Screening Guidelines for Early Detection of Cancer of the Breast

1. The National Cancer Institute recommends that women begin receiving screening mammograms every 1 to 2 years starting at 40 years of age and every year once they reach 50 years of age, continuing for as long as a woman is in good health. Screening mammography involves taking low-dose radiographs from two views of each breast, typically from above (craniocaudal view) and from an oblique or angled position (mediolateral-oblique view). Mammography can detect approximately 85% of breast cancers. If the mammogram indicates an abnormality, the woman will most likely be urged to undergo further breast imaging (i.e., with spot-view mammogra-phy, ultrasonography, or other imaging tests). If further imaging confirms or reveals an abnormality, the woman may be referred for a biopsy to determine whether she has breast cancer. Screening mammography can miss 10% to 15% of breast cancers. These tumors can be missed (1) if the tumor is very small;(2) if the tumor is in an area not easily imaged (e.g., in the axilla);or (3) if the tumor is obscured by other shadows.

2. A clinical breast examination should be part of a periodic health examination, about every 3 years for women in their 20s and 30s and every year for women 40 years of age and older.

3. Women should know how their breasts normally feel. They should report any changes immediately to their health-care provider. Breast self-examination should be taught to women in their 20s.

4. Women at increased risk (e.g., family history, genetic tendency, past history of breast cancer) should speak to their health-care provider about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g., breast ultrasonography, magnetic resonance imaging), or having more frequent examinations.

Table 16-2. Differentiation of Breast Masses

Characteristic

Cystic Disease

Benign Adenoma

Malignant Tumor

Patient age

25-60 years

10-55 years

25-85 years

Number

One or more

One

One

Shape

Round

Round

Irregular

Consistency

Elastic, soft to hard

Firm

Stony hard

Delimitation

Well delimited

Well delimited

Poorly delimited

Mobility

Mobile

Mobile

Fixed

Tenderness

Present

Absent

Absent

Skin retraction

Absent

Absent

Present

Table 16-3. Characteristics of Breast Masses Suspect for Cancer

Characteristic

Sensitivity (%) Specificity* (%)

Fixed mass

40 90

Poorly delimited mass

60 90

Hard mass

62 90

*Based on the assumption that nonmalignant breast masses have benign characteristics. Data from Venet L, Strax P, Venet W, et al: Adequacies and inadequacies of breast examination by physicians in mass screening. Cancer 28:1546, 1971.

Useful Vocabulary

Listed here are the specific roots that are important for understanding the terminology related to breast disease.

Root

Pertaining to

Example

Definition

gyne(co)-

woman

gynecomastia

Excessive development of the male breast

lact(o)-

milk

lactation

Secretion of milk

mammo-

breast

mammography

Radiographic visualization of the breast

mast(o)-

breast

mastitis

Inflammation of the breast

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