Breast cancer detection is composed of tests or screenings which are intended to find breast cancer in usually aymptomatic individuals. The goal is to find cancers before they cause symptoms, while cancer is still confined to the breast and easier to treat and cure. Many doctors feel that such early detection tests may save thousands of live each year, with the potential to save even more if all women and health care providers took advantage of these tests. Of note is that the once lauded breast self examination (BSE) has recently come under scrutiny, and has been discovered to carry certain limitations which may or may not outweigh the benefits.
There are special issues in both breast cancer detection and risk for women with larger breasts.
Much of this article is sourced directly from the American Cancer Society's article on breast cancer detection.
American Cancer Society recommendationsEdit
Breast cancer risk changes based on a variety of age-related, genetic, hereditary, breast composition-related, and environmental factors. The American Cancer Society believes the use of mammograms, MRI (in women at high risk), clinical breast exams, and finding and reporting breast changes early, according to the recommendations outlined below, offers women the best chance to reduce their risk of dying from breast cancer. This combined approach is clearly better than any one exam or test alone. However, it is still vital that an individual consults their doctor.
Women 40 and olderEdit
Women in this age group should have a screening mammogram every year, and continue to do so for as long as they are in good health.
Women in their 20s and 30sEdit
Women in this age group should have a clinical breast exam performed at least every three years by their doctor as a part of their regular health exam.
Women 20 and olderEdit
An option for women 20 and older is the breast self-examination. However, there are both benefits and limitations to this technique, which are best discussed with a health professional. If any changes in the breast are detected, it should be reported to a doctor immediately.
Special risk factorsEdit
The American Cancer Society believes that women at high risk (greater than 20% lifetime risk) should get an MRI and mammogram every year. Women at moderate risk (15-20% lifetime risk) should consult with a doctor to determine the benefits and limitations of adding yearly MRI screening to their yearly mammogram. Women at low risk (less than 15% lifetime risk) are not recommended to have yearly MRI screening.
High risk factorsEdit
Women at high risk include those who:
- Have a known BRCA1 or BRCA2 gene mutation
- Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, but have not had genetic testing themselves
- Have a lifetime risk of breast cancer of 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (such as the Claus model)
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
Moderate risk factorsEdit
Women at moderately increased risk include those who:
- Have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based mainly on family history
- Have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
- Have extremely dense breasts or unevenly dense breasts when viewed by mammograms
Risk assessment toolsEdit
Several risk assessment tools, with names like the Gail model, the Claus model, and the Tyrer-Cuzick model, are available to help health professionals estimate a woman's 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.
As a result, they may give different risk estimates for the same woman. For example, the Gail model bases its risk estimates on certain personal risk factors, like age at menarche (first menstrual period) and history of prior breast biopsies, along with any history of breast cancer in first-degree relatives. The Claus model estimates risk based on family history of breast cancer in both first and second-degree relatives. These two models could easily give different estimates using the same data. Results obtained from any of the risk assessment tools should be discussed by a woman and her doctor when being used to decide whether to start MRI screening.
The current goal of the breast health movement is breast self-awareness, an informal familiarity of an individual of his or her own breasts. Breast self-awareness is an improvement over the breast self-examination in that it is less intimidating for individuals, easier to follow-through, and suffers less from the BSE's limitations.
The Susan G. Komen Foundation describes the four components of breast self-awareness:
- Know your risk.
- Talk to your family to learn about your family health history.
- Talk to your provider about your personal risk of breast cancer.
- Get screened.
- Ask your doctor which screening tests are right for you if you are at a higher risk.
- Have a clinical breast exam at least every 3 years starting at age 20 and every year starting at age 40.
- Have a mammogram every year starting at age 40 if you are at average risk.
- Know what is normal for you.
- See your health care provider if you notice any of these breast changes:
- Lump, hard knot or thickening inside the breast or underarm area
- Swelling, warmth, redness or darkening of the breast
- Change in the size or shape of the breast
- Dimpling or puckering of the skin
- Itchy, scaly sore or rash on the nipple
- Pulling in of your nipple or other parts of the breast
- Nipple discharge that starts suddenly
- New pain in one spot that doesn’t go away
- See your health care provider if you notice any of these breast changes:
- Make healthy lifestyle choices.
- Maintain a healthy weight.
- Add exercise into your routine.
- Limit alcohol intake.
- Limit postmenopausal hormone use.
- Breastfeed, if possible.
A breast self-examination, also known as a BSE, is a method which may be used when attempting to detect early breast cancer. By this method, an individual follows a heavily-structured procedure by which to detect irregularities within the breast.
Once heavily promoted as a must for every woman, the BSE is now considered optional, with the simpler, less formal breast self-awareness having greater importance. The clinical breast examination is considered far more essential than either of these methods.
A study published in 2008 discovered that BSEs were ineffective in breast cancer detection. Moreover, BSEs were even harmful in that they lead to a greater number of false positives and unnecessary biopsies. From the Susan G. Komen Breast Cancer Foundation,
A meta-analysis combined results from the two largest randomized controlled trials on breast self-exam to date (one in Shanghai, China and one in Russia). The Shanghai study included about 266,000 women and the Russia study included about 122,000 women. The combined analysis found no difference in breast cancer mortality after 15 years between women who did routine breast self-exam and those who did not. And, the breast self-exam groups had more false positive results, leading to nearly twice as many biopsies with benign (not cancer) results as the other groups. These findings showed breast self-exam does not offer the benefits of other breast cancer screening tests.
Clinical breast examinationEdit
A clinical breast exam (CBE) is an exam of your breasts by a health care professional, such as a doctor, nurse practitioner, nurse, or doctor's assistant. For this exam, you undress from the waist up. The health care professional will first look at your breasts for abnormalities in size or shape, or changes in the skin of the breasts or nipple. Then, using the pads of the fingers, the examiner will gently feel (palpate) your breasts.
Special attention will be given to the shape and texture of the breasts, location of any lumps, and whether such lumps are attached to the skin or to deeper tissues. The area under both arms will also be examined.
The CBE is a good time for women who don't know how to examine their breasts to learn the proper technique from their health care professionals. Ask your doctor or nurse to teach you and watch your technique.
Magnetic Resonance ImagingEdit
Magnetic Resonance Imaging, or MRIs, can be used to help diagnose breast cancer.
It is recommended that women who get screening MRI do so at a facility that can do an MRI-guided breast biopsy at the same time if needed. Otherwise, the woman will have to have a second MRI exam at another facility at the time of biopsy.
There is no evidence right now that MRI will be an effective screening tool for women at average risk. MRI is more sensitive than mammograms, but it also has a higher false-positive rate (it is more likely to find something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of these women, which can lead to a lot of worry and anxiety.
- Main article: Mammogram
Considerations for those with large breastsEdit
Differences in screening techniquesEdit
Mammography was discovered to be especially sensitive and specific for women with larger breasts.
Clinical breast exams will require more time and care in women with larger breasts to obtain the same level of accuracy as for women with smaller breasts. From "A Practical Guide to Clinical Medicine," from the University of California, San Diego, the following comments are made concerning CBEs for larger-breasted women:
In this setting, it can be technically challenging to assure that you've done a thorough examination of all the tissue. In order to minimize error there no special "tricks." Instead, rely on basic exam principles, in particular: Take your time - may take 3 or minutes to examine each breast! Be thorough and ordered, covering all areas of the breast sequentially.
The same concerns for large breasts with CBEs applies to large breasts with BSEs.
- Main article: Breast asymmetry
Increase in risk with mammographic densityEdit
Increases in mammographic density of breast tissue (density as determined per mammography) are found to correlate with increases in breast cancer risk. Interestingly, women with a low BMI are found to have mammographically denser breast tissue. However, a connection between low BMI/large breast size and mammographic density has yet to be studied.
Increase in risk with BMIEdit
Obesity (sometimes leading to larger breasts) has been found to increase breast cancer risk in post-menopausal women.
Increase in risk with breast size?Edit
The connection between breast size and breast cancer risk is tenuous at best and often conflicting, with some studies suggesting a connection and others rejecting it. Currently, breast size is not considered to be a factor in the development of breast cancer. However, a preliminary study published in July 2012 suggests that there might be some common genetic basis for both large breasts and breast cancer in women of European descent. (Women of other descents have not yet been studied.) However, these results still require a significant amount of research before a definitive conclusion can be made.
- ↑ Wikipedia: "File:En Breast cancer illustrations.gif"
- ↑ 2.0 2.1 2.2 American Cancer Society: "Breast Cancer Detection"
- ↑ Susan G. Komen: "Breast Self-Awareness"
- ↑ Susan G. Komen: "Breast Self-Exam"
- ↑ 5.0 5.1 Gayde, et al. "Outcome of mammography in women with large breasts."
- ↑ 6.0 6.1 University of California, San Diego: "A Practical Guide to Clinical Medicine"
- ↑ Susan G. Komen: "Factors Under Study"
- ↑ Eriksson, et al. "Genetic variants associated with breast size also influence breast cancer risk."