Overview of Breast Cancer Screening in the Average-Risk Patient
Breast cancer is the most common type of cancer in women and also causes the second highest number of cancer-related deaths among women. Stage IV breast cancer, the most advanced stage, cannot be cured and is managed with treatments that aim to relieve symptoms and improve quality of life. The key to reducing the serious effects and death from breast cancer lies in early detection. The challenge is in figuring out who should be tested for breast cancer and when. As we learn more about breast cancer, medical decisions are becoming less focused on the size of the tumor alone, but also on genetic and biological factors that can help guide the course of treatment.
Self-examinations of the breasts, clinical breast examinations by a healthcare professional, and imaging tests like mammography, ultrasound, and MRI (Magnetic Resonance Imaging) are the main ways to spot breast cancer early. Many studies have shown that mammograms should be a regular part of health checks for women aged 50 to 69. In the past, there was some debate about whether to suggest regular mammograms for women aged 40 to 49 or those 70 and above. However, current guidelines from several expert medical groups including the United States Preventive Services Task Force and the American College of Obstetricians and Gynecologists suggest starting routine mammograms at age 40.
How often a woman should be screened is also an area of debate, with some recommending yearly screenings and others suggesting every two years. Increasingly, though, there is a trend toward more screening because it increases the chance of finding breast cancer early when it is easier to treat. It’s very important to identify women who are at average risk and those at high risk for breast cancer because screening suggestions will vary. As we understand more about the genes that can cause breast cancer and other risk factors, we now have tools to predict a woman’s lifetime risk of developing breast cancer.
If you are high-risk, have symptoms, or already have been treated for breast cancer, it’s recommended to see a breast cancer specialist for tailored advice about screening. Ultrasounds and MRIs are often suggested in addition to mammograms for high-risk women. Expanding our knowledge on predicting risk and early detection methods is our best tool for fighting breast cancer.
Anatomy and Physiology of Breast Cancer Screening in the Average-Risk Patient
The adult breast is made up of several parts including the skin, tissue underneath the skin, and two main components known as the epithelial and stromal components. The epithelial component includes tiny tubes that connect the functionality parts of the breast, called lobules, to the nipple. The stromal component, which is mostly made of fibrous and fatty tissue, mainly makes up the volume of the breast when it’s not producing milk.
The breast tissue covers a region that stretches vertically from the second to the sixth ribs, and horizontally from the edge of the breastbone to the mid-axillary line on the side of the body. A portion of the breast tissue, called the axillary tail of Spence, extends into the underarm area. The skin on the breast is thin and houses oil glands, sweat glands, and hair follicles. While the nipple doesn’t have hair follicles, it has a lot of nerve endings sensitive to touch and also has oil and sweat glands. The areola is the circular colored skin around the nipple, and varies in size. It has small bumps near its outer edge because of the openings of large oil glands, known as Montgomery Glands.
The breast is covered by a layer of tissue known as the superficial pectoral fascia, which extends into the superficial abdominal fascia of Camper, a layer of tissue in the abdomen. Underneath the breast, there’s a deep pectoral fascia, which covers the pectoralis major and serratus anterior muscles. These two tissue layers are bound together by fibrous bands, called Cooper’s suspensory ligaments, which naturally help to support the breasts. Much of the breast’s blood supply comes from the internal mammary vessels. Nerves that provide sensation to the breast mainly come from the anterolateral and anteromedial branches of thoracic intercostal nerves T3 to T5, and additional sensation is provided by the lower fibers from the supraclavicular nerves of the cervical plexus.
Why do People Need Breast Cancer Screening in the Average-Risk Patient
The American Society of Breast Surgeons (ASBrS) and other organizations have guidelines for breast cancer screening, or regular tests to early detect breast cancer.
According to the ASBrS, all women aged 25 or older should get a formal breast cancer risk assessment. This will be updated from time to time. Screening mammography, a test that checks for breast cancer, should stop when a woman’s lifespan is expected to be less than 10 years.
For women aged 40 and above with normal breast density and an average risk of breast cancer, it is recommended to get an annual mammography, preferably a 3D mammography without the need for extra imaging tests. If a woman has dense breasts, yearly 3D mammographies should begin at age 40, with extra imaging done as needed.
Women with a higher-than-average risk of breast cancer because of genetic reasons, or if they have had radiation therapy in the chest area between ages 10 to 30, should start yearly mammograms at age 30 and be offered yearly supplemental MRI imaging starting at age 25.
The National Comprehensive Cancer Network (NCCN) also have guidelines for breast cancer screening. They include recommendations that may vary for different groups like average-risk patients, patients with increased risk, and those who have been exposed to radiation therapy. Supplemental screening methods may also be recommended as they can improve the detection of cancer but could also increase recall rates and lead to benign breast biopsies.
The NCCN suggests that women of average risk between ages 25 and 39 should have a clinical assessment, counseling to reduce the risk, and a clinical breast check every 1 to 3 years. Should there be any changes in their breasts, they should tell their doctor right away.
The American Cancer Society (ACS) also has recommendations. Women of average risk should start routine mammography at age 45. Once they turn 55, they could switch to having this test every 2 years or keep on with the yearly schedule. But women aged 40 to 44 also have the choice to start annual mammography.
When a Person Should Avoid Breast Cancer Screening in the Average-Risk Patient
The advice around testing for breast cancer doesn’t always apply in the same way to everyone. There are some specific groups of people where the guidelines might be different.
For example, people with a very short life expectancy, more often than not because of other serious health issues, might not need to be tested if they are not showing any symptoms. People in hospice care fall into this category. If they were to be diagnosed with breast cancer, it wouldn’t really change how long they are expected to live.
Then there are people who already have symptoms like new lumps in the breast, changes to the skin, or fluid coming from the nipple. These people need to be checked immediately. A doctor who specializes in breast cancer should look at their symptoms to figure out the best way to treat them.
It’s a bit different for people who have had breast cancer before. Depending on their medical history and the kind of treatments they had, they might not need to have regular screening tests. For instance, people who had their entire breast removed usually don’t need more tests. But if someone had only part of their breast removed and their cancer was hard to detect with a mammogram, they might need to have an MRI scan as well as normal mammograms. Again, a specialist doctor should give them advice on what is best for their situation.
Finally, there are high-risk people. These are people who have more than a one in five chance of getting breast cancer at some point in their lives. This could be because of their family history, their genes, the density of their breasts, their personal health history, or if they have had certain types of abnormal cells confirmed by a biopsy. People in this category should be evaluated by a specialist who can help them decide what screening tests are best suited for them.
Equipment used for Breast Cancer Screening in the Average-Risk Patient
Mammography is like a super detailed X-ray designed specifically for breasts. Using a very small amount of X-ray radiation, it can reveal tiny changes in breast tissue, even ones so small you can’t feel them. It’s the best test we have for catching breast cancer early in the general population. There are two types of mammograms. Screening mammograms are for people who have no breast symptoms or issues. If the screening mammogram picks up something unusual, a diagnostic mammogram is done for a closer look.
High-tech versions of this exam, like 3D mammography and tomosynthesis, are even better at spotting tiny cancers. They also help reduce “false positives,” where the exam makes it look like cancer is there, but it’s really not.
Doctors use a system called the Breast Imaging Reporting and Data Systems (BI-RADS) to understand the results of your mammogram. It’s a standard way to describe what’s on the mammogram, so everyone is clear about what the results mean. Most of the time, though, mammograms don’t show cancer. Only about 1-2% of them spot something that needs a biopsy, and even then, about 80% of those suspicious spots turn out NOT to be cancer.
Here’s a quick rundown of what the BI-RADS scores mean:
- BI-RADS 0: We need more information. We might need older mammograms for comparison, or additional imaging.
- BI-RADS 1: Everything looks normal. Just stick to your usual schedule of mammograms.
- BI-RADS 2: There are some benign (noncancerous) findings. Keep getting your regular mammograms.
- BI-RADS 3: What we found is probably benign, but we want to double-check. We’d like you to come back for another mammogram in six months.
- BI-RADS 4: What we found could be cancer, and we’ll need a biopsy (sample of tissue) to check.
- BI-RADS 5: What we found looks highly like cancer, and we need a biopsy to confirm it.
- BI-RADS 6: We’ve confirmed cancer with a biopsy. It’s time to start treatment.
Sometimes, an MRI of the breast might be used as well. This test is more expensive and takes longer than a mammogram. It also requires a contrast material that’s given through a vein. But in some cases, it can be more effective than mammography at spotting certain issues in the breast and checking the lymph nodes. Normally, MRIs aren’t recommended for women at average risk for breast cancer. But they can be useful for women at higher risk, women with dense breasts, some women with silicone breast implants, and those who find traditional mammogram compression painful.
There are other types of breast imaging tests, too. Thermography measures skin temperatures over potential breast cancers, but it’s not standard practice. Ultrasound can be used to get a better look at something seen on a mammogram or felt in an exam. It can also help examine dense breasts, but it’s not often used as the main screening test because it can’t detect all types of abnormalities.
Who is needed to perform Breast Cancer Screening in the Average-Risk Patient?
If you notice any changes in your breasts, it may sometimes be a sign of breast cancer. It’s crucial that you tell your doctor about these changes straightaway. Any change in your breast should be taken seriously and examined properly by your doctor, who will carry out further tests if needed, according to the guidelines.
Your doctor will keep a close watch if you have a high risk of developing breast cancer. High risk means you have more than a 20% chance of getting breast cancer in your lifetime. This risk is calculated through certain models, like Gail and Tyrer-Cuzick. If you are at high risk, you may be referred to a breast cancer expert at a specialist centre. Additionally, if your family has a history of certain types of cancer such as breast, ovarian, prostate, stomach, or pancreatic cancer, you might have to undergo genetic testing. You’ll be referred to a genetic counselor, who’ll guide you through the process, if you want to proceed with this testing.
Preparing for Breast Cancer Screening in the Average-Risk Patient
It’s very important for doctors to regularly check the health history of a patient and their family. This check includes looking at risk factors, previous tissue sample results, exposure to radiation, and any family history of breast cancer. Knowing this information helps doctors figure out which women could benefit from professional advice related to genetics and more careful screening for breast cancer by a specialist.
Recent research talks about the idea of breast self-awareness. This means a woman knows what her breasts usually look like and feel like, and she’s able to notice any changes. If a woman spots anything different, she should let her primary doctor know. This is a bit different from a breast self-examination, which is when a woman checks her breasts in a regular and systematic way.
How is Breast Cancer Screening in the Average-Risk Patient performed
When it comes to checking for breast cancer, it’s important to use imaging techniques that are both very accurate and safe, considering any potential risks to the person being screened. The best way to take a picture of the breast is typically mammography – basically, an x-ray of the breast. Other methods may include ultrasonography, which uses sound waves to create a picture, and MRI, which uses magnets and radio waves.
Another vital part of checking for breast cancer is through self-checkup at home and clinical examinations by a healthcare professional.
Screening methods, like mammography, work best when they’re tailored to each individual. This means taking into account factors such as age, hormonal exposure, family history, and other risk factors such as radiation exposure, obesity, and genetic factors.
If an MRI is used, there might be a need to inject a contrast material, enhancing the ability to tell the difference between normal breast tissue and abnormal spots.
Possible Complications of Breast Cancer Screening in the Average-Risk Patient
Mammograms, which are x-rays of the breast, are commonly used to screen for breast cancer. However, they’re not perfect and sometimes may not detect cancer, especially in breasts with dense tissue. This can lead to falsely negative results, meaning that the mammogram says there’s no cancer even when it’s present. Some types of breast cancer might not show up on a mammogram at all. That’s why it’s important to have a physical exam by a healthcare professional as well.
If something isn’t clear in the mammogram or differs from the physical exam, doctors can use other tools like an MRI or ultrasound which can provide more detailed pictures. These tools can be especially helpful for those at high risk of breast cancer.
There are some downsides to using screening tests too often. People who get screened more frequently might end up having to go through surgery or radiation treatment that they didn’t actually need. This can cause stress, cost a lot of money, and cause other types of harm. Plus, each mammogram exposes a woman to a small amount of radiation, which can increase the risk of breast cancer slightly if a person has many mammograms over a long time.
Ultrasounds can also be used to check for breast cancer. However, they are not always reliable because the results depend a lot on who is running the machine and how good the machine is. Future research could help us understand better how ultrasounds can play a role in breast cancer screening.
What Else Should I Know About Breast Cancer Screening in the Average-Risk Patient?
Age isn’t the only important factor in deciding when to start screening for breast cancer. Other risk factors need to be considered too. These could include how dense your breasts are, your genetics, and your personal history. The usefulness of mammograms, which are X-rays of the breast, increases as a woman gets older, compared to younger women.
Dense breasts are normal, especially in younger women, as they usually become less dense with age. However, if older women have dense breasts, it could mean they are more likely to get breast cancer. Dense breasts can also make it difficult to identify small spots that could be cancer on a traditional mammogram. While mammograms are less effective in spotting breast cancer in women with dense breasts, other tests like MRI and ultrasounds can be used. These alternatives are especially recommended for women who are at a higher risk of getting breast cancer.
If you have a close relative who has had breast cancer, you might consider starting the screening process earlier and use MRI and ultrasound tests alongside mammograms. Women who have a specific genetic change called the BRCA mutation should get a yearly breast MRI and mammogram. It’s important to identify women who have a lifetime risk of breast cancer over 20%, as regular rules for screening don’t apply to these women. Women at high risk should see a breast cancer specialist for a personalized screening plan. If necessary, they should also see a genetic counselor to discuss genetic testing.