Breast Cancer Screening is the clinical examination and investigations which are done in women with high risk and without any signs and symptoms, so that the disease can be diagnosed at an early stage. Diagnostics differs from Screening as it is done in females with symptoms of breast cancer.

The components of Breast cancer screening

• Breast awareness
• Risk assessment
• Clinical examination
• Screening Mammogram
• Breast MRI if required
• Breast USG is not routinely advised and it is not recommended as screening procedure

The Increased Risk Category for Breast Cancer:

• Women who have received therapeutic thoracic radiation /Mantle Radiation (For Hodgkins Disease)
• Women of 35years or older with a 5yr risk of invasive Breast Carcinoma >1.5% (The risk assessment tool: http://www.cancer.gov/bcrisktool/Default.aspx)
• Family History Of Breast and Ovary Cancer (Increased Lifetime risk of >20%)
• Women with Lobular carcinoma in situ
• Previous history of Breast Cancer

American Cancer Society Guidelines for the Early Detection of Breast Cancer

• Yearly mammograms are recommended starting at age of 40 and continuing for as long
  as a woman is in good health
• Clinical  breast exam (CBE) about every 3 years for women in their 20s and 30s and
  every year for women of and over 40yrs.
• Women  should know how their breasts normally look and feel and report any breast
  change promptly to their health care provider.
•  For women younger than 40 years, monthly breast self-examination (BSE) and clinical breast exams every 3 years has been recommended, beginning at age 20 years

Screening mammogram

Mammography is a technique used to see the detailed image of breast in order to detect breast lump at its earliest stage. It uses Low dose X-ray. Mammo can detect microcalcifications smaller than 100microns and thus it can detect lesions before the mass can be palpable.

Mammography can be

• Screening : Done in Asymptomatic Women
• Diagnostic: Done in Symptomatic Women (Breast Lump, Nipple Discharge etc)

It can locate the exact size and location of the tumor. The American college of radiology (ACR)has established the Breast Imaging Reporting and Data System (BIRADS) to have a common standardization of interpretation among radiologists. It actually is categorization of patient’s risk of malignancy and also recommends a specific course of action.

Limitations of mammogram:

• Low sensitivity and specificity ( Chance of getting high False Positive and False Negative)

• False-positive results may arise when benign microcalcifications are regarded as malignant
• Local parenchymal distortion may be called as malignant.
• Benign circumscribed lesion may show signs of Malignancy
• Sensitivity is very low in dense breast (where the risk of breast cancer is high)
• Uses low ionizing radiation which may be harmful to the patient.

The Benefits of mammogram outweigh the risks and inconveniences.

 mammogram in women with Breast Implants:

Women with breasts augmented by implants may be a special challenge.

MRI is useful for detecting breast cancer and differentiating it from implant rupture

Breast Cancer Awareness Month (BCAM) is an annual international health campaign organized by many Government and NGOs, observed in and around the world in the month of october to increase awareness of breast cancer and to raise funds for research into cause,prevention, diagnosis, treatment and cure of breast cancer. This campaign is also used to offer information and support to the breast cancer survivors. This is an opportunity to make the people aware about breast cancer, its symptoms and signs so that it will help women to detect cancer in breast in the earliest stage.

Breast cancer can be detected early with education and awareness. In my view the imaging and examination should be done after proper explanation and counseling of the patient. I would like to include lifestyle changes, diet recommendations and better risk assessment with the imaging as per the guidelines for early detection of breast cancer. As “prevention is better than cure” my aim is to educate people so that I don’t have to inform my patients   “you have breast cancer”

Refferences

1. ^ Official National Breast
   Cancer Awareness Month (NBCAM) Frequenlty Asked Questions
2. http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer
3. http://www.acog.org/from_home/Misc/uspstfInterpretation.cfm