Last modified on May 22nd, 2020
Breast Cancer ScreeningTo screen or not to screen – that is the dilemma. The problem is not simply medical but also a matter of economics. Diagnosis of cancer, whether initial or recurrence, is the period of greatest acute stress for a cancer patient. This crisis is defined by sadness (depression), fear (anxiety), confusion, and occasional anger.The goal of screening women for breast cancer is to detect cancer in its earliest stage when surgery and medical treatment can be most effective in reducing mortality. Screening is only beneficial when an earlier diagnosis results in a reduction in mortality and morbidity and when the risks of the screening test are low. There are three methods for breast cancer screening that are currently practiced: X-ray mammography, clinical breast examination and breast self-examination.Of the three screening methods, the most reliable by far is mammography. However, in women with very dense breast tissue, both ultrasound and mammograms may miss tumors, which, however, can be detected by a Magnetic Resonance Imager (MRI). MRI is also more accurate for detecting cancer in women who carry the breast cancer genes BRCA1 and BRCA2. However, the principal means of diagnosis – and many believe the only definitive one – is biopsy – a minor surgical procedure in which the lump or part of the lump is removed and examined under a microscope for cancer cells. A doctor might perform fine needle aspiration, a needle or core biopsy, or a surgical biopsy.
Clinical Breast Examination (CBE)During a clinical breast examination, the doctor checks the breasts and underarms for lumps or other changes that could be a sign of breast cancer. The CBE involves bilateral inspection and palpation of the breasts and the axillary and supraclavicular areas. Examination should be performed in both the upright and supine positions. One of the best predictors of examination accuracy is the length of time spent by the examiner.The efficacy of CBE alone in screening for breast cancer is uncertain. The results of several large studies have convincingly demonstrated the effectiveness of CBE when combined with mammography as screening for breast cancer in women older than age 50 years. The American Cancer Society advises that women should have CBEs every three years from age 20 to 39 years. Annual CBEs should be performed on women 40 years of age and older.
Breast Self-Examination (BSE)A systematic examination by a woman in which she uses her fingers to feel for changes in her breast shape and fluid discharge from the nipple in order to detect any abnormalities. It is ideally carried out every month. Estimates vary, but 80 to 95% of breast cancers are first discovered as a lump by the patient. Intuitively it follows that regular breast self-examination as a complementary screening modality perhaps along with mammography may help discover some cancers at an earlier stage, when the prognosis is more favorable.Approximately four out of every five breast lumps so detected turn out to be a cyst or other benign (noncancerous) lesion. If a lump is found, however, it is essential to determine as quickly as possible if it is cancerous or not. There are now several epidemiologic studies indicating that survival is increased in women practicing breast self-examination and that cancers detected by breast self-examination tend to be smaller.
Breast Cancer PreventionBreast cancer cannot be completely prevented, but the risk of developing advanced disease can be greatly reduced by early detection.Several drugs are now available to treat or prevent breast cancer. Chemopreventive agents such as Tamoxifen and Raloxifene act to prevent the development of breast cancer by interrupting the process of initiation and promotion of tumors. The antiestrogenic effect of these agents appears also to lead to growth inhibition of malignant cells. Chemoprevention is the most promising intervention for achieving primary prevention of breast cancer at this time.
TamoxifenTamoxifen is a nonsteroidal antiestrogen with a partial estrogen agonist effect. It is FDA-approved for advanced breast cancer, and is now used for estrogenreceptive cancer patients and also for high-risk individuals who are still menstruating and producing considerable estrogen.Given by mouth, it may increase the risk of stage I endometrial cancer and also may worsen vaginal dryness and hot flashes. Tamoxifen may be less effective as a preventive agent in women with a strong family of breast cancer.
RaloxifeneRaloxifene hydrochloride is a selective estrogen receptor modulator (SERM) that blocks the action of estrogen in the breast and endometrial tissue. The incidence of estrogen receptor positive invasive breast cancer was reduced by 76% among women treated with either dose of raloxifene at 40 months of follow-up time. The side effects of raloxifene include an increased risk of thromboembolic disease, but not an increased risk of endometrial cancer.Also, there are recent studies that link low incidence of breast cancer with various environmental factors, especially diet. One food touted to be cancer preventive is soy (found in foods such as tofu, tempeh, soy milk and vegetarian meat substitutes), but there is no clear evidence for this supposition. Consuming more fruits and vegetables, eating less red meat (perhaps substituting soy protein) and avoiding cholesterol (olive oil has none) may also help in preventing breast cancer.A chemical (indole-3-carbinol or I-3-C) found in broccoli, cabbage and other cruciferous vegetables now available as a diet supplement may help prevent estrogen-related breast cancers. Another possible preventive measure is regular use of standard doses of anti-inflammatory drugs such as ibuprofen and aspirin two or more times a week.Finally, a recent study showed that exercise helps prolong life for breast cancer survivors. The precise mechanism is not known, but it is suspected that physical activity lowers hormone levels, decreases insulin resistance and reduces weight gain, all factors in breast cancer.
The information on this Web site or in emails is intended for sharing of knowledge and information. It is not intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. We encourage you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.