L24: Population Screening – Breast Flashcards
What are the breast cancer risk factors that you cannot control?
- genetic mutation
- chest wall radiation
- dense breast tissue
- Ashkenazi ancestry
- family history
- previous atypical cells
- early menstruation
- late menopause
- no children
What are the breast cancer risk factors that you can control?
- combined hormone therapy
- dietary – fat
- alcohol consumption
- lack of exercise
- smoking
- excess body weight
What are the most significant risk factors of breast cancer?
- being a woman
- growing older
Does breast cancer occur more in women with or without a family history?
without a family history
- 85% of breast cancers occur in women without a family history
- less than 15% of women who get breast cancer have a family member diagnosed with it
- woman’s risk of breast cancer nearly doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer
- among women diagnosed with breast cancer, dense breasts are more frequent than a family history
What are some of the signs of breast cancer?
- bump/lump (note: it is a myth that breast cancer always causes a lump you can feel)
- dimpling
- crust on nipple
- warmth or redness
- sores on skin
- thickening
- growing vein
- nipple discharge – spontaneous, bloody, or clear
- change in shape/size
- nipple retraction
- orange peel skin
Why is it important to detect breast cancer early?
early detection impacts survival
- stage 1: 99.8% five-year survival rate
- stage 4: 23.3% five-year survival rate
How do we screen for cancer?
- breast self-examination
- clinical breast examination
- mammography – 2D and 3D
- ultrasound – handheld or ABUS
- MRI (high risk patients)
- contrast-enhanced mammography
- molecular breast imaging
Describe the radiation risks from mammograms.
- radiation risks of breast cancer from mammogram is primarily in women less than 20 years old
- mammogram (4 pictures) – 0.4 mSv
- chest x-ray – 0.1 mSv
- dose from a mammogram is similar to the radiation that people are exposed to naturally over the course of about 7 weeks (or 3-4 weeks living in Colorado)
What were the findings of the Pan-Canadian study of mammography screening and mortality from breast cancer?
- data obtained on 2.8 million screening participants from 7 screening programs in Canada, representing 85% of the population
- women having mammograms are 40% less likely to die from breast cancer than those that do not have mammograms
- women aged 40-49 are 44% less likely to die
What is the Canadian Task Force on Preventive Health Care?
- make guidelines on screening for various cancers, high blood pressure, diabetes, hepatitis, aneurysms, postpartum depression, developmental delay in children, etc.
- no content experts (oncologist, radiologist, breast surgeon) are permitted on breast cancer screening guidelines panels
- ignore all modern observational research, and insist on using only 40-60-year old RCTs to assess the benefits of screening
- in their view, the ‘harms’ of screening outweigh the ‘benefits’
Experts degree with the Canadian Task Force on Preventive Health Care (CTFPHC).
- recommends against routine screening mammography in women aged 40 to 49 years
- recommends screening mammography every 2-3 years for women aged 50 to 74 years
- recommends against performing breast self-examination (BSE)
- recommends against performing clinical breast examination (CBE)
- recommends against supplemental screening for women with dense breasts
Who needs more than a mammogram?
- women at higher-than-average risk
- women at higher risk of interval cancer – have had breast cancer, have dense breasts, have genetic mutations, previous lymphoma, etc.
What is a dense breast?
higher proportion of breasts are made up of glandular tissue and fibrous tissue than fatty tissue
Describe dense breasts as a risk for breast cancer.
- dense breasts are an independent risk factor for cancer
- cancer is 5x more likely in women with the highest level of density, than in fatty breasts
- more prevalent risk than having a mother/sister with breast cancer
- increase the risk of interval cancer
- increase the likelihood of a recall from screening
What are the pros of contrast-enhanced breast MRIs?
- highest cancer detection – 10-16/1000 1st round
- no ionizing radiation
- reduced interval cancers
- reduced late-stage disease
