Breast cancer

Early Breast Cancer Detection

The goal of screening tests for breast cancer is to detect malignant neoplasm in women that don’t have any disease symptoms and when the breast change cannot be felt. Neoplasms discovered during screening tests are usually small and are limited to breast area. The size and the distribution of breast cancer are the most important indicators of the prognosis.

For women that have average disease risk the method of screening choice is mammography (In Croatia, starting from 2006, the national early cancer detection program is conducted for women over 50 years).

Unfortunately, mammography is often not enough for detecting early breast cancer stages in all cases, primarily taking the breast structure and the density of glandular tissue. That is why it is often important to do additional tests (ultrasound, MRI) to eliminate uncertainties.

MRI uses magnet and radio waves for breast imaging and is used for screening procedures in women with a high risk of developing breast cancer. American Cancer Society recommends that all women that have a high breast cancer risk (life risk that is more that 20%) do a mammography and breast MRI at least once a year. Women should start these screening tests at 30 years and continue as long they are in good health.

Considering the recommendations of American Cancer Society, women that have a high disease risk are:

1. Those that have known BRCA 1 and BRCA 2 genetic mutation

2. Those that are not genetically tested and whose first degree relative (mother, father, brother, sister or a child) has known BRCA 1 and BRCA 2 genetic mutation

3. Those that have a statistical life risk (20-25% or more) for developing breast cancer based on family data

4. Those that had chest radiation because of another malignant disease (e.g. Hodgkin’s lymphoma) between 10 and 30 years of life.

5. Those that have genetic diseases such as Li-Fraumeni Syndrome, Cowden Syndrome or Bannayan-Riley-Ruvalcaba Syndrome or if their first degree relatives have said syndromes.

For women with moderate risk of developing breast cancer – those with life risk between 15% and 20% it is recommended that, in agreement with a doctor, MRI procedures are included besides regular annual mammography.

Women that have a moderate disease risk are:

1. Those that have a statistical life risk (15-20%) for developing breast cancer based on family data

2. Those that have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia

3. Those that have extremely thick breasts or an asymmetrical glandular parenchyma on mammogram screenings.

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1. Oeffinger KC, Fontham ETH, et al. Breast Cancer Screening Recommendations for Women at Average Risk 2015 Guidline Update From the American Cancer Society. JAMA 2015; 314 (15):1599-1614.

2. Internet Citation: Final Update Summary: Breast Cancer: Screening. U.S. Preventive Services Task Force. September 2016.
 
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast- cancer-screening1

3. Warner E, Messersmith H, Causer P ,Eisen A, Shumak R, Plewes D. Magnetic Resonance Imaging Screening of Women at High Risk for Breast Cancer. Report for the Quality Initiative of the Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO) April 12, 2007.

Lehman C, Gatsonis C, Isaacs C, Pisano E, Ascher S, Weatherall P, et al. Cancer yield of mammography, MRI, and ultrasound in high risk women enrolled in a prospective multi institution breast cancer screening trial. 2004 ASCO Annual Meeting. 2004.