By: Rosemary Leeming, M.D., breast surgeon, Geisinger
Family history makes a difference.
Breast cancer is all too common. In fact, one in eight women will be diagnosed with the disease in their lifetime, and about 300,000 women will be diagnosed with invasive cancer this year alone.
But there is good news: if it’s caught early, breast cancer is very treatable. Currently, the five-year survival rate—or the portion of women who live more than five years after diagnosis—is almost 91 percent, thanks to cutting-edge screening and treatment. For reference, the five-year survival rate for lung cancer is only about 25 percent.
When treating breast cancer, the most important thing is early detection and mammograms are the best tool for screening in most women.
Guidelines for mammographic screening differ between organizations, but earlier this year, the U.S. Preventive Services Task Force (USPTF) joined multiple other national groups in recommending that average risk women start screening at age 40 rather than their previous recommendation to start at 50. The USPTF continues to recommend mammograms every other year from age 40 to age 74 although many organizations recommend annual mammograms. Some women should start screening even earlier if they have risk factors such as a close family history of breast cancer or certain high-risk findings on biopsy. We typically recommend starting ten years prior to when a close relative was diagnosed.
Carefully reviewing your family and personal history with your doctor can help identify your ideal starting age, as well as the best screening method. A formal risk assessment can also be done through the Geisinger high risk breast program.
What is a mammogram?
Mammograms are specially designed, low-dose X-rays of the breast and have changed since they were first developed in the 1930s. Digital images were introduced in 2000 and breast tomosynthesis (3D-mammograms) was introduced in 2011. Each refinement has improved the ability of the study to detect breast cancer - improving both the sensitivity and specificity of the test. During a mammogram, breasts are compressed between two plates to spread the tissue, decreasing the amount of radiation needed to get a clear picture. They can detect early changes in the breast tissue well before a lump can be felt. Some cancers show up only as fine specks of calcium which are only detected on mammogram.
It’s important to note that mammograms aren’t perfect. Normal breast tissue can hide cancer, and in breasts with a lot of thick tissue (“dense” breasts) mammograms are less sensitive. In these cases, it’s important to conduct regular self-exams and ask your doctor for additional screening options which are covered by insurance if needed. If you have symptoms such as a lump or nipple discharge, make sure the technologist is aware so they can arrange for additional imaging of the area.
Other screening options
Ultrasounds aren’t just for pregnant women! These machines use high-frequency sound waves to produce an image of the breast tissue. They are painless—a technician passes a handheld device over the area. Since ultrasounds use no radiation, they are often used in very young women or for additional testing after an abnormal mammogram. They are the best way to tell if a lump contains fluid which is a benign condition, or is solid, which requires further evaluation.
There is debate about using ultrasound screening in high-risk women. Breast ultrasound is very sensitive and can pick up very small changes, but many of these are not cancer and patients may undergo additional testing and even biopsies that may not be necessary.
Your doctor may also recommend a breast MRI, which uses spinning magnets to take a cross-sectional image of the breast. The test involves lying motionless on a bed inside the machine for several minutes while the scan is performed. This is the most sensitive test we have for breast cancer but like ultrasound, it also has a lot of “false-positive” findings. It is not typically recommended for screening in average risk women.
For the latest health and wellness tips and advice, visit geisinger.org/balance.
Comentários