Screening

Breast Cancer Screening

Early detection of breast cancer

The purpose of breast cancer screening tests is to detect a malignant neoplasm in women who have no symptoms of the disease and when the change in the breast cannot be felt. Neoplasms detected during screening are usually small and limited to the breast, and it is the size and extent of breast cancer that are the most important indicators of the prognosis.

For women at average risk, the method of choice for screening is mammography (In the Republic of Croatia, the national program for early detection of breast cancer has been implemented for women older than 50 since 2006).

Unfortunately, mammography is often not sufficient for early detection of breast cancer in all women, primarily taking into account the structure of the breast and the density of glandular tissue. Therefore, it is often necessary to do additional tests (ultrasound, magnetic resonance imaging) in order to remove doubts.

Magnetic resonance imaging (MRI) uses magnets and radio waves to create a breast image, and is used for screening in women at high risk for developing breast cancer. The American Cancer Society recommends that all women at high risk for developing breast cancer — those with a life risk greater than 20% — have mammograms and breast MRIs once a year. Such screening tests should begin at age 30 and continue as long as the woman is in good health. According to the recommendations of the American Cancer Society, high-risk women are:

  1. those having a known BRCA1 and BRCA2 gene mutation
  2. those that have not been genetically tested but have a proven BRCA1 and BRCA2 mutation in first-degree relatives (mother, father, brother, sister, or child).
  3. those in whom a life risk for the development of breast cancer of 20-25% or higher was statistically determined on the basis of family data
  4. those who had chest radiation due to some other malignancy (e.g. Hodgkin’s lymphoma) at the age of 10-30 years
  5. those who have genetic diseases such as Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or those syndromes have their first-degree relatives

In women with a moderate risk of developing breast cancer - those with a life risk of 15-20% - it is recommended that, in agreement with the doctor, in addition to regular annual mammograms, the examination includes magnetic resonance imaging. Moderate risk women are considered to be

  • those in whom a life risk for the development of breast cancer of 15-20% was statistically determined on the basis of family data
  • those with a personal history of breast cancer, in situ ductal carcinoma (DCIS), in situ lobular carcinoma, or atypical ductal and atypical lobular hyperplasia
  • those with extremely dense breasts or asymmetric glandular parenchyma density on mammograms

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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.