The latest in breast cancer screenings

Guest information:

Leah Millheiser, M.D.
Instructor, WRHR Scholar
Phone: (650) 725-9447

For more information: www.breastcancer.org OR www.cancer.gov/cancertopics/types/breast

The Facts (courtesy of the National Cancer Institute):

  • Breast cancer is the 2nd most common cause of cancer deaths in women after lung cancer.
  • It is the second most common cancer diagnosed in women (occurs in 1 out of 8 women)
  • Women in the US have the highest rate of breast cancer in the world
  • Carriers of the BRCA 1 or 2 mutation have a 50-80% lifetime risk of breast cancer

    Signs of breast cancer:

  • Hard breast lump or mass
  • Inward-turning nipples
  • Breast pain
  • Breast skin changes: dimpling, redness, thickening, irritation
  • Abnormal nipple discharge

    Breast cancer risk factors:

  • BRCA 1/BRCA 2 gene mutations (men and women)
  • Age
  • Mother or sister with history of breast cancer
  • Estrogen exposure (early age of menstruation (<12 yrs old) or later age of menopause (> age 55)
  • Race: Caucasian women are at higher risk than African-american women. African-american women are more likely to die from breast cancer than Caucasian women. Hispanic, Asian, Native American women are least likely to develop and die from breast cancer.
  • Previous chest wall radiation
  • Never been pregnant or older age at first pregnancy
  • Excessive alcohol intake
  • Obesity

    Different types of breast cancer screening:

  • Mammography
  • Mammography + MRI
  • Clinical Breast Examination

    Mammography:

  • Baseline mammogram younger than age 40 is no longer routinely recommended.
  • Yearly mammogram is advocated for all low-risk women starting at age 40. The benefit is greater in women > 50 years of age.
  • Mammograms may miss some breast cancers.
  • Mammograms have been shown to decrease the rate of breast cancer deaths.
  • False positive rate: 10% postmenopausal women, 20% premenopausal women; this may lead to additional testing

    Reasons why women don't get routine mammograms:

  • Fear of radiation exposure
  • False positive and false negative results
  • Fear of pain
  • Fear of abnormal findings
  • Fear of embarrassment

    MRI + Mammogram:

  • Woman with known BRCA 1 or BRCA 2 mutation
  • Known first-degree family member with BRCA 1 or 2 mutation
  • 20% or greater lifetime risk based on risk assessment tools
  • History of chest wall radiation

    Clinical Breast Examination:

  • Women in their 20's and 30's should have one every 1-3 years by their clinician
  • Women 40 and older should have a yearly breast exam by their clinician

    Ultrasound:

  • Not a substitution for screening mammograms
  • Can help distinguish between solid masses and cysts
  • Used to further evaluate suspicious lesions found on mammogram or masses felt on exam in young women

    Monthly Breast Self-Examination:

  • Unlike clinical breast exam and mammogram, breast self-examination has not been shown to decrease the rate of breast cancer deaths. However, it is a good way for women to detect changes in their breast tissue and report any changes to their clinicians. Therefore, it is still recommended by health care professionals. It's not recommended as a replacement for a clinician's breast examination or mammogram

    Recommendations for breast cancer screening in women with BRCA 1 or 2 mutations:

  • Breast self-examination starting at 18
  • Annual mammogram and MRI starting at age 25

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