By Dr Amrish Kamboj, MD Pathology (All India Institute of Medical Sciences)
Breast cancer is the most common type of cancer in women, with approximately one in nine women developing the disease in her lifetime. Recently, researchers have been able to identify some of the genes responsible for breast cancer. Heredity probably accounts for approximately 5% of the breast cancer cases diagnosed. However more than 80% of breast lumps are not cancerous and biopsy examination is the only way to know for sure.
In this article we have outlined the Frequently asked Questions (FAQs) about breast cancer screening recommendations, and how a palpable breast lump is investigated.
What is breast cancer screening?
Screening – looking for evidence of disease before signs or symptoms appear – is the key to finding breast cancer in its early, treatable stages.
Depending on your age and risk factors, screening may include breast self-examination, examination by your nurse or doctor (clinical breast exam), mammograms (mammography) or other tests.
What are the methods for early detection of breast cancer?
The key to curing breast cancer is early detection and prompt treatment. A physical examination, mammography and breast self-examination (BSE) make up the conventional early detection approach.
A breast self-examination should be practised monthly. Breast self-examination is an option beginning at age 20. Ask your doctor, nurse, or mammography technician to teach you the proper method. Remember, most breast lumps are not cancer, but need proper medical evaluation to rule out cancer.
A clinical breast exam/physical examination is performed by a doctor, and it is strongly recommended that you see your doctor for regular breast exams – at least every three years between the ages of 20 and 40 and every year after age 40.
During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you miss when you examine your own breasts, and will also check for enlarged lymph nodes in your armpit (axilla).
A mammogram, which uses a series of X-ray images of your breast tissue, is currently the best imaging technique for detecting tumours before you or your doctor can feel them. Screening mammography is recommended for women over 40. We will discuss mammography guidelines in a later article.
If possible, try to schedule your mammogram around the same time as your annual clinical exam. That way the radiologist can specifically look at any changes your doctor may discover.
What are the methods for confirming breast cancer?
A proper diagnosis of breast cancer can only be made by a microscopic examination of tissue extracted from the breast. This type of examination is called a biopsy. A lump in the breast usually requires that a biopsy be performed even when a mammogram has described the tissue as being normal. Biopsies can provide important information about an unusual breast change and help determine whether surgery is needed and if so, the type of surgery required.
Breast tissue is commonly obtained by Fine-needle aspiration biopsy (FNB or FNAC) or surgical biopsy.
What is Triple Diagnosis?
In recent years, it has become a standard to use three modalities to evaluate all palpable breast lumps: – Clinical Breast Exam (CBE), radiological imaging (Mammogram and Ultrasound) and FNAC. A combination of these three modalities is called Triple Diagnosis and this has led to a marked improvement in pre-operative diagnosis. If these three investigations when done independently of each other are in agreement that a lesion is either cancer or not cancer, then diagnostic accuracy is over 99 per cent.
What other tests are used in
evaluation for breast cancer?
Some other tests used include a Computer-aided Detection (CAD) (a computer scans your mammogram after a radiologist has reviewed it), digital mammography, Magnetic Resonance Imaging (MRI) (can reveal tumours which are too small to detect through physical exams or are difficult to see on conventional mammograms) and breast ultrasound (to evaluate an abnormality seen on a mammogram or found during a clinical exam)
A few procedures are under experimentation and include a ductal lavage and Molecular Breast Imaging (MBI). Genetic testing is also available in developed countries but is not considered a screening test.
Does breast screening save lives?
The World Health Organisation’s International Agency for Research on Cancer (IARC) concluded that mammography screening for breast cancer reduces mortality. The IARC working group, comprising 24 experts from 11 countries, evaluated all the available evidence on breast screening and determined that there is a 35 per cent reduction in mortality from breast cancer among screened women aged 50 – 69 years old. This means that out of every 500 women screened, one life will be saved.
The US Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.
When to seek medical advice?
Although most breast changes aren’t cancerous, it’s important to have them evaluated promptly. See your doctor if you discover a lump or any of the other warning signs of breast cancer, especially if the changes persist after one menstrual cycle or they change the appearance of your breast.
If you’ve been treated for breast cancer, report any new signs or symptoms immediately. Possible warning signs include a new lump in your breast or a bone ache or pain that doesn’t go away after three weeks.
Ask your doctor about the Triple Diagnosis approach
What’s the gist of this discussion on Breast Cancer Screening?
To put it in simple words: Breast cancer screening is important, it saves lives and the three main conventional methods of screening are:
1) Breast self-examination (BSE) done monthly, starting as early as age 20
2) Clinical breast examination (CBE) at least every 3 years between the ages of 20 and 40 and every year after age 40.
3) Mammogram every 1-2 years for women aged 40 and older
Consult your doctor today and develop a Breast-Screening Programme based on the above recommendations and taking into consideration your family history and other significant risk factors.
