Decoding the Latest Recommendations for Breast Cancer Screening


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According to the National Breast Cancer Foundation, one in eight women will be diagnosed with breast cancer during her lifetime. Breast cancer experts all agree by far that the best way to protect women is with early and frequent screening. However, recent changes to screening guidelines by the American Cancer Society have left women wondering, “When is the best time to get a mammogram?”

In 2015, the American Cancer Society recommended that women with average risk for developing breast cancer begin getting annual mammograms at age 45 (up from age 40), then change to biannually at age 55. To support the changes, the American Cancer Society cites the cost of false positives leading to unnecessary additional tests and anxiety for women.

Dr. Jay Baker, M.D., chief of the Division of Breast Imaging at Duke University Medical Center, says the new recommendations are unfortunate. “False positives may create more anxiety for women. That phone call from a physician is never a welcome one,” he says. “But data clearly shows that screening every year, starting at age 40, saves more lives.”

Baker says mammograms can detect cancer at an earlier stage than a patient or even provider can detect during an exam. “When we find cancers earlier, they’re smaller,” he says. “If we can catch cancer when it’s small and before it can spread, treatments are less invasive and hugely successful.”

Since widespread screening began in the 1980s, Baker says the number of women who have died from breast cancer has decreased by 40 percent. He adds that the exception to these recommendations is the patient with an increased risk of breast cancer. Women with a first-degree relative who has or had breast cancer (a mother, sister or daughter, for example) have a higher risk of developing breast cancer themselves. In that case and if possible, women should begin screening 10 years earlier than the age of the relative’s diagnosis.

In another surprising statement, the American Cancer Society found little evidence that breast exams (either self-exams or exams conducted by a provider) benefit a woman in screening for cancer. Baker says this is because few cancers are first discovered with a physical exam, unless they’re large and advanced. However, he clarifies that if a woman detects a lump, she should contact her physician to check it out.

Baker recommends that whether women decide to get their first mammogram at age 40 or 45, they start talking to their providers about breast cancer screening at age 40. The following organizations can also connect patients with low-cost or free mammograms.


The Five Stages of Breast Cancer and Treatments

Stage 0

  • Noninvasive.
  • Comes in two forms: Lobular Carcinoma in Situ (LCIS), located in milk-producing glands, and Ductal Carcinoma in Situ (DCIS), located in the breast ducts.

Treatment

LCIS is not a precancer, but a provider may still remove the tissue to be certain only LCIS is present. Having LCIS increases your risk for developing cancer in the future. Post surgery, patients should have annual mammograms and breast exams. Hormone mediction and other preventative steps, like lifestyle improvements, may also be recommended.

DCIS won’t spread outside the breast, but can develop into invasive cancer. Surgery to remove the tissue and radiation are usually recommended. Depending on the type of DCIS, patients may require a hormone treatment, which reduces the risk of the cancer returning.


Stage I

  • Invasive but small.
  • Either the cancer hasn’t spread to the lymph nodes or it has only spread to a small area in one lymph node.
  • Requires surgery along with radiation.
  • Chemotherapy and hormone treatments may also be necessary, depending on the type of cancer.

Treatment

Two forms of surgery are available for most tumors. Breast Conservation Surgery, also known as a lumpectomy, saves as much breast tissue as possible. The second option, a mastectomy, removes the entire breast. Patients can choose to complete breast reconstruction surgery at the same time as a mastectomy. If radiation is required after surgery, however, patients may choose to complete reconstructive breast surgery at a later date.


Stage II

  • Affected area is larger than it is in stage 1.
  • Cancer has spread to more than one lymph node.

Treatments
Treatments include surgery and radiation, along with chemotherapy and hormone treatments.


Stage III

  • Tumor has grown to a size more than 2 inches across.
  • Tumor may have also spread into several lymph nodes or nearby tissue, including the muscle wall or skin.
  • Though uncommon, stage III can also include inflammatory breast cancers (when cancer cells block lymph node vessels in the skin).

Treatment

Often, a mastectomy is necessary to remove the tumor(s), followed by radiation or chemotherapy and hormone treatments.

With inflammatory breast cancer, the breast may be warm to the touch, appear red and swollen, and have the pitted appearance of an orange peel. Aggressive treatments are used, since inflammatory cancer can spread quickly. A modified radical mastectomy is usually recommended, in which the entire breast and lymph nodes are removed.


Stage IV

  • Considered advanced.
  • Tumor has spread into the lymph nodes and throughout the body.
  • Breast cancer most commonly spreads first to the bones, liver and lungs, followed by the brain and other organs.

Treatment

The first line of defense for Stage IV patients is often systemic drug and hormone therapies, including chemotherapy. Surgery is less effective. Stage IV cancer is difficult to cure. However, treatment can slow or shrink tumors, improve symptoms and prolong patients’ lives.

 

Source: The American Cancer Society

 

Learn More

American Cancer Society

National Breast Cancer Foundations’ National Mammography Program

National Breast & Cervical Cancer Early Detection Program

The National Cancer Institute

Susan G. Komen® North Carolina Triangle to the Coast

 

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