BREAST CANCER EARLY DETECTION GUIDELINES

'Screening' is a systematic evaluation of a 'normal' individual to see if there is any underlying cancer. A 'normal' individual implies one who does not have any symptoms or signs of cancer. By now, if you have read the earlier two sections on early detection of breast cancer, you very well know how important it is to detect it early. There are various Screening Guidelines, for early detection of breast cancer. One of the most commonly accepted and followed, are the NCCN Guidelines . The following discussion elaborates on the NCCN Guidelines.

TERMS USED IN GUIDELINES

Before we list the guidelines, it is essential to understand a few terms used in the guidelines. They are as follows:

'Breast Awareness'

Breast Awareness implies familiarity with one's own breast. A self examination can be done monthly during bath, best time being just after the end of menses. This helps to keep in notice any irregularity, any lumps, the skin, the nipple etc. Also, breast awareness also includes a knowledge of breast cancer. A woman should be aware of what possible changes could occur in a breast when a cancers develops in the breast. If you haven't read it, please do read the 'Early Detection of Breast Cancer' section.

'Clinical Breast Examination' (CBE)

Clinical Breast Examination (CBE) implies a visit to a doctor, where the doctor makes a detailed evaluation of the patient's history and performs a body checkup including breast examination with an aim to detect any suspicious abnormality. A doctor, who is in touch with the subject and who has an experience in breast disorders may be able to pick up an early cancer even before it may manifest, as also may be able to appropriately rule out any cancer in a woman who may be having some breast symptom.

'Mammography'

Mammography is a special x ray of the breast performed in two directions, to show up any abnormal lumps located in the breast. Mammography can detect very small lumps which may not be felt by hand. However, mammography has a sensitivity of at most 60 to 70% and we strongly urge readers preferably not to undergo mammography on their own will; but only after consulting a doctor. Consulting a doctor is of utmost importance, since mammography may show a lot of nonspecific findings which can generate a lot of anxiety for no reason; and on the other hand, if something is diagnosed, then a doctor's guidance for further management will be of prime importance.

GUIDELINES BY AGE GROUP

Woman in 25 to 40 years of age, Normal risk

For a lady who is between 25 to 40 years of age and does not have any hereditary (familial) or other increased risk factors (see below) for breast cancer, the screening (early detection) guidelines are as follows:

Clinical Breast Examination (CBE): This must be done every 1 to 3 years. Every year may sound impractical, since the risk of breast cancer in this age group is relatively low, especially in the late twenties and early thirties, and a visit to a doctor just once every two to three years should not be a problem. But as a lady starts approaching near her forties, it is preferable to visit the doctor once a year.
Breast Awareness: Keeping in mind the symptoms of breast cancer, a lady must perform a regular self examination once a month, a few days after menses is over.

Woman more than 40 years of age, Normal risk

For a lady who is more than 40 years of age and does not have any hereditary (familial) or other increased risk factors (see below) for breast cancer, the screening (early detection) guidelines are as follows:

Breast Awareness: Keeping the symptoms of breast cancer in mind, a lady must perform a regular self examination once a month, a few days after menses is over. For post menopausal women, they can select one fixed date, or maybe week (for example, first week of every month), and do Self Examination regularly.
Annual Clinical Breast Examination (CBE): A yearly examination by a qualified and trained medical personnel is a must. As a lady touches late thirties, the risk of breast cancer starts rising. So now, the Clinical Examination is to be done once a year.
Mammography: Most guidelines recommned Mammography once a year. Screening mammography does not help much in women below around 40 years of age, as the density of breast tissue is much more and small tumors can be missed. After 40 to 45 years, the glandular tissue starts reducing and fatty tissue starts dominating, and mammography becomes more sensitive. It can be done once a year, but depending on breast density, it can be done once in two years as well. Hence, it is always recommended that one should do a Mammography after consulting your doc.

Woman, any age, Increased risk

For a woman who has an increased risk for breast cancer, the screening (early detection) guidelines are as follows:

Breast Awareness: Keeping the symptoms of breast cancer in mind, a lady must perform a regular self examination once a month, few days after menses or on a fixed date in post menopausal age group.
Annual Clinical Breast Examination (CBE): A yearly examination by a qualified and trained medical personnel is a must. In some very high risk cases, doctors may even advise a meeting two times in a year, between certain ages.
Mammography For women, who have received radiation therapy to the chest, a mammogram should be done annually after 25 years of age. For those with a family history of breast or ovarian cancer, annual mammogram should start by 35 years of age. For women belonging to proven breast and ovarian cancer families (genetically) or those who have multiple first or second degree relatives with breast or ovarian cancers (and some other related cancers, explained below), an annual mammogram must start much early, by around 25 years of age. For many familial cancer, doctors may not recommend a mammography at all (to avoid Radiation) and instead recommend an MRI
MRI of the breast: In the above high risk categories, an annual MRI of the breast is also recommended as an adjunct to mammogram.

Which women have an increased risk?

To explain in simple terms, following women have a higher than average risk of developing breast cancer:

Positive Family History: One or more family member (blood relation) has a history of breast or ovarian cancer. But each and every breast cancer patients' first degree relativew do not automatically become 'high risk' for breast cancer. Only some do. Let your doc decide.
Genetic Predisposition: One or more family member (blood relation) is known to harbour a 'genetic' abnormality causing breast cancer. This significantly increases the risk of developing a breast cancer
Previous Radiation Therapy to chest wall: If a woman has received radiation therpay to chest wall for any cause, she stands an increased risk of developing breast cancer
Risk of developing breast cancer can be calculated by various means, the commonest is based on the GAIL model, for women above 35 years of age. After this calculation, if the 5 year risk of developing a breast cancer is greater than 1.7%, the women is considered to be at an 'increased' risk of developing breast cancer and must follow the 'increased risk' guidelines. If the 5 year risk is less than 1.7%, the woman is considered to be at a 'normal' risk for breast cancer and may follow the 'normal risk' guidelines. Of cours,e let your doc decide this.

COMMON QUESTIONS RELATED TO SCREENING:

The above discussion was to guide on how to feel for a lump and how to lookout for a lump, so that, on regular breast examinations, one can lookout for such lumps, and if felt, consult a doctor. Following points must be kept in mind:

Who decides my risk (i.e. What risk do I stand, to develop breast cancer)
A doctor, of course; preferably someone who is trained in breast conditions, like a Surgical Oncologist, hwo handles breast cancers. Just because there maybe one family member having a history of breast or ovarian cancer, would not make one as a high risk candidate, a few other factors have to be considered. So it's best, you leave to a doctor, as to what your risk for developing a cancer is.

I am above 40. Should I just go and do mammography?
No, please don't do that directly. Mammography has its own pitfalls and it is very essential to read the report correctly, especially, since it is common to find small non cancerous conditions on mammography. If you do on your own and do not know how to read the report, it will be a source of immense anxiety. So it is best to consult your doc first, and let him or her prescribe the mammography for you. Doing a Mammography under medical guidance will make a lot of difference.

Which doctor should I go to, then?
If you can access a Surgical Oncologist, nothing like it. If not, you can always see a General Surgeon, should not be a problem, as most surgeons dela with breast lumps. If even a Surgeon is not available, you can go to your Family Doctor (Family Physician); most of them can very well guide you to a good Mammography centre and if need be, they will guide you to a Specialist (Surgical Oncologist) accordingly.

Standard Guidelines

Early Detection of Breast Cancer