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Page: Screening
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Due to the high incidence of breast cancer among older women, screening is now recommended in many countries, the same also applies to men. Screening methods suggested include breast self-examination and mammography. Mammography has been shown to reduce breast cancer-related mortality by 20-30%. Routine (annual) mammography of women older than 40 is encouraged as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials.
Mammography is still the modality of choice for screening of early breast cancer, and breast cancers detected by mammography are usually smaller than those detected clinically.
Magnetic resonance imaging (MRI) has been shown to detect cancers that are not visible on mammograms, but it has several disadvantages. For example, although it is 27-36% more sensitive, it is less specific than mammography. As a result, MRI studies will have more false positives (up to 5%), which may have undesirable financial and psychological costs. It is also a relatively expensive procedure, and one which requires the intravenous injection of a chemical agent to be effective. Proposed Indications for using MRI for screening include:
* Strong family history of breast cancer
* Patients with BRCA-1 or BRCA-2 oncogene mutations
* Evaluation of women with breast implants
* History of previous lumpectomy or breast biopsy surgeries
* Axillary metastasis with an unknown primary tumor
* Very dense or scarred breast tissue
Ultrasound alone is not adequate as a screening tool but it is a useful additional for the characterization of palpable tumours and directing image-guided biopsies.
The U.S. National Cancer Institute recommends screening mammography with a baseline mammogram at age 35, mammograms every two years beginning at age 40, and then annual mammograms beginning at age 50. In the UK, women are invited to attend for screening once every three years beginning at age 50. Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer. More and more men are being prompted to undertake breast screening due to the rise of breast cancer in men.
Several scientific groups however have expressed concern on the perceived benefits of breast screening by the public. In 2001, a controversial review published in The Lancet claimed that there is no reliable evidence that screening for breast cancer reduces mortality. The results of this study were widely reported in the popular press.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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