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  health > cancer > story page AIDSAlternative MedicineCancerDiet & FitnessHeartMenSeniorsWomen

Breast cancer detection: Upping your odds for survival

May 25, 1999
Web posted at: 10:27 AM EDT (1427 GMT)

In this story:

Know your own body

The case against BSEs

The importance of a clinical exam

Regular mammograms are a woman's best friend

The great divide

The consensus

New help for dense breasts


By Tula Karras

(WebMD) -- Breast cancer is the number one diagnosed cancer in women in the United States. And although there are known risks that can predispose certain women to developing the disease (such as a family history), 75 percent of women who are diagnosed with breast cancer have no known risk factors.

Know your own body

Your first line of defense is to do a monthly breast self-examination (BSE). In fact, 55 percent of cancers can be found by the woman herself. A lifetime of self-examination will alert you to even the most subtle changes, all of which should be reported to your doctor.

The case against BSEs

In 1997, a study appeared in the Journal of the National Cancer Institute suggesting that BSEs did not improve the death rate for women with breast cancer. The researchers, however, were quick to point out that their findings were preliminary and that BSEs may be effective when looking at periods of longer than five years. Most doctors feel that until more research is done, women should continue to conduct BSEs once a month.

The importance of a clinical exam

As knowledgeable as you can become about your own breasts, a doctor or nurse has the advantage of having performed hundreds of clinical exams on different women with a number of special concerns, such as fibrocystic breasts, and can often distinguish between a lump that is benign and one that needs a closer look. A trained health-care professional can find 65 to 75 percent of cancers during a clinical exam.

The American Cancer Society advises that women should have a clinical breast exam once a year, beginning at age 40. The exam is usually performed at the same time as a gynecological exam or Pap smear and/or a mammogram.

Regular mammograms are a woman's best friend

Mammograms, a low-dose X-ray of the breast, can detect up to 85 percent of cancers, some of which are too small to be felt, and some of which are actually in a precancerous stage. Digital mammography, computerized images that can detect cancers with greater accuracy than traditional X-ray mammography, is the next big step in breast cancer screening and should be widely available within the next several years.

The great divide

There is controversy over whether women in their 40s should receive mammograms annually or every couple of years. Part of the reason for the disagreement is that some studies have shown no survival benefit to getting annual mammograms before age 50. Also, there is a higher rate of false positives (lumps that are biopsied but found to be benign) in women under 50. Ultimately, it's up to you and your doctor to decide, depending on your risk factors, how often you should get mammograms in your 40s.

The consensus

All experts agree that after age 50, annual mammograms save lives. Seventy-five percent of all cancers are found in women age 50 and over, partly because the cancers have developed to detectable sizes and partly because mammograms are more accurate when done on older women, whose breast tissue is more fatty and produces clearer mammograms.

New help for dense breasts

A study presented at a 1998 meeting of the Radiological Society of North America found that combining a mammogram with an ultrasound test increased breast cancer detection from 70 percent to 94 percent in women with very dense breast tissue. Ultrasound, which uses high-frequency sound waves, is sometimes used as a follow-up when a mammogram reveals something suspicious.

A new imaging technique - technetium tetrofosmin scintimammography (Tc-99 tetrofosmin) - has also been found to help diagnose cancer in women with dense breasts. Tc-99 tetrofosmin was approved for diagnosis by the Federal Drug Administration in early 1999. A recent study from Boston Medical Center found that Tc-99 tetrofosmin can accurately distinguish a cancerous lump from a benign lump nearly 90 percent of the time.

Magnetic resonance imaging (MRI) has also been found to help detect a certain cancer, invasive lobular carcinoma, which is nearly impossible to pick up with mammography. A recent study from the University of Pennsylvania, in Philadelphia, found that MRI accurately detected cancer in 25 out of 28 women with invasive lobular carcinoma; in sharp contrast, mammography was only able to detect the cancer in one woman.

All of these techniques need more research before they become part of the national detection and screening guidelines currently in place by the American Cancer Society and National Cancer Institute.

Copyright 1999 by WebMD, Inc. All rights reserved.

Examining the Breasts
Detection and Diagnosis
American Cancer Society Statement on Screening Guidelines

American Medical Association
Listing of FDA Certified Mammography Facilities
Susan Komen Breast Cancer Foundation
American Cancer Society
Message Board: Breast Cancer: Open Discussion
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