This article by Paul Baron, MD, a breast surgeon with Roper St. Francis Physician Partners, gives us insight into the latest news of diagnosing breast cancer and trends to be aware of.
It used to be that during Breast Cancer Awareness month you’d see flyers and pamphlets illustrating how to properly perform a breast self-exam. You can probably even picture the drawing in your head (one line depicting an arm over her head, a hand circling the opposite breast…).
While it certainly does not hurt to perform self-exams, we are less convinced these days that self-exams are significant in helping detect breast cancer. It’s common for me to see many women in my office who are shocked to discover they have breast cancer because they never felt a lump and have no family history of the disease.
Our most effective tool for diagnosing breast cancer early, when we can best treat it and improve survival rates, is through mammography. Mammography screening gives us X-ray images of breast tissue, and now with highly advanced imaging technology, including 3D mammography, we can find early cancers that are tiny and would perhaps not be felt during a self-exam. This advanced technology helps us detect small invasive cancers that we would not find on a traditional mammogram.
The advantage of finding breast cancer early is that patients are more likely to be treated by lumpectomy and not require a full mastectomy. Often a lumpectomy alone is sufficient and a patient may not need chemotherapy, which is great news in terms of overall wellness and quality of life.
The other recent trend in treatment is to not base it on the size and stage of the tumor, but rather we determine how to best treat a specific cancer based on evaluation of the tumor’s biomarkers. This means that a suspicious breast tumor is biopsied and sent to pathology to tell us whether its receptors are estrogen positive or negative, progesterone positive or negative, and what the Her2 status is. We know what drugs are most effective in treating the cancer based on these markers. The other recent breakthrough is from the MINDACT study which found that the molecular classification of a tumor based on its Mammaprint analysis can be more important to determining how to treat a patient than even the clinical features and biomarkers. This new finding may enable many women to avoid chemotherapy who may have been recommended it in the past.
In essence, today we consider the biology of the cancer to be more important in helping us determine the most effective treatment plan than the size or stage of the tumor. And because mammography helps us find hard-to-treat invasive cancers earlier than ever and we have tailored treatment plans for different tumor types, we are finding that a significant number of breast cancer patients, who formerly would have been chemotherapy candidates, no longer need it, which is great news.
So what are the most current mammography recommendations? This can become confusing because the guidelines seem to frequently shift regarding who needs a mammogram and how often.
Following careful consideration of multiple existing national guidelines, the RSF Breast Care team recommends the following breast cancer screening schedule for women of average risk for breast cancer and who have not been diagnosed personally with breast cancer:
• Annual screening mammography starting at age 40 and continuing through age 70
• Continuation of annual mammography after age 70 for those patients whose life expectancy is at least ten years
• Annual clinical breast exam
• Discuss risk of breast cancer screening’s false positive and false negative results with healthcare provider ordering the screening.
Most importantly, know your family history, talk with your doctor about what screening makes sense for you, and follow the basic cancer prevention recommendations: eat a healthy balanced diet, exercise regularly, and don’t smoke. By all means still perform a self-breast exam, but don’t rely on that alone. Mammography saves lives!
By Paul Baron, MD, a breast surgeon with Roper St. Francis Physician Partners