Screening for Breast Cancer

Few years ago one of my dear friend went for a routine breast screening, as she had a family history of breast cancer. On clinical examination and mammography, a small suspicious lump was detected for which biopsy was done and report confirmed cancerous growth in ducts of breast.

BREAST CANCER? What will happen now?

We were so worried until she started her state of the art treatment for breast cancer. She had surgery followed by chemotherapy, radiotherapy, and immunomodulation. She fought with the disease very courageously and won the battle. Now it’s more than one and a half decade, she is happy and healthy, excelling professionally, enjoying her grandchildren but we still remember that time as a nightmare. And now when I see her with glowing smiley face; I thank God for saving her for us.

It’s a story with happy ending but I still feel she was extremely lucky to be picked and diagnosed at a very early stage of the disease. Do you know that every 1 in 8 woman has a chance of getting breast cancer? Unfortunately there is a lack in awareness of screening program globally and due to social or economic reasons, the medical advice is late. As a result, thousands of women either undergo aggressive surgical and medical treatments or lose their lives, every year.

In the past, breast cancer diagnosis was considered as a death warrant, but now it’s different as we know, CANCER IS TREATABLE! And as with every cancer; early detection and treatment is a cornerstone in controlling the disease and increasing the life expectancy.

The purpose of this blog is to create awareness about WHY AND HOW? to screen for breast cancer and answer the queries about it:

Why to SCREEN?
Screening for breast cancer can pick the disease at a very early stage when it is easily treatable and prognosis is good. Now a days modern surgical techniques, latest drugs and treatment modalities have increased the number of breast cancer survivors to millions. They have fought well and won the battle against cancer. It is expected that this number would further increase in future with various screening programs.

What is NORMAL?
Every women should know about the normal appearance and feel of breast, so that she can pick any abnormal change. But it should always be accompanied by regular clinical examination and mammograms, as the latest technology detect changes much earlier than they are even noticed by a woman.

What is ABNORMAL?
There are certain abnormal features which need further evaluation:

• Any lump or swelling in breast or armpit
• Any localized heaviness, pain, or tenderness
• Any color change or puckering of skin
• Nipple retraction
• Any discharge from nipple
• Change in shape or size of breast

What are UNCONTROLABLE factors?
These are predisposing factors of getting breast cancer:

• Women of any age group
• Family history of cancers of breast, uterus, and ovary
• Disturbed menstrual cycle (Early menarche and late menopause)
• Altered density of breast tissue
• Genetic changes (BRCA 1 and BRCA 2 genes)

What are CONTROLABLE factors?
These are risk factors which increase chances of getting breast cancer:

• Contraceptive pills
• Hormone replacement therapy after menopause
• Alcoholism
• Smoking
• Obesity
• Lack of exercise
• Radiation exposure

How to REDUCE risk of cancer ?
There are Lifestyle modifications which help in reducing chances of getting breast cancer:

• Take a Healthy balanced diet
• Exercise daily or at least three times a week
• Stop smoking and alcohol intake
• Get a regular screening

When to SCREEN ?
There are regular screening programs. All women should be evaluated for risk of getting breast cancer at 30 years of age. It could be done by evaluating patients history, examination and IF needed certain other investigations.

• For average risk women, screening should start at age 50 until 75 years and is done after every (02) two years. 
• For high risk women, its recommended earlier; at age 40 and is done annually.

Women having cancer at a younger age (less than 40 years) would have more benefit from MRI.

Who to SCREEN?
All women with average risk above age of 40 years
Screen earlier, if falling in high risk:

• Genetic BRCA1 and 2
• Radiotherapy of chest before 30 years
• Family history of cancer
• Patients with predisposing and high risk factors

How to SCREEN?
Self-breast examination is important but screening program and investigations detect problems very early.

• Mammography: It is a modified sliced Xray images of breast tissue, in which breast is compressed between two plates to take images for detecting areas of modified density. It has limitations of detecting a lesion in obese women with dense breast tissue, it also depends on size and site of tumor formation which can be missed in dense breast tissue.
• Ultrasound: It is helpful in obese patients where X ray mammography is difficult to perform and sometimes it supplements findings of mammography.
• MRI (Magnetic Resonance Image)
• It is helpful for further evaluation of suspicious areas picked on mammography and ultrasound;  it is also used for follow-up of cases of breast cancer.

Limitations of Screening

• The role of screening of low risk women at age less than 40 years is doubtful.
• Similarly screening after 65 years can pick very low percentage of low grade tumors.

Any Side Effects of Screening?
It should be done after taking history and clinical examination by a trained medical professional to find all the risk factors as:

• There are false positive or false negative results
• Young obese patients
• Hormone intake
• Dense breast tissue
• Strong family history
• Further invasive testing could be stressful and painful

Remember! screening at appropriate time can save millions of lives

LET’S DEFEAT BREAST CANCER
CREATE AWARENESS AND FIGHT BACK TOGETHER

Dr. Ayesha Azam Khan