Breast Cancer Screening And Prevention: Beyond Mammography
Starting after age 40, women should have a breast exam by a health professional every year. When a woman turns 50, she should have a mammogram at least once every two years. Routine mammography for women ages 40 to 49 is optional. In addition to mammography, other tests may be ordered as part of a screening or diagnostic strategy, especially in women who are at increased risk of developing breast cancer.
Newer Tests For Breast Cancer
Ultrasound (sonography) uses sound waves to look at breast tissue. Ultrasound is particularly useful at telling whether a lump is a solid mass (worrisome) or whether it is a fluid-filled cyst (usually reassuring). This makes it a good test for examining younger women, who tend to have lumpier, cyst-filled breasts. Ultrasound has been used for many years to diagnose women with breast problems, but some experts feel it may also be useful as a screening test. Since ultrasound will not detect all breast cancers, it is most often ordered in conjunction with a mammogram.
Digital mammography has potential advantages over standard mammography. The radiologist can alter the lightness or darkness of the breast pictures, as well as enlarge and rotate the images. Traditional mammography is developed on film and cannot offer this flexibility. For premenopausal woman and older women with dense breasts, digital mammography appears to be slightly better at highlighting abnormalities.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses magnetic waves to construct three-dimensional pictures of the body. Breast MRI may prove to be better than mammograms at detecting the earliest signs of cancer in younger, high-risk women. MRI also may be used to more closely examine breast tissue that appears abnormal on mammograms. While many experts are excited about this type of scan, MRI may be overall less accurate than mammograms, and more likely to give “false positive” results — abnormal results despite the fact the no cancer is present — that can increase a woman’s anxiety. At present, breast MRI should probably not be used as a screening test in women at average risk of breast cancer.
Ductal lavage is a technique for looking for the earliest changes of breast cancer in cells taken from a woman’s breast. A tiny tube is inserted into the hole (duct) where milk flows from the nipple. Fluid is washed through the milk duct, and then spread on a microscope slide. A specially trained technician then examines the fluid for cells that appear normal and abnormal, much in the same way that a Pap smear is examined. If abnormal cells are seen, further testing or treatment may be considered. However, most abnormal cells seen on ductal lavage do not represent breast cancer, and ductal lavage is rarely used by itself to diagnose cancer.
Ductal lavage needs further study before this test is appropriate for widespread use. Like the other tests mentioned above, ductal lavage is probably most useful in women at increased risk of breast cancer.
Genetic testing may help to identify women who have inherited a gene that puts them at high risk of breast cancer. It is important to remember that while many women have a family member who has been diagnosed with breast cancer, only about 10 percent of breast-cancer cases appear to be linked to an inherited genetic problem. At present, genetic testing for breast cancer is mostly focused on the BRCA1 and BRCA2 cancer genes. These genes are most commonly found in Jewish women with eastern European (Ashkenazi) backgrounds, but other women can carry the BRCA genes as well.
Genetic testing can be a very useful technique, but it is not for everyone. Women who are found to have one of the BRCA genes may have to make difficult decisions about methods to prevent breast cancer, for example whether they should have their breasts removed or take preventive hormone blocking therapy. It is also important to remember that women who test negative for a breast-cancer gene still remain at risk for developing a non-inherited form of the disease.
Which test is for you?
|Which Tests Are Right For You?|
|Age||Breast Exam By Doctor||Mammogram||Breast Self-Exam|
|Under 40||Talk to your doctor about whether breast exams are necessary. Some experts recommend yearly breast exams for all women, while others feel that regular breast exams can and should wait until age 40.||Most experts recommend against regular mammograms for young women, unless they are at high risk of breast cancer. Your doctor may recommend a mammogram if he or she is concerned about a lump or other breast problem.||For many years, doctors have recommended that all women examine their own breasts each month to help detect the earliest signs of cancer. However, when large groups of women who do or don’t do regular breast self-exams are compared, the two groups have an almost equal risk of dying from breast cancer. Adding breast self-exams to doctor exams and mammograms doesn’t help breast cancer to be found much more quickly. In 2003, the American Cancer Society changed its guidelines to say that “it is acceptable for women to choose not to do breast self-exams or to do it occasionally.” Talk to your doctor about whether breast self-exams make sense for you.|
|40-49||Talk to your doctor. Prior formal recommendation to have this done yearly is being questioned. Many doctors still advise yearly exams.||Talk to your doctor. There is disagreement regarding the need for routine mammography in women who are not at high risk. Many doctors still advise screening mammography every 1-2 years.|
|50-75||Every 1-2 years|
|Over 75||Formal recommendations advise against routine screening for women 75 and older. However, some experts believe that breast-cancer screening should continue in older women who are otherwise healthy, while others feel it is reasonable to stop at a certain point. For example, women who have a limited life expectancy due to their age or health problems may not see any benefit from screening. If you are over 75, talk with your doctor about when it may make sense to stop screening for breast cancer.|