Screening For Breast Cancer

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Written by Allen Lawrence, M.D.

Sunday, 29 May 2011 02:43

Over the past years there has been considerable controversy regarding screening fro breast cancer. Some experts say you should have mammographies other say that you do not need them. Some experts tell you that you should be doing regular Breast Self-Examinations, while other experts tell you they are unnecessary and can create problems for you. Who is right? What is a girl to do? Who should she be listening to and why?

In an attempt to clear this mystery up I have reviewed a large portion of the literature and this along with 40+ years of experience bring us to the following article.

Let’s start with the obvious, all of the experts no matter what they end up stating is their best opinion start out with the belief that routine screening for breast cancer can improve your chances for early detection of breast cancer, hence early treatment and better survival. Every expert some where ein his or her opinion acknowledges that when breast cancer is caught early, the chance for successful treatment is greatest. That seed the argument appear to break off in one of two major directions, those who believe that screen should be done frequently and those that believe that screen should be less frequent.

The rub in most expert opinions is about two things: 1) when screening should be done and which screening procedures provide the best result for dollars spent. Yes, often the experts are making their decision based on the economic impact of breast cancer screening. 2) the argument that certain screening procedures are in fact flawed and imprecise and can then lead to false positives, which may then lead to unnecessary biopsies, lumpectomies and even mastectomies. This last issue is possibly the most important issue but is often buried within the statistics that are offered to deal with the economic issues surrounding breast cancer screening.

About Breast Cancer

According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer in women with more than 178,000 or more new cases expected each year. It's also the second leading cause of cancer death, after heart disease, with more than 40,000 expected each and every year.

The good news however, is that breast cancer death rates have been steadily decreasing since 1990. A key point in the choices you ultimately need to make. This decline has been attributed in part to the increase of early detection through breast cancer screening and better education of women and of course better surgical and therapeutic procedures.

Basic Breast Cancer Screening

Currently most experts recommend the following:

Starting at age 20 woman should have a physician performed breast examination every one to three years.
Starting at age 40 woman should have a yearly mammogram along with their clinical breast examination.

Most insurance companies go along with this program, but not all. Certain companies in certain states either do not cover “preventive” procedures or are written with such high deductibles that women cannot afford to have physician breast examination or mammographies performed. Hence, they do not get screened.

Breast Self-Examinations

Obviously these are not covered by insurance so the insurance companies either do not get involved or take the position as M. D. Anderson, one of the largest cancer hospitals in the county, has, that they do not recommend that women conduct a "formal" breast self-examination anymore. Their recommendation, in their own words, “All women should be familiar with their breasts so that they will notice any changes and report them to their doctor without delay."

It is, of course, hard for me, a Gyn of 40+ years, to understand how any woman could “get familiar” with her breasts without doing a “formal” breast self-examination on a regular basis. So when “experts” say breast self-examinations are not needed, how could they imagine that women would be able to “be familiar with their breasts so that they will notice any changes and report them to their doctor without delay."

The reason breast self-examinations appear to be an issue is that women tend to find abnormalities in their breasts and when they present to their doctor, their doctor feels obligated to perform diagnostic testing and possibly even a biopsy or lumpectomy and more often than not, cancer is not found only benign harmless tissue changes. This is a problem for two reasons: 1) it costs the insurance companies money and 2) possibly more important it creates an increase problems and risk for the woman. She most likely will experience anxiety, fear, discomfort, possible “unnecessary surgery” if the biopsy or lumpectomy proves ti not uncover a malignancy then the surgery will likely be deemed to have been “unnecessary.”

The problem here however, is not breast self-examinations but rather the quality of the testing to begin with that it still is not yet capable of distinguishing benign from malignant breast lesions. It can only be hoped that with all the dollars spent in treating breast cancer each year and all of the misery it causes, somewhere someone is working to improve the quality of the screening procedures.

In the meantime then this is a real issue for women, one which each woman must for herself decide on, how do I get smart enough and skilled to understand what I am looking for and the risks of performing regular, monthly self-breast examinations that I am sufficiently proficient to know when there are any changes that should be reported to my doctor without delay.

MRI for Women at High Risk

Some studies have suggested that certain women “at high risk for breast cancer” should have both mammogram and magnetic resonance imaging (MRI) performed are regular intervals as they will then have a better chance for early detection of breast cancer when it is easiest to treat.

The American Cancer Society recently updated its breast cancer screening guidelines to include MRI scans, in addition to mammography, for certain women at high risk of developing breast cancer. They recommend an MRI and mammogram for women who have one or more of the following conditions:

Genetic test results showing a gene mutation: BRCA 1 or 2, Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome.
One or more first-degree relative (parent, child, sibling) with one of the above mutations (if the woman has not yet been tested).
A lifetime breast cancer risk of 20 to 25 percent or greater on an accepted risk assessment tool predominantly based on family history.
A history of radiation therapy to the chest between the ages of 10 and 30.

To date it is unknown as to whether regular MRIs may be beneficial for women at high risk who do not meet any of the above criteria. So far there is no consensus that most women would benefit from MRI scans for regular breast cancer screening.

It is still important to have regular gynecologic examinations and during these examinations each women should speak with her doctor to determine if she is at high risk of developing breast cancer and if an MRI scan would be appropriate die her. Your doctor should be able to help you determine what screening tests are most appropriate for you. You should also should check with your health insurance carrier to see if the cost of a screening MRI is covered under your current policy and if not do what will be necessary to upgrade your coverage.

The take home message from this article is: Women, Your Should Be Screened for Breast Cancer On A Regular Basis..

For more information on breast cancer screening and MRI, visit MD Anderson Medical Center Cancer Awareness Web Site, click here. .

For more information on Breast Self-Examination, click here.