What and When and How of Mammography and breast cancer detection

Vinitha was clearly worried and said” I want a mammogram! My friend Shirin has been diagnosed with breast cancer.”

What is the best way to diagnose or detect early breast cancer?

 Many are advised or want a mammogram for early detection of breast cancer.   I will talk about mammogram, its usefulness and limitations and who should actually do a mammogram.

First I will take you to the mammography room to see how its done. Our team has made a video for you.

  http://youtu.be/qmqRyJoIzW8

The most diagnostic feature is the little small white spots you see, specs of calcium deposits in the tiny tumor. 

Who should do a mammography?

The American Cancer Society recommends mammogram every year for women between 40 – 70 years. Recently the  U.S. Preventive Services Task Force (USPSTF)  recommended  sweeping changes in its breast cancer screening guidelines for those who are not high risk population like most women. Similar policy is adopted in UK and Australia

  • Routine screening of average-risk women should begin at age 50, instead of age 40.
  • Routine screening should end at age 74.
  • Women should get screening mammograms every two years instead of every year.

High risk population are those who already had breast cancer one side or if there is a strong family history like mother and sister having breast cancer and they  need more intense screening.

Women who do not have any children, and perhaps have not breast fed an infant, should be more careful.

Is Breast self examination useful?

 One of the useful techniques is breast   examination.  Thanks to illustrations in magazines, many women now in urban areas pick up very small lumps as their fingers can know which are the abnormal little hard lumps in the breast.

Even BSE has to be done properly and here’s the right way to do. It need not be done every month and can be done say once in 4 months.

http://www.medindia.net/animation/breast_self_examination.asp

Not all lumps are malignant.  In fact most of the lumps in the breast are benign.  Now, a typical benign lump would be something that is painful, tender and the breasts become heavy before periods and the lumps also become less distinct. 

Breast Cancer on the other hand is a painless, small firm nodule like a little buried pea. Firm nodules can also occur in young age, say around 15-20 years, are called fibroadenomas that  typically move around in the breast and they are benign.

Should the Mammogram be followed by breast clinical examination? 

The problems with mammogram are the false positives, if indeterminate lumps are there; biopsies have to be done to rule out malignancy. It is also produces significant scare and anxiety for women.  Breast examination by a clinician can clarify if you pick up a lump on self examination. 

MRI and Ultrasonography of breast

If there is a doubt on mammogram, MR of the breast is the next, a more sophisticated and of course a more expensive investigation and can give a clear picture on those lesions which are doubtful.  Otherwise a routine  ultrasonography of the breast is also good enough. 

What is BIRADS score?

The mammogram report will have a BIRADS score as below

Breast Imaging, Reporting & Data System (BI-RADS)

BI-RADS scores range from 0 to 6:
 
0: This score identifies a mammogram study that is still incomplete. The X-ray may have been cloudy, making it difficult to read the images

1: This score is good news! It means that your mammogram is negative

2: This score also means that your mammogram is normal, with no apparent cancer, but that other findings (such as cysts) are described in the report.

3: Now we are entering a gray zone. A BI-RADS score of 3 means that your mammogram is probably normal. You’ll be asked to follow-up with a repeat mammogram in six months. And if you have a family or personal history of breast cancer, the radiologist may opt to do more tests now rather than wait.

4: This score means that the findings on your mammogram are suspicious and that there is an approximately 20 percent to 35 percent chance that a breast cancer is present. To make a diagnosis, the doctors will need to perform a biopsy to get a small tissue sample.

5: This score means that your mammogram results are highly suspicious, with a 95 percent chance of breast cancer. You will need to have a biopsy for diagnosis.

6: This means that you have already been diagnosed with breast cancer and the pathologist has confirmed the diagnosis.

 

If a mammogram is suspicious BIRAD 4-5, then a fine needle biopsy can be done under sono guidance or the suspicious area removed after localization with a small wire and subjected to pathological examination. Once again there is no need to panic.  It is a small procedure and gives a definitive answer in a couple of days.

What we have seen in many women, in fact, is that a lump also is neglected till it becomes hard and gets fixed.  This is what we should avoid at any cost.

 A lady’s health is the most important and it is the responsibility of the whole family to take care of the lady of the house.

We salute all women for all the sacrifices.  Please do not sacrifice your health.

Start Breast self examination at 30

Screening mammography at 50 every 2 years

Breast clinical examination  if mammo or BSE abnormal  from 50 onwards

High risk population starts a decade earlier

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