Article contributed by Dr. Shefali Agrawal, Surgical Oncologist.
Breast and cervical cancer are the two most common cancers in women in India and both can be detected at an early stage with screening.
Routine screening for breast cancer will reduce the risk of dying from breast cancer.
WHAT IS SCREENING MAMMOGRAPHY
Screening tests can help in finding cancer at an early stage before development of symptoms. By the time symptoms develop, the cancer may have grown or spread. By detecting the cancer early or before the development of symptoms, it may be easier to treat or cure.
Screening for breast cancer is done by mammography. A mammogram is a set of X-rays of the breast to look for abnormal signs or patterns that may suggest cancer. Mammography may detect abnormal signs like calcifications or a mass before a lump can be felt in the breast. Presence of such findings may require additional tests such as an ultrasound of the breasts or a needle biopsy.
A mammogram performed in an asymptomatic patient or a normal person with no signs and symptoms of breast disease for the detection of breast cancer is called a Screening Mammogram. A screening mammogram or a mammography test is a simple routine X-Ray of both breasts and is very important for early detection of breast cancer. If an abnormality is then detected a more detailed mammogram is performed. This is called a Diagnostic Mammogram.
CURRENT SCREENING GUIDELINES
In the United States, the US Preventive Services Task Force recommends that women aged 50 to 74 years should get a screening mammogram every 2 years. Some women below the age of 50 years may elect to get screened however, all women with the average risk of breast cancer for their age do not need to be screened.
Women with a history of breast cancer in their family or those who are taking the hormone estrogen such as menopausal hormone replacement therapy (HRT), may be at increased risk for breast cancer and may commence screening mammography at a younger age in consultation with their physician.
BENEFITS OF SCREENING MAMMOGRAM FOR DETECTION OF BREAST DISEASE
Several studies have shown that women who have routine or screening mammograms have 10% to 25% less chances of dying from breast cancer than women who do not have mammograms.
There is some evidence to suggest that breast cancer may be more common in cities than rural India however, this may be the consequence of improved detection due to increased utilization of screening mammography and awareness about self-breast examination.
So if you are not satisfied, get a second opinion.
Mammograms like all tests have limitations. They may miss a cancer in 10% women called a false-negative result or something which looks like a cancer on mammography may not turn out to be a cancer called a false-positive result. A false-positive mammogram may lead to additional tests or procedures and patient anxiety until the benign nature of the findings is confirmed.
The risk of harm from radiation exposure during a mammogram is extremely low as mammograms require very small doses of radiation. However, women should talk to their physicians if they have any concern about radiation from repeated X-rays or if there is any possibility that they might be pregnant as radiation can harm a growing fetus.
Despite these limitations, screening mammography is the single most effective test for the early detection of breast cancer and its diagnosis several years before the development of symptoms.
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Centers for Disease Control and Prevention
Vimla (name changed), a 58 year-old female who has undergone routine screening mammography for the past 7 years was noted to have a small mass in the left breast on screening mammography. She had no symptoms of breast cancer and examination of the breasts was normal with no palpable mass. Her screening mammogram revealed a small mass suspicious for cancer (arrow) in the left breast as shown below. She underwent a stereotactic (mammographically-guided) needle biopsy of the breast mass confirming an invasive ductal breast cancer.
She was keen to preserve her breast and avoid a mastectomy (complete removal of the left breast)or major breast reconstructive surgery. A wide local excision or removal of the cancer and sentinel lymph node biopsy of the left armpit was performed. Pathology demonstrated that the margins of the specimen were negative for tumor confirming that the mass had been completely removed. The sentinel lymph node was negative for tumor and she did not require a complete axillary lymph node dissection thus avoiding the drawbacks of extensive lymph node surgery such as lymphedema or swelling, numbness or weakness of the arm. She received radiation for 5 weeks to the left breast and systemic endocrine therapy (an oral anti-estrogen pill) to reduce her chances of recurrence of cancer.
Vimla successfully underwent Breast-Conserving Therapy for Stage 1 breast cancer with a 10-year survival of >90%. This was largely possible due to detection of the cancer at an early stage by screening mammography.
Mammogram shows a small mass lesion in the left breast suspicious for cancer. Courtesy, National Cancer Institute.
This was contributed by Dr. Shefali Agrawal,
Senior Consultant, Department of Surgical Oncology, Indraprastha Apollo Hospitals, New Delhi.
Dr. Shefali Agrawal is a Surgical Oncologist who specializes in the surgical management of breast cancer. Dr. Agrawal was trained in Surgical Oncology from Roswell Park Cancer Institute, Buffalo, New York and Advanced Gastrointestinal Surgery from the world-renowned Johns Hopkins University School of Medicine, Baltimore, USA. Prior to joining Apollo Hospitals she was an Assistant Professor of Surgery at Temple University of School of Medicine, Philadelphia, USA.
Dr. Agrawal has several publications in top surgical journals including Annals of Surgery, Annals of Surgical Oncology, Cancer, Journal of Surgical Oncology and contributions to book chapters.
She is an Invited Speaker at premier international conferences and a member of several professional societies including Society of Surgical Oncology,International Hepato-Pancreato-Biliary Association and American College of Surgeons.