therapy are as follows:
- ER and PR positive: 75-80%
- ER positive and PR negative: 40-50%
- ER negative and PR positive: 25-30%
- ER negative and PR negative: 10% or less
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What Are The Different Types Of Mammograms
According to the National Cancer Institute:
Screening mammogram.;A screening mammogram is an X-ray of the breast used to detect breast changes in women who have no signs or symptoms of breast cancer. It usually involves 2 X-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.
Diagnostic mammogram.;A diagnostic mammogram is an X-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape. A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman’s age.
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If You Have A Normal Result
You will receive a letter to let you know your mammogram does not show any signs of cancer. Your next screening appointment will be in 3 years time. Do contact your GP or local screening unit if you havent received an appointment and think you are due one.;
It is important to see your GP If you notice any symptoms between your screening mammograms.
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What Is Your Risk For Breast Cancer
If you don’t already know your risk of breast cancer, you can ask your doctor about it. You can also look it up at www.cancer.gov/bcrisktool/.
If your doctor says that you have a high or very high risk, ask about ways to reduce your risk. These could include getting extra screening, taking medicine, or having surgery. If you have a strong family history of breast cancer, ask your doctor about genetic testing.
Early Detection Is Key
Reynolds Memorial Hospital is proud to offer 3D mammography as part of our Radiology services.3D Mammography is an exciting advancement in breast cancer detection. It allows doctors to see breast tissue detail in a way never before possible, giving them clearer results, especially with dense breast tissue. We are committed to finding breast cancer at its earliest stages, when its most treatable.
Reynolds Memorial Hospital
Appointments made through Central Scheduling: Appointments available Monday Saturday, evening appointments also available.
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Whos Eligible For The Breast Cancer Index Test
You may be eligible for the Breast Cancer Index test if:
- you were diagnosed with early-stage breast cancer
- the cancer was hormone-receptor-positive
- there was no cancer in your lymph nodes or the cancer is lymph-node positive and is in one, two, or three lymph nodes
- youve been taking hormonal therapy for 4 to 5 years and want to know if taking hormonal therapy for more time will be beneficial
Research has shown that extending hormonal therapy for 5 more years for a total of 10 years of hormonal therapy can offer benefits for some women diagnosed with early-stage, hormone-receptor-positive disease.
The Breast Cancer Index test is performed on preserved tissue that was removed during the original biopsy or surgery.
Because many women have troubling side effects, including hot flashes and joint pain, from hormonal therapy, they want to know if extending the time they take hormonal therapy is worth tolerating the side effects.
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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This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOGs complete disclaimer.