Screening for Breast Cancer: A Hope for Survival

Do you know how common is breast cancer? How it’s affecting women? What are the risk factors? What are screening tests for it? How effective is screening in detecting, treating and saving life? When to start screening? How frequent and When to stop?

This blog is dedicated to all those women who have suffered from breast cancer. We all stand and salute all FIGHTERS and SURVIVORS of breast cancer and their families, those who have won the battle and those who are still fighting with it. At the same time we cannot forget to honor our dear ones who lost their lives. The purpose of this blog is to identify the risk factors and to emphasize the importance of screening tests for decreasing the morbidity and mortality of breast cancer.

CHILLING FACTS ABOUT SEVERITY OF PROBLEM

• It is the most common cancer of women worldwide, 30% of all cancers.
• It is one of the leading cause of cancer deaths.
• Every 2 minute a woman is diagnosed with breast cancer.
• 1 in 8 or 12% women can develop invasive cancer in lifetime.

BUT TIMES HAVE CHANGED… Now early diagnosis is possible through regular screening mammography started at 40 years, modern treatment plans have also attributed to improve 5 year survival rates up to 90% .

WHAT IS BREAST CANCER?
It is abnormal and uncontrolled growth of cells of milk ducts or glands of breast tissue.

WHAT ARE TYPES OF BREAST CANCER?
Most commonly ductal tissue is affected with cancer whereas milk glands and sacs lobules are involved less frequently.

WHAT ARE THE DANGEROUS SIGNS OF BREAST PROBLEMS?

• Any change in shape or appearance of breast
• Redness
• Lump
• Any new nipple discharges
• Any type of pain

WHAT ARE BREAST CANCER RISK FACTORS?
The two main factors associated are:

• Females: As more than 99% breast cancer occur in women
• Advanced age, more than 40 years

Other factors are:

• Reproductive risk factors (Receptors positive tumors )
• Nulliparity
• Prolong interval between menarche and first pregnancy
• Early menarche
• Late menopause
• Family history
• breast or ovarian or uterine (endometrial) cancer
• Fallopian tube, peritoneal (lining of body) prostate, pancreas
• Gene mutations
• Patients with known breast biopsy reports (4 fold increased risk)
• Ductal or lobular Atypical hyperplasia (cancer changes in lining of ducts or glands)
• Lobular carcinoma in situ
• Radiotherapy
• Dense breast on mammography
• Hormone replacement therapy after menopause
• Obesity with high body mass index (BMI)
• Smoking
• Alcohol intake

WHICH FACTORS REDUCE BREAST CANCER RISK?

• Multiparity
• Breast feeding

HOW AN INDIVIDUAL’S BREAST CANCER RISK BE ASSESSED?
Review of history, reproductive risk factors, family history, examination findings, investigations like mammography and biopsy reports all help in evaluation and assessment of breast cancer risk. Please note most women who present with invasive disease do not have any risk factor.

WHAT ARE SCREENING TESTS?

• Self-breast examination
• Breast self-awareness
• Clinical breast examination
• Mammography

HOW THE SCREENING TESTS SHOULD BE SELECTED FOR AN INDIVIDUAL?
After patient risk evaluation, there should be an informed shared decision making process, which includes all the information about the potential benefits and harms, timing of initiation and cessation and patients values and preferences.

WHAT IS THE GOAL OF SCREENING FOR BREAST CANCER?
The purpose of screening is to:

• Pick healthy individuals with sub clinical disease having no symptoms
• Prevent adverse outcomes of breast problems
• Avoid aggressive treatments
• Improve survival rate

IS SELF BREAST EXAMINATION SIGNIFICANT IN AVERAGE RISK WOMEN?
NO, in average risk women; self-breast examination is not recommended due to lack of evidence of benefit.

WHAT IS BREAST SELF AWARENESS?
It is woman’s awareness of NORMAL appearance and feel of her breasts. It means women should be able to notify any change or abnormal findings (pain, lump, redness, nipple discharge) to their medical practitioner.

WHO SHOULD HAVE A CLINICAL BREAST EXAMINATION?
It is done by a medical professional as a part of routine gynecologic examination, it should be done for:

• All women who notice any change in breast
• All average and high risk candidates

WHEN AND HOW FREQUENT CLINICAL BREAST EXAMINATION BE DONE?

• Women 25 to 39  years, every 1 to 3 years
• Women more than 40 years, annually

WHAT IS MAMMOGRAPHY?
It is a modified X-Ray which is very effective to detect cancer at such an early stage when chances of survival are high.

WHEN TO START MAMMOGRAPHY?
It is offered from 40 years on wards, not later than 50 years. It should be a shared decision.

WHAT SHOULD BE THE INTERVAL OF MAMMOGRAPHY?
It should be done every year.

WHEN TO STOP MAMMOGRAPHY?
It should be continued till 75 years.

HOW TO REDUCE BREAST CANCER RISK?

• Breast Feeding
• Exercise
• Weight Control
• No Smoking
• Avoid Radiation Exposure
• Limit Alcohol

REMEMBER AWARENESS AND EARLY DETECTION are the prime factors for prognosis and survival in war against breast cancer. These screening tests can help in risk assessment and identification of women at average and high risk, for early referral for treatment and can save millions of precious lives.

Dr. Ayesha Azam Khan