What you need to know regarding Breast Cancer Screening
What is Breast Cancer Screening?
Screening is the process of testing or checking for disease regularly before there are any signs and symptoms of the disease. The earlier the diagnosis of cancer is made, the better the treatment options available and ultimately aids in prognosis and survival. (1)
Why all the fuss?
In recent years breast cancer has quickly become the most prevalent cancer amongst women in Africa and globally. According to the American Institute for Cancer Research, when both male and females are taken into account, the incidence of breast cancer amongst both sexes is only slightly overtaken by lung cancer in the given year.
A brief history of breast cancer screening
Dr L Tabar compiled years of breast cancer studies and had his conclusive article written in November 2018. A nominal 55 000 women were evaluated between 1958 and 2015. This study showed that with annual screening from the age of 40, the ten-year survival rate of patients diagnosed with breast cancer would go up by a staggering 60%, while the 11 to 20-year survival rate will go up by 47%. (3) Conclusively, a great deal more breast cancer patients will be diagnosed, and the survival rate will be significantly higher when screening modalities are used. (3)
The ACR, American College of Radiology, now recommends annual screening for all women from the age of 40. This showed the best results in the screening criteria of early detection, good prognosis and ultimately increased life span. (4)
The South African guidelines
Currently, the Radiological Society of South Africa (RSSA) and Breast Imaging Society of South Africa (BISSA), recommend annual screening from 40 to 70 years of age, and regular self- and clinical examination.
The Cancer Association of South Africa (CANSA) published a fact sheet in April 2017. Their recommendation was annual mammography for women between 40 and 54 years of age, and bi-annual for women over 55 years. Provision of data concerning breast health as well as discussion with primary physicians is also recommended. (4)
What does early detection mean?
When talking about early detection of breast cancer, Ductal Carcinoma in Situ (DCIS), considered the earliest form of breast cancer, must be the topic of conversation. DCIS is the presence of abnormal cells inside the milk duct of the breast. DCIS is non-invasive, meaning there has been no spread to other ducts or other parts of the breast. (5)
Because of the non-invasive nature and early stage of this cancer, minimal treatment is usually required, and patients generally have a particularly good prognosis. This would be the aim of early detection.
Screening at your fingertips
Breast self-examination is an integral part of breast cancer screening and does not have to be a daunting task.
Here are three easy steps to follow
1. Look
- Stand in front of a mirror and look at,
- Shape
- Colouration
- Skin, dimpling or bulging
- Nipple changes, fluid coming out
- Redness, rash, swelling
- Repeat with a raised arm
2. Feel
- Lie down using the right hand for the left breast and left hand for right
- Use a flat hand, not fingertips
- Cover entire breast, from collarbone to top of abdomen and armpit to cleavage
- Follow your pattern, make sure not to miss anything, and make sure to feel under the nipple
3. Repeat
- Repeat the process while standing upright. (6)
The myths of screening
Radiation is harmful
FALSE
The radiation dose of a Mammogram, while not zero, is very low. You will get the same dose when flying abroad and will receive more background radiation each year.
The chance of developing breast cancer naturally is 1 in 8, while the likelihood of developing radiation-induced breast cancer is 1 in 10 000.
Mammography finds harmless cancers and misses important ones
FALSE
Mammography is the number one modality for picking up all types of breast cancer With the newest mammogram technology, 40% more cancers are found. When DCIS is found, minimally invasive treatment is necessary.
FALSE
Of all screened patients diagnosed with breast cancer, 20% are younger than age 50. The most aggressive cancers are found in patients younger than 50.
I am 75 or older, and I don’t need mammograms anymore
FALSE
Breast cancer can occur at any age. As we age, mutations in cells occur more frequently. Screening through mammography and ultrasound remains the only available tool to pick up these changes before cancer occurs or spreads.
I’ve had one normal Mammogram, and I don’t need another one
FALSE
Yearly mammography makes it possible for the Radiologist to pick up any changes that occur in the breast tissue. Often, the precursors of breast cancer are picked up because there are a series of breast images available for comparison.
Most cancers found on mammograms before they are palpable, they have a 95% cure rate.
What to expect at Keystone Radiology?
If this is your first Mammogram at Keystone, there will be a few simple forms to fill in before your procedure.
A qualified mammographer will take you through every step of your procedure.
You will be asked to remove all clothing from your upper body and given a cape to wear.
At least four different images of the breast will be taken, top to bottom and side views. This procedure can be somewhat uncomfortable for some patients, but should never be painful. You will get an Ultrasound of the breast after the Mammogram is completed, performed by a sonographer. After both procedures are done, the Radiologist will discuss your examination and findings with you as well as answer any questions that you may have.
What happens when we find a lesion?
Any abnormal findings and the implication thereof will be discussed with you immediately after the examination. If a breast biopsy is necessary, a booking will be made at one of our facilities and all the details and of the procedure will be explained to you on more than one occasion. The authorisation will be obtained by Keystone on your behalf and communicated to you.
My results came back positive, what now?
We will give you personal feedback on your results as soon as it is available. We will refer you to the best specialist for specific results. We make the appointment and walk you through the next steps. Our door will always remain open for follow up procedures as well as answering questions and lending emotional support.
Make a booking
- https://www.cdc.gov/cancer/dcpc/prevention/screening.htmhttps://www.wcrf.org/dietandcancer/cancer-trends/worldwide-cancer-data
- Tabar L et al, Cancer 2018, https//doi.org/10/1002/cncr.31840
- Lipschitz L, Screening mammography with special reference to guidelines in South Africa https://sajr.org.za/index.php/sajr/article/view/1370/2153
- https://www.mayoclinic.org/diseases-conditions/dcis/symptoms-causes/syc-20371889
- https://www.breastcancer.org/symptoms/testing/types/self_exam
- https://www.eizoglobal.com/solutions/casestudies/dr_linver/index.html