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Breast Cancer
The National Cancer Institute has recently completed its DMIST trial to determine whether digital mammography is able to detect breast cancer more accurately than conventional screen-film mammography. From the patient’s perspective, a digital mammography examination is similar to the traditional mammography examination. Positioning and compression of the breast are identical. The American College of Radiology announced on November 13, 2003 that the target 49,500 participant recruitment goal had been reached.
Women who joined DMIST had both a screen-film and digital mammography examination; were asked to return in one year for their annual mammogram; and will be contacted for telephone up to three years after their initial exam to see if they had normal mammograms and clinical breast exams. The first DMIST results are expected to be published by the end of 2004.
Breast Self-exam
Breast self-examination should be done monthly and is one basic way for a woman to familiarize herself with her breasts and keep a close watch on the visual appearance of her breasts and the changes she feels. The best time to do a BSE is 2 to 3 days after the end of menstruation, as the normal lumpiness of the breast is then minimized. There are various ways of performing BSE. One of the best methods of BSE is performed in the supine position (i.e. lying down, as this spreads out the internal breast tissue and deeper lumps can be felt easily) with one arm raised over the head. Using the smooth surface of the fingers of the opposite hand, a woman checks the breast with small circular motion keying in to any lumps that can be felt. She works from around the nipple area to the outer edges of the breast in concentric circles.
Regular breast exams can detect lumps of about 1.2 cm. An average size lump found by women untrained in breast-self exam is about 3.75 cm. Regular mammograms can detect lumps as small as 0.2 cm.
Additional details on breast self-exam, including a video can be found at www.komen.org/bse/
Evaluation of indeterminate microcalcifications
Calcifications classified on a routine mammogram as indeterminate may be evaluated with magnification views (enlargements). This assists the radiologist in determining the cause of the microcalcifications and whether it is benign, suspicious, or malignant. (Benign and malignant calcifications are discussed above). “Probably benign” means that the calcifications have a 98% chance of being caused by a non-cancerous process. “Suspicious” microcalcifications, however, may be seen with either benign or malignant process, but most commonly these are benign, as with fibrocystic change. Biopsy is the best method to determine the cause of calcifications classified as “suspicious,” since the chance of malignancy is 20-25%. If you have any questions about microcalcifications, or if your results of your mammogram are unclear to you, you can discuss this with our radiologist Dr. Lisa R. Weinstock by calling Women’s Digital Imaging at (201) 444-4484.
For more information on breast health or breast cancer, click here.
Breast Cancer Risk Factors
The American Cancer Society estimates that there will be 212,600 new cases of invasive breast cancer in 2003. It is the most frequently diagnosed non-skin cancer in women. Approximately one of every eight women will develop breast cancer at some time during her life. An estimated 40,200 deaths are anticipated from breast cancer in 2003.
In addition to invasive cancer, 55,700 new cases of in situ breast cancer are expected to occur among women in 2003. Of these, approximately 85% will be ductal carcinoma in situ (DCIS). The increase in detection of DCIS cases is a direct result of increased use of screening with mammography, which detects invasive breast cancers before they are palpable; that is, before they are felt.
Patients can be helped to estimate their individual risk for invasive breast cancer. Six key risk factors have been conclusively identified in the clinical literature: age (>50); age of menarche; age of first live birth (>30); number of first degree relatives (mother, sister(s) and /or daughters) with breast cancer; number of previous breast biopsies (whether positive or negative); and at least one biopsy with atypical hyperplasia. Other risk factors such as age at menopause; dense breast tissue on a mammogram; use of birth control pills; high fat diets; alcohol; physical activity; obesity; or environmental factors have either been inconclusive or researchers have been unable to calculate the risk for an individual women (Source: National cancer Institute).
Approximately 5% of cases of breast cancer and 10% of cases of ovarian cancer are due to an inherited predisposition. Since 1995, it has been possible to test people at high risk for inherited mutations to the BRCA1 and BRCA2 genes. Not all women with these genetic mutations develop cancer; the lifetime risk of acquiring breast cancer is 56-85% and for ovarian cancer is 16-40%. Each child of a person with a BRCA mutation has a 50% chance of inheriting the mutation. The decision to undergo genetic testing is very personal and complex. There is a general consensus that testing be done in a supportive environment that includes counseling and formal psychological support.
Breast Cancer Statistics
The National Cancer institute estimates that one in eight women in the United States will develop breast cancer during their lifetime. Alternatively, this implies that seven of eight women will never develop breast cancer – a far more favorable outcome.
Age Range Risk of Developing Breast Cancer
30-39 years old — 1 out of 252 (0.4%)
40-49 years old — 1 out of 68 (1.5%)
50-59 years old — 1 out of 35 (2.9%)
60-69 years old — 1 out of 27 (3.7%)
If detected early, breast cancer can be effectively treated with breast-preserving surgery, followed by radiation therapy. Currently, 63% of breast cancers are discovered at an early, localized stage; the 5-year relative survival rate is 97%. If the cancer has spread regionally, however, the rate is 78%, and for women with advanced (metastatic) disease, the rate is 23%. Today, only 6% of breast cancers are diagnosed at an advanced stage. Early detection saves lives and increases treatment options.
Breast Cancer Detection & Diagnosis
Diagnostic Algorithm
Website: http://www.R2tech.com/prf/
There are exciting new technologies and procedures including Breast MRI and Ductal Lavage which may prove to facilitate the early detection of breast cancer. We are currently not offering these procedures at WDI however we will refer you to a quality facility and help with the entire process of making the appointment to receiving results as quickly as possible.
Breast MRI
Magnetic Resonance Imaging (MRI) is currently not used as a breast cancer screening tool due to its expense and lack of reimbursement; and more importantly, inadequate specificity – too many false positives. MRI scans have difficulty in discerning malignant from benign tissue. As an emerging, yet unproven technology, MRI for breast imaging is currently being assessed at various academic medical centers.
Ductal Lavage
Ductal lavage is an emerging technology and represents a minimally invasive method of collecting cells from a women’s breast to search for atypical cytological changes. It is intended for women who are at high-risk for developing breast cancer. These risk factors include having had breast cancer in the past; having close relatives who have had breast cancer; or who have a BRCA1 or BRCA2 gene mutation.
Ductal lavage involves the application of a numbing cream to the nipple, self-massage and aspiration. Although most women have 6-9 ducts per breast, droplets usually appear from only one or two ducts. A small cannulae (tube) is utilized to collect the fluid and send it to the laboratory for evaluation.
Additional Information:
— Biopsy read more
— Mammography read more
— Osteoporosis read more
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