This is part 1 of the Cancer preventive care series. You can read the series preamble here
Screening for breast cancer has changed many times over the years and the guidelines have been fine-tuned. The starting age varies from country to country, some recommend starting screening at 40, others at 50. Once you reach the correct age, screening is recommended every two years. Your doctor can give you a requisition for this every 2 years or, some areas have Breast Screening Programs which allow you to refer yourself and they send you reminder letters every 2 years and you can book without needing to see your doctor each time. The breast screening programs usually end at age 74 as your chances of developing breast cancer is decreased after that age. You are encouraged to continue having regular mammograms because I have seen breast cancer diagnosed at 80.
Mammograms are basically x-rays taken to identify potential areas of concern within the breast tissue. Mammograms can find lumps that are somewhere between 3-10mm in size… 3 times smaller than those that can be detected by touch. The breast is placed between two plates and the x-rays are taken. It’s also important to have repeat screening done at the same imaging facility allows accurate comparisons to be made with previous imaging which allows for more accuracy as far as pinpointing possible problem areas. Some women have very dense breast tissue which makes it difficult to analyze. If that’s the case it is recommended that you have an ultrasound done with each mammogram.
If you have a family history of breast cancer mammograms are recommended annually. There are also genetic programs available where you can be tested to determine if you carry the gene that will eventually lead to your own diagnosis. You can discuss options with the genetic counselor who will advise a number of options including doing nothing but annual screening or going as far as having a double mastectomy. Very few cancers actually have a cause but rather there are a number of risk factors that play a part in the formation of the abnormal cells. The only true cause of breast cancer is having one of the inherited gene mutations, usually BRCA1 or BRCA2. These same genes increase your chances of developing ovarian cancer as well. The risks increase with being female, but men can develop breast cancer, increasing age, obesity, periods starting at a young age, menopause starting at a late age, having your first child after 30 years of age or not having a child at all, postmenopausal hormone
replacement especially estrogen and progesterone combinations, and alcohol and smoking. Though no longer recommended, doing regular self-exams to check for lumps is still a starting point especially before you reach the age of regular mammograms.
Unfortunately, lumps found by self-examination are generally 10-30mm in size. Your doctor or nurse can also perform this type of exam and should at the time of a physical or a pap test. If something is detected on your mammogram, additional imaging is done first usually includes a more in-depth mammogram as well as an ultrasound of the affected breast. If either of these indicates a problem the next step is usually a biopsy where a needle is used to withdraw cells that are then sent to the pathology lab. The pathology report will indicate whether the cells are malignant (cancerous) or benign (non-cancerous). Once the pathology report reaches the surgeon who did the biopsy you will meet with him and treatment options will be discussed. If malignant, surgery will be scheduled which could be a lumpectomy, mastectomy or double mastectomy followed by an appointment with an oncologist to review and discuss treatment options which could include hormone therapy, chemotherapy and/or radiation. The smaller the tumor found the less likely the cells have spread to the lymph nodes
and other parts of the body. This means that surgery and other treatment can completely get rid of cancer.
The alternative, not having the screening done, is running the risk of a lump not being found until the cancer cells have spread into the lymph system and possibly metastasized (spread) to other organs including the brain. Once cancer has metastasized there’s less that can be done. Though cancer is scary, when it’s discovered early enough, it’s treatable, and that’s the best outcome anyone could ask for.