A screening tool that has long been recommended is now having its effectiveness challenged, but a local healthcare professional affirms its lifesaving potential and promotes its continuation.
A recently published article based on a study claiming that evidence fails to support benefits from breast self-exam (BSE) should not stop women from following established guidelines for practicing this screening tool, cautions Dr. Robert Schmidt, a radiologist with Central Illinois Radiological Associates and OSF Saint Francis Susan G. Komen Breast Center.
“Breast self-exam is a very helpful part of the screening process and has found cancers earlier for a better outcome from treatment,” said Dr. Schmidt, who is fellowship-trained in breast imaging. “We’ve seen many patients who have found a lump that was not detected on a mammogram.
“Mammography is not a perfect exam. It is one of the main tools for breast cancer screening, detecting somewhere between 75 and 90 percent of cancers. But that means that 10 to 25 percent of cancers are not seen on mammography.”
Limitations in the instrumentality make it difficult for certain areas of the breast to be imaged well enough through mammography to detect some abnormalities, according to Dr. Schmidt. Furthermore, lobular breast cancer sometimes insinuates itself as breast tissue and doesn’t form a distinct mass that can be seen on a mammogram. Mammography also is less sensitive in cases of extremely dense breast tissue.
“Mammography is still very important because several things are still only going to be seen on the mammogram,” Dr. Schmidt said. “These include calcifications in the breast tissue and changes in the breast tissue from mammogram to mammogram.”
The combination of BSE and mammography is the best formula for early detection of breast cancer.
The American Cancer Society recommends that women start performing monthly breast self-exams at age 20. In doing so, women become familiar with how their breasts normally feel and sensitive to any abnormalities, which should be reported to their physician. Between the ages of 20 and 40, women should undergo a clinical breast exam by their physician every three years. An annual clinical breast exam and mammogram are recommended starting at age 40.
The general age guideline for mammography differs for women at a higher risk of developing breast cancer, according to the expert. “For women who have a first-degree relative—mother, father, brother or sister—diagnosed with breast cancer before age 50, we recommend screening mammograms 10 years before the age the relative was diagnosed,” Dr. Schmidt advised.
Different screening guidelines and tools apply to women who are at very high risk for breast cancer, according to Dr. Schmidt. “The American College of Radiology came out with recommendations for screening MRI in 2007,” he said. “These recommendations pertain to a very small percentage of women.”
Included in the very-high-risk group of women who should have a screening MRI are those:
- With a genetic marker that puts them at 80 percent risk of having breast cancer.
- Who have a rare syndrome that increases their risk for several cancers, including breast cancer.
- Who meet certain criteria based on a risk model that includes such factors as age, race, number of first-degree relatives with a history of breast cancer and number of breast biopsies.
- Who had chest radiation for lymphoma as teenagers.
Dr. Schmidt points out that breast self-exam, mammography and screening MRI share a common objective: detecting breast cancer at its earliest stage. “We want to find breast cancer at as early a stage as possible in order to have better outcomes from treatment, better survival and better quality of life. iBi
