Breast Cancer Awareness Month: What You Need To Know About Screening Diagnostics Beyond Mammography

Breast cancer is the most common type of cancer diagnosed in women, with an astounding 1.7 million new cases each year.

If we do the math, we’ll see that breast cancer accounts for roughly one in four newly diagnosed cancer cases in women. Even though access to medical care has greatly improved in the last couple of decades, breast cancer is the fifth most common cause of death from cancer in women. Of course, men can also be diagnosed with breast cancer, but statistically, it is about one hundred times less common than in women.

Breast cancer: Who belongs to the highest risk groups?

Breast cancer is most commonly diagnosed in women older than 50, but unfortunately, there is a trend towards an even younger population.  However, patients are encouraged to undergo their first ultrasound examination in their early twenties.

As for the risk factors for breast cancer, they can be categorized into two groups:

Breast cancer risk factors we can’t control, such as:

• Aex (women)
• Age (50-69)
• Genetics (the existence of BRCA genes)
• Early first menstrual period (before the age of 12)
• Early menopause (before the age of 55)

Risk factors on which we can have an impact include:

• A sedentary lifestyle
• Obesity (which is directly linked with estrogen levels)
• Smoking
• High levels of emotional stress
• Other possible existing underlying diseases
• The use of hormone (replacement) therapy (estrogen or progesterone) — though this type of therapy can be medically prescribed for good reason

As for prevention, there is little to be actively done when it comes to preventing breast cancer from forming. However, preventive diagnostics can help patients who have an existing disease, to diagnose it in its earliest stages.

What types of examinations are there to identify breast cancer early?

The first step towards breast cancer diagnostics is self-examination. This method, although helpful, is said by many experts to be somewhat outdated, especially in the age of diagnostic imaging. Nevertheless, it remains a standard, because it is something that women can do virtually anytime and even in the comfort of their own home, and for free.

It is imperative for women to get to know their breasts, since the glandular tissue in a young woman may appear lumpy, although that is perfectly natural. The whole idea of self-examination is for a woman to feel if something is different compared to the last time they checked.

Ultrasound is a cheap technique that doesn’t produce ionizing radiation, so it can be repeated as often as needed without any consequences, and an experienced doctor can tell if a lesion is benign or not with a high level of certainty.

If a consensus can’t be reached, the patient is then advised to have a mammogram, which serves as a gold standard when it comes to breast diagnostics. A woman should undergo mammography examinations at least once in every two years, unless your doctor says otherwise.

If mammography results are unclear, the next step in diagnosis is a breast biopsy. A tissue sample is taken, and the lesion is examined directly under the microscope, after which the doctors will know exactly what’s happening, and take further steps if needed.

In what way are these breast cancer screening techniques helpful?

Preventive mammography screening is usually organized between the ages of 50 and 69. The exact age range is different in every country, and is dictated by the health system and the economic strength of each country. For example, in the USA, organized preventive mammography screenings when they are 40 years old. This is the underlying reason why organized screenings are performed in these age groups. Of course, nothing is stopping you from requesting this examination even at a younger age, especially if the doctor deems it necessary.

Ideally, this exam should be performed in the first few days after the end of a woman's menstrual period. Also, it’s important to know that breasts in young women still have a lot of glandular tissue, and therefore, mammography isn’t as effective as in older women, and an ultrasound exam is preferred.

The thing is, breasts in mature women have more fatty tissue, and in there, the doctor can see changes that are extremely small (called microcalcifications). This is the exact purpose of mammography, since these microcalcifications, which are an indirect sign of breast cancer, cannot be seen using an ultrasound, nor palpated during physical exams. The doctor will characterize this lesion regarding if it needs to immediately undergo biopsy, or send the patient home and set up a new appointment in six months or one year.

Basically, the idea behind mammography is to try and “catch” the lesion when it’s extremely small, and not to wait for it to grow to one centimeter or even more. If the size of the lesion is one centimeter, unless the cancer happens to be spreading extremely fast, this means that it has been growing there for about five years!

To make things worse, when the change is palpable, it is highly indicative that it measures even more than that. By the time the patient sees the doctor, nobody can know if the disease has potentially spread beyond that one lesion.

These screening examinations are safe, fast, noninvasive, and offer a high level of certainty. Although mammography uses ionizing radiation in the shape of X-rays, the amount of radiation received during the examination is roughly equal to the amount you'd be expoed to during a transcontinental flight, so in this case, the benefits greatly outweigh the risks. Therefore, if a malignant lesion is to be found in its early stages, the patient has a high chance of survival, and her quality of life won’t be diminished.

Why breast cancer screening should be on your radar, no matter who you are

We all know that people, unfortunately, have the tendency to think: “Oh, this won’t happen to me!”

Similarly, if a woman notices something is wrong with her breast during self-examination, instead of waiting for it to recover on its own, she should immediately schedule an appointment with her doctor.

In clinical practice, it is not uncommon for a woman to visit a doctor only after someone in her proximity succumbs to breast cancer. Unfortunately, this kind of behavior is understandable, since breast cancer is a hard thing to even think about, let along process. However, there is no room for panic, as almost every lesion that is diagnosed early in its development can be successfully treated.