Breast Cancer Screening
Center for Obstetrics & Gynecology
Breast Cancer Screening Tests
It is recommended that breast cancer screening tests are performed annually on healthy women with no symptoms. Screening mammogram can reveal a breast cancer before it is palpable, and can catch cancer in its earliest stage, when it is more likely to respond to treatment.
Typically breast imaging screening tests begin at 40 with mammography. However, there some women who need to begin imaging at an earlier age due to an increase risk for breast cancer.
- Prior thoracic radiation, begin imaging 8-10 years after radiation, or at age 25.
- 5 year risk of invasive breast cancer > 1.7% , based on Gail Model
- Women with lifetime risk of breast cancer > 20%.
- Genetic predisposition for breast cancer or known genetic mutation.
- LCIS/atypia on previous biopsy or surgery
- Previous history of invasive breast cancer or DCIS
Clinical breast exam: your physician should visually examine your breasts in the sitting and supine position, palpating the breast tissue including the under arm (axilla) to feel for lumps or other breast changes. Examination in both positions is done to elicit any subtle shape or contour changes in the breast. Clinical breast exams should be performed on all women every one to three years beginning at 20, and every year beginning at 40.
Mammogram: Each breast is placed between two plates and compressed, with two xray views taken of the breast tissue. Digital mammography is preferred for women < 50, and with dense breast tissue. Digital mammograms have less radiation exposure than regular film mammograms. A thyroid collar can be used to protect the thyroid from potential radiation exposure from a mammogram. You can ask the xray tech for a collar if one is not given to you at the time of your mammogram.
Breast Ultrasound: Breast ultrasound is not one of the routine screening modalities in asymptomatic women. However, in women with dense breast tissue, asymmetric breast tissue, or a palpable lump breast ultrasound can be extremely valuable.
Breast MRI: MRI is not one of the routine screening modalities for breast cancer screening for asymptomatic women. Women with a significant risk for breast cancer may be eligible for screening MRI. Examples of women who may qualify are known gene positive patients (BRCA 1, BRCA 2, Cowden’s disease, Li-Fraumeni), women with a lifetime risk for breast cancer > 20%, and young breast cancer survivors with dense breast tissue. Before being scheduled for a MRI, your insurance provider will be contacted to see if it will be covered. It is best to have a MRI at a facility that can also do a MRI biopsy if needed. Gadolinium is the contrast agent used for breast MRI. It may affect kidney function, you may be asked to have a blood test to assess your kidneys prior to MRI if you have a history of kidney disease or high blood pressure.
Self-awareness: Women should also become aware of their breast tissue, look in the mirror with your arms overhead for skin changes, exam your breast 5-8 days from the time of your menstrual cycle, lying down, or in the shower or bath to become familiar with how your breast tissue feels. If you determine that you notice any concerning changes please bring this to the attention of your health care provider.
Recommendations from American College of Obstetricians and Gynecologists
The College now recommends that women aged 40 years and older be offered screening mammography annually, based on the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential for reduction in breast cancer mortality. In 2010, approximately 207,090 new cases of invasive breast cancer were diagnosed, and 39,840 deaths were attributable to breast cancer. Tumors detected at an early stage that are small and confined to the breast are more likely to be successfully treated, with a 98% 5-year survival for localized disease.
Sojourn time is an important emerging concept in cancer screening.Sojourn time is the interval when cancer may be detected by screening before it becomes symptomatic, and varies among cancer types, with more biologically aggressive tumors typically having shorter sojourn times. Estimates of mean sojourn time for breast cancer in women increase with age.Individuals who are likely to have types of cancer with shorter sojourn times are more likely to benefit from more frequent screening when compared with those with slow-growing tumors that have a larger preclinical window.
The College continues to recommend that clinical breast examination should be performed annually for women aged 40 years and older.
The College continues to recommend clinical breast examination for women with a low prevalence of breast cancer (ie, women aged 20-39 years) every 1-3 years.
Breast Cancer Screening Tests
The American College of Radiology has a radiographic reporting system that is a lexicon for all imaging results called BIRADS (Breast Imaging Reporting and Data Systems). All imaging results will have a category assigned to the result, which is standardized for all imaging centers. Depending upon the results further imaging or actions may be recommended.
BIRADS: 0 Additional Imaging Evaluation And/Or Prior Images Are Needed For Comparison
It is important when an abnormal imaging result is suspected to compare the findings to previous imaging, or to obtain further diagnostic tests for evaluation.
BIRADS: 1 Negative
Normal results, no further evaluation is needed.
BIRADS: 2 Benign Findings
Results may indicate previously known benign changes, such as a biopsied fibroadenoma, benign calcifications etc.
BIRADS: 3 Probably Benign Findings-Short Interval Follow-Up Suggested
The results indicate that follow-up imaging is recommended, the imaging studies needed will be in the report; such as a mammogram and sonar in 6 months. It is important to let the radiologist know if you have a personal or family history of breast cancer, for this may change the recommendation. The estimated risk for breast cancer is at 2%. You may want to consult a breast cancer surgeon for further evaluation.
BIRADS: 4 Suspicious Abnormality-Biopsy Should Be Considered
Further immediate action is needed with this category. A stereotactic, ultrasound guided, or MRI biopsy may be recommended. There are varying degrees for risk of breast cancer with this category up to a 2-95% chance of malignancy. An appointment with a breast cancer surgeon is recommended for follow-up.
BIRADS: 5 Highly Suggestive of Malignancy-Appropriate Action Should Be Taken
There is a high probability that a cancer exists, biopsy is needed. Risk of breast cancer could be as high as 95%. An appointment with a breast cancer surgeon is recommended.
BIRADS: 6 Known Biopsy-Proven Malignancy-Appropriate Action Should Be Taken
If a patient is diagnosed with breast cancer sometimes further imaging is required such as an MRI for better characterization of the lesion. If a patient has chemotherapy prior to surgery she may have further imaging to see the response to chemotherapy and a BIRADS 6 category will be issued.
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