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Breast cancer screening
• Mammography is the most widely used screening modality, with solid
evidence of benefit for women aged 40 to 74 years
• Clinical breast examination and breast self-exam have also been
evaluated but are of uncertain benefit
• Technologies such as ultrasound, magnetic resonance imaging,
tomosynthesis, and molecular breast imaging are being evaluated,
usually as adjuncts to mammography
American Cancer Society Guidelines for the
Early Detection of breast Cancer
• Yearly mammograms are recommended starting at age 40 and
continuing for as long as a woman is in good health
• Clinical breast exam (CBE) about every 3 years for women in their 20s
and 30s and every year for women 40 and over
• Women should know how their breasts normally look and feel and
report any breast change promptly to their health care provider.
Breast self-exam (BSE) is an option for women starting in their 20s
• Some women – should be screened with MRI in addition to
mammograms
• The number of women who fall into this category is small: less than
2% of all the women in the US
Women at high risk
• This includes women with about a 20% or greater risk using risk
assessment tools based mainly on
1. family history
2. women who had radiation therapy to the chest between the ages
of 10 and 30 years
3. women who either have or who are at high risk for mutations in
certain genes( BRCA1 and BRCA2)
4. Certain genetic syndromes, such as Li-Fraumeni or Cowden
syndrome
Harms
• Overdiagnosis and Resulting Treatment of Insignificant Cancers
(follow-up of the long-term CNBSS and studies in the United States
and Scandinavia found that at least 20% of screen-detected breast
cancers are overdiagnosed)
• Although the specific plan of recommended treatment is typically
tailored to individual tumor characteristics, at this time there is no
reliable way to distinguish which cancer would never progress in an
individual patient; therefore, some treatment is nearly always
recommended
Harms
• Radiation-Induced Breast Cancer
• The breast dose associated with a typical two-view mammogram is
approximately 0/4 mSv (seivert)and extremely unlikely to cause
cancer. One Sv is equivalent to 200 mammograms. Latency is at least
8 years, and the increased risk is lifelong
• Theoretically, annual mammograms in women aged 40 to 80 years
may cause up to one breast cancer per 1,000 women