Guest Author - Dr. Denise Howard
The goal of breast cancer screening is to detect breast cancer as early as possible. The earlier it is detected, the greater the likelihood of preventing death. Another benefit of screening is the detection of other changes that indicate a higher risk of developing cancer in the future. Women who are at greater risk can then be monitored more closely based on their risk assessment.
Breast cancer screening consists of self-breast examination, clinical examination by a physician and routine imaging, usually with mammography. This article will focus on the recommendations for women at average risk.
There is much discussion as to the benefit of self-breast examination. In general, most physicians suggest that women start examining their breast in their early 20s. The idea is that you become familiar with your breast and if there are any changes you are more likely to notice it earlier. The examination should be done once a month, approximately 1 week after the period. It consists of observation of the breast and palpation around the entire breast and into the axilla. The idea is to note any skin or architectural changes and to feel abnormal lumps.
The American College of Obstetricians and Gynecologists recommend a yearly gynecologic examination for all women. The breast examination is a part of this evaluation and essentially consists of the provider observing and palpating the breast.
The institution of routine screening mammography has been the main contributor to the decreased mortality from breast cancer. A mammogram can detect lesions as small as 1 mm in diameter. A lesion this size would not be felt on breast examination and would potentially continue to grow several years before it could be detected by examination.
The sojourn time is the time frame from when a tumor can be detected by mammogram to detection by clinical examination. The major factor in this detection time is age but other factors may play a role. For instance, in women age 40-49 years the sojourn time is 2-2.4 years and it increases after this. The sojourn time is considered when making recommendations for routine mammogram screening intervals. The goal is to detect the cancer as early as possible to maximize the chance of a cure.
There are many other factors to consider when recommending screening intervals. The cost of screening and exposure risk are two examples. It is these considerations and perspectives that explain why recommendations may vary amongst organizations. In the age group 39-49 years, over 1900 women would have to be screened to prevent 1 breast cancer death while in the 60-69 group only 377 would need to be screened.
The different organizations that are concerned with this issue include: the American College of Obstetricians and Gynecologists, the American Cancer Society, the National Cancer Institute and the U.S. Preventive Services Task Force. All but 1 recommends mammography screening starting at 40 years, while the recommended interval is 1-2 years for this group. After age 75, the decision for routine screening should be based on an individualís life expectancy and health status.
As you can see, the recommendation for routine screening mammography are done from a population perspective and takes a number of factors into consideration. Women who are at higher risk of developing breast cancer should consult with a specialist to develop an appropriate screening interval. You should work with your doctor to develop a plan that is rational and feasible.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!