In observance of October being breast cancer awareness month, we’ll take a minute to discuss all things screening. This blog will be geared towards the ladies, but this is not to say men cannot develop breast cancer. It is rare (making up less than 1% of breast cancer cases) but does occur and sadly has a poorer prognosis as there is generally a delay in recognition. It can present similarly as in women: a painless lump under or around the areola or nipple changes. This actually brings us right into the first step of screening, our self evaluation.
Breast cancer screening starts with the individual. While the United States Preventative Services Task Force (USPSTF) and the American Cancer Society (ACS) no longer advise that a woman be taught how to perform a self breast examination. They do advise getting to know what your breast tissue normally looks and feels like. Anything that is out of the norm would need to be evaluated by a health care provider.
The recommendations for clinical breast exams (CDEs) have changed as well. While they were once part of your well-woman check, they are no longer recommended by the USPSTF or the ACS. A higher rate of false positives and no increased detection rates are cited as the rationale for the change. Having said that, The National Breast and Cervical Cancer Early Detection Program studied the value of CBEs in the community setting. It did find that it was able to detect about 5 % of cancers not visible on mammography. The final conclusion one can make off of this is that CBEs may possibly help detect early cancer, but come with the risk of false positives and unnecessary work up when used as an adjunct with mammography.
The mammogram: a special time in life where a complete stranger will compress your breast tissue between 2 plates and take Xray pictures of them. Yes, I’m speaking in jest, but that really is about all there is to it. It is not the most comfortable procedure but not painful and very quick. The age for which to start imaging varies by the institution. In general, women with an average cancer risk can opt to start screening at the age of 40 after a conversation with their provider acknowledging that there may be an increased risk of false positives. The USPSTF goes on to say that screening can be optional between ages 40-49, and performed every 2 years. They then recommended it every other year from age 50-74. The ACS recommends annual screening from age 45-54 and then every other year from 55-74. The ACOG (American College of Obstetricians and Gynecologists) recommends annual screening of women from age 40-74.
What about breast cancer screening at 75? The mammogram guidelines from 75 years and up are not as clear. The general consensus is that if a woman is in good health, with a life expectancy of more than 7 years, then screening should continue as long as she is in agreement.
If you have concerns over family history, need for early screening, or just when and if you should be screening, please make an appointment with your provider to discuss the next step. If you do not have a provider, we would be happy to help you here at Action Medicine. We appreciate you taking the time to read our blog and wish you a safe and happy long weekend!
- Dr. Mike
- Brooke Rieth NP