Breast cancer

mammogram screening guidelines

MAMMOGRAM SCREENING GUIDELINES

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In one of our previous articles, we wrote that mammography (MMG) is a screening diagnostic method for breast cancer. Today, we would like to expand on this topic and have invited a specialized specialist to share information about MMG and the current mammogram screening guidelines being used. This article was written by Y. Timovskaya, Ph.D., doctor oncologist of the highest category, Member of ESMO with the help of A Galishyna, head of the diagnostic department of the Specialized Breast Center, a doctor of radiation diagnostics, member of ESR, EUSOBI. This article was last modified on 10 August 2021. It has been proven that regular examinations increase the rate of early detection of breast cancer. 👉 But are all examination methods (examination, mammography, ultrasound) equally effective for the early detection of breast cancer?👉 And how often should they be applied: annually, every six months, or are there other options? Today we will deal with these issues. Early Diagnosis of Breast Cancer For early detection of breast cancer, especially preclinical forms, the effectiveness of mammography (MMG) and magnetic resonance imaging (MRI) of the mammary glands with contrast enhancement has been proven. Ultrasound examination of the mammary glands is a useful addition to them. When choosing a diagnostic method, there is no universal approach that would suit everyone. The results of breast cancer treatment directly depend on the stage at which the treatment of this disease is started. The smaller the stage, the shorter, cheaper, and more effective the treatment. Therefore, the whole world is fighting to identify the early, if possible, preclinical stages of breast cancer (we wrote about what clinical breast cancer is in a separate article). IN THIS ARTICLE 1 Early Diagnosis of Breast Cancer 2 Ultrasound breast screening and Mammogram: definition 3 How to Choose Diagnostic Methods 4 Mammogram vs Ultrasound 5 Mammogram screening guidelines 6 What you need to tell the doctor to determine the research method At the same time, it is necessary to take into account the patient’s age, complaints, anamnesis, clinical examination data, and the results of previous medical tests. Ultrasound Breast Screening and Mammogram: definition ✔ Mammography (MMG) is an X-ray method for breast examination, which is the gold standard for diagnosing breast cancer. It perfectly detects microcalcifications, one of the early signs of breast cancer. The most important thing when using MMG is the fact that even standard views allow you to visually assess the full volume of an organ. ✔ Ultrasound – ultrasound examination of breast tissue, an additional diagnostic method. Suitable for patients with increased density of breast tissue (women under 35-40 years old). Therefore, it may be more appropriate for patients under 35-40 years of age to have an ultrasound scan rather than mammography (MMG). It is also the best method for fragmentary assessment of breast tissue. It is also used for the differential diagnosis of some formations. These, for example, include formations with a clear outline, identified on mammography. Each of these methods has advantages and disadvantages. There are no absolute contraindications to their implementation. How to Choose Diagnostic Methods As we wrote above, each clinical case requires an individual approach in the selection and examination sequence. So, for example, if a patient has complaints, her examination is diagnostic in nature. In this case, the doctor’s task is to choose the most appropriate diagnostic method. The aim will be to find out the reason for the complaints, the nature of the process, and the extent to which it has spread. It’s worth saying that a multimodal approach is often used. In such cases, a combination of several methods is used (MMG + ultrasound, MMG + MRI, using interventional techniques). It is also important to note that doctors sometimes need to apply special techniques within the same research method. For example, in the case of MMG, these are spot view, magnification view(s), Cleopatra’s view, etc. But in any case, the doctor is responsible to choose the appropriate diagnostic methods and techniques. Therefore, it is very important to contact specialists who can use the entire arsenal of diagnostic methods. Is it possible to avoid examinations if there are no complaints from the breast? The American Society of Breast Surgeons says that all women over the age of 25 must have a formal breast cancer risk assessment. You can do it yourself, or go through the risk assessment according to the NCCN guidelines in Healsens (below there will be links to download the app). After such an assessment is made, categories of patients without complaints should undergo screening. If a woman is not at risk, then such examinations can be started from the age of 40+. But we’ll talk more about mammogram screening guidelines below. If the risk of breast cancer is above average, then annual screening mammograms should be started at an earlier age, and in addition to mammography, additional examinations may be required. Mammogram vs Ultrasound It is worth pointing out what the limitations are for each diagnostic method. Thus, it will become more obvious what is decisive when choosing a diagnostic method. So, for ultrasound, the following limits are distinguished: Since ultrasound assesses the gland tissue fragmentarily, section by section, for patients with large breast sizes, this method is also not very suitable. This is due to the fact that there is a high risk of missing small formations. Mammography is not recommended without direct indications (suspected cancer) during pregnancy and lactation. In addition, in young patients, the diagnostic value of MMG decreases. This is due to the fact that young women have a higher density of breast tissue. And finally, we add that MMG is also ineffective in the presence of inflammatory diseases of the mammary glands. Mammogram screening guidelines At the moment, medical guidelines aim for an individualized approach, taking into account personal risks. Generally, the higher the risk of breast cancer, the earlier and more often screenings are recommended. So, for example, the American Cancer Society divides women into risk groups. For Women at Increased Risk of Breast

screening mammography

WHAT IS A SCREENING MAMMOGRAM?

WHAT IS A SCREENING MAMMOGRAM? Read More »

Since our goal is disease prevention and early diagnosis, we talk about screenings a lot. This time, as we continue the topic of breast cancer prevention we will discuss what a screening mammogram is? Written by Y. Timovskaya, Ph.D., doctor oncologist of the highest category, Member of ESMO.  Diagnostic or Screening Mammogram? So what is screening? According to Wikipedia, screening (“selection, sorting”) can mean – a system of primary examination of groups of clinically asymptomatic individuals in order to identify causes of disease. But in order to accurately capture the subtleties of this definition, we will take a couple of examples. IN THIS ARTICLE 1 Diagnostic or Screening Mammogram? 2 What is screening for? 3 Breast cancer screening mammography RELATED ARTICLES So, a 45-year-old patient comes to the doctor and complains of mammary gland pain. The doctor examines her, does not find any pathology, but gives her a referral for mammography. Here’s another situation: the patient comes to the doctor and complains of a chronic gastritis exacerbation. The doctor, in addition to giving recommendations for the gastritis treatment, recommends undergoing mammography. What does it have to do with screening? Screening is done to detect serious diseases such as cancer and breast cancer (BC) in particular. Both patients have no breast cancer symptoms. Both were advised to undergo mammography. However, in the first case, the patient complained about breast pain, and in the second case, she didn’t. Therefore, in the first case, it will be a diagnostic mammogram. In the second case – screening mammogram. Globally, there is no difference, both patients will undergo mammography. Another thing is important here. In the first case, the patient came with mammary gland complaints, which indicates the necessity of examination. In the second case, the doctor took the initiative and recommended a mammogram. Unfortunately, while situations described in the first case are numerous, those described in the second case are few. Doctors often forget about this important examination method. Mammograms are scheduled only in those cases when patients have breast complaints. Therefore, we consider it expedient to inform healthy women to require mammography tests when visiting their doctors. In our further articles, we will return to the world recommendations on how often and to whom it is recommended to undergo screening mammography. What is screening for? But what is screening for? What does it give us and why is mammography screening performed all over the world? Unfortunately, the incidence of breast cancer is constantly increasing. There are many reasons. We cannot influence the incidence rate. Long-term results of breast cancer treatment directly depend on the stage at which treatment started. The smaller the stage, the shorter, cheaper, and more effective the treatment. Therefore, the whole world is fighting to identify the early, if possible preclinical stages of breast cancer. Thus, mammography is the main assistant in identifying breast cancer at its early stages. Let’s look at some examples again. Breast cancer screening mammography During self-examination (when women regularly check the condition of their glands), the average size of detected tumors is more than 2 cm. Rarely, only in cases where the tumor is actually located on the gland surface, subcutaneously, the patient has a chance to find this tumor measuring 1.2-1.5 cm. In all other cases, unfortunately, it is virtually impossible to identify a small tumor on your own. Therefore, self-examination, as a method for early detection of breast cancer, is not included in international recommendations for patients. Furthermore, breast ultrasound is a favorite method for patients. But, alas, the method is not suitable for breast cancer screening. First, ultrasound can detect tumors in the mammary glands if the tumors are larger than 8 mm. Secondly, the incidence of breast cancer is higher in older age groups. Besides, the value of ultrasound as a diagnostic method decreases with age and with increased size of the gland. For this and other reasons, the ultrasound diagnostic method is not a screening method. It should be noted however that ultrasound has many advantages. We will talk about it separately. But only mammography can be used as the main method of breast cancer screening. During mammography, a tumor of 3 mm or more can be detected. It’s also possible to detect signs of non-invasive breast cancer in the form of microcalcification, as well as precancerous pathology. We wrote about the clinical forms of breast cancer separately. For patients with breast cancer and those treated for breast cancer, routine annual MMGs are performed. It’s important for the early detection of relapses and contralateral cancers. My wish to everyone is that all examinations would only be screenings confirming that we are healthy.

breast cancer risk factors

THE MAIN RISK FACTORS OF BREAST CANCER

THE MAIN RISK FACTORS OF BREAST CANCER Read More »

1 in 8 women will develop breast cancer (BC) in their lifetime. More than 2 million new cases of this disease are diagnosed worldwide every year. There are of course breast cancer risk factors. What do you need to know to prevent illness? Is it possible to reduce your own risk of developing breast cancer? Let’s find out. Written by Y. Timovskaya, Ph.D., doctor oncologist of the highest category, Member of ESMO. Together with @ Galishina Anna – Head of the Diagnostic Department of the Specialized Breast Center, doctor of radiation diagnostics of the highest category, member of ESR, EUSOBI. 8 major risk factors It’s possible to conditionally identify the main factors in the development of breast cancer. There are only 8 of them! Of course, in general, there are many more risks and we have already written about some little-known ones. But the most significant are the following: IN THIS ARTICLE 1 8 major risk factors 2 New risks 3 Why understand your risk factors? 4 Variable and permanent breast cancer risk factors 5 Patient stories RELATED ARTICLES 6. Hyperestrogenemia (increased concentration of estrogens in the blood), especially associated with the intake of hormonal drugs. And these are combined oral contraceptives (COCs), and hormone replacement therapy (HRT), and IVF. 7. Failure to comply with the healthy lifestyle rules, which leads to metabolic disorders. 8. Not having children or lactation or late childbirth. New risks In addition to the main risks, there are few that we are able to influence. They include: 👉 Low level of vitamin D. Research suggests that women with low levels of vitamin D have a higher risk of breast cancer. This happens because vitamin D may play a role in controlling normal breast cell growth and may be able to stop breast cancer cells from growing. 👉Exposure to Chemicals in Cosmetics So, research strongly suggests that at certain exposure levels, some of the chemicals in cosmetics may contribute to the development of cancer in people. Such substances include parabens (the most common are methylparaben, propylparaben, ethylparaben and butylparaben) and phthalates. 👉Exposure to Chemicals in Food There’s a real concern that pesticides, antibiotics, and hormones used on crops and livestock may cause health problems in people, including an increase in breast cancer risk. Now let’s talk about why we need all this information and what is the practical use of it? Why understand your risk factors? Do all factors in the breast cancer development lead to the development of breast cancer? No. Did all breast cancer patients have all these risk factors? No either. At the same time, a combination of risk factors increases the risk of developing breast cancer. However, it is not yet possible to determine exactly which of 8 women will develop the disease. Yet doctors talk about the importance of understanding risk factors. But why? There are situations when a woman has all the risk factors, and at the same time, she will never get sick with this disease. On the other hand, there are diametrically opposite situations when a woman does not have any risk factors except the first one, and she still gets breast cancer. However, such situations are marginal. They are located at the edges of the variation row for breast cancer patients. In most cases, that is in 80% of patients with breast cancer, known risk factors played a role in the disease development. Thus, women very often unconsciously provoked progressing tumor processes through their actions. And a major part of the cause of this problem was ignorance. In other words, many people have never heard of risk factors that subsequently cost them their health. Therefore, all over the world, the information war against breast cancer is recognized as one of the most effective mechanisms to reduce mortality from this disease. Variable and permanent breast cancer risk factors It should be noted that risk factors can be divided into two groups. The first one includes those that we cannot affect, such as gender, age, family history, and the presence of gene mutations. In this case, if you are aware of them, your doctor should adopt an individual preventive care program and screening diagnostics. In all the other cases, it’s up to us to influence the risk factors. Thereby we can reduce our own risk of developing breast cancer. It is important not only to know about breast cancer risk factors but also to realize that our health may depend on us. Of course, it is not possible to prevent breast cancer with 100% certainty. At the same time, we can reduce the risk of death through early diagnosis. Therefore, it is necessary to take into account the presence of risk factors and behave accordingly, considering your risk group. Patients’ stories So now, let’s get from theory to practice. We’ll go over two cases to illustrate how important it is to understand your risks. Subsequently, we will definitely devote a few future articles to this topic. 👉 Case 1. A 38-year-old woman with a family history of breast cancer. She didn’t have childbirth and lactation, but there is a record of pregnancy termination in her history at the age of 27. Since then, she has been constantly taking combined oral contraceptives (COCs) for contraception. 👉 Case 2. A 52-year-old woman with climacteric syndrome, type 2 diabetes, a history of 1 childbirth at 22, no lactation, 4 abortions, the last one at the age of 42. She has been taking hormone replacement therapy (HRT). So, patients already have risk factors for developing breast cancer, which they cannot change. But these women increased the risk of the disease by taking additional hormonal estrogen-containing drugs. Of course, in spite of the above cases, not everyone using HRT will develop breast cancer. However, when the disease is already there, oncologists always hear regrets about the lack of awareness. If they had known that they had been increasing the risk, they would have acted differently. Only 1 in 8 factors is enough to play a key role

bolezn-monaxin

WHAT IS NUN’S DISEASE?

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Do you know what nun’s disease is? In ХVII century, a European empress, having learned her diagnosis, wrote in her diary: – Doctors are mistaken about the diagnosis, I cannot have nuns’ disease. I have a husband and children. Written by Timovskaya Yu.A., MD, PHD, senior oncologist, Member of ESMO So what is this nun’s disease? The term became popular hundreds of years ago due to the fact that a large number of nuns were diagnosed with breast cancer. What was the reason for this phenomenon? Firstly, there were many more nuns before the ХХ century than in our time. Secondly – indeed, women who did not give birth or breastfeed got this disease more often. We’ve already talked about the 8 most significant risk factors for breast cancer. And today we’ll talk about little-known facts. IN THIS ARTICLE 1 So what is this nun’s disease? 2 Little-Known Facts about Breast Cancer 3 More about Early Diagnosis RELATED ARTICLES Little-Known Facts about Breast Cancer Historical facts Fact #1. In ancient times, people tried to treat breast cancer using excrement of insects, especially wasps, and bees. At that time, there was no cure for the disease. In order to alleviate the symptoms women had, it was recommended to apply a mixture of cow brains and wasp excrement to the breast affected by a tumor. This treatment was mentioned in ancient Egyptian papyri on methods of treating various diseases. The breast cancer clinic has not changed since those times. But the approaches to treatment have changed dramatically. As for the treatment, the first record of a mastectomy (those. breast removal) offered for breast cancer was over 1,500 years ago. The first record of a breast mastectomy was in 548 A.D. on Theodora, the Empress of Byzantine. Most importantly, the risk of dying from breast cancer is decreasing every year all over the world. It is gratifying that, as opposed to the second half of the twentieth century, the risk of death from breast cancer nowadays has reduced by 60% thanks to progress in early diagnostics of tumors and introduction of modern treatment methods. Facts in numbers Breast cancer (BC) affects not only people, but animals as well. For example, breast cancer is a common disease in cats and dogs. At the same time, dogs get sick more often than cats. On the other hand, the disease is more aggressive for the latter. Interestingly, dogs receive a treatment similar to that received by people. Fact # 2. Men also have breast cancer. However, if the risk of breast cancer in women is 1 in 8, then in men this risk is significantly less. Only 1 in 1000 men have breast cancer. The left breast is 5 – 10% more likely to develop cancer than the right breas. The left side is also roughly 5% more prone to melanoma. Nobody is exactly sure why this is so. Next fact is about the risk. Thus, it was found that women who work night shifts have twice as high risk of developing breast cancer. True, this only applies to cases where women have worked at night for more than 30 years. For those who have worked in such jobs for less than 30 years, individual risks remain unchanged. And let’s end this list on a positive one. 80% of patients with breast cancer will be treated successfully and announced healthy. Related Articles More about Early Diagnosis In the following articles we will talk about methods of early diagnosis, namely: 👉 Are all examination methods (examination, MMG, ultrasound) equally effective for the early detection of breast cancer?👉 How often should they be used: annually, once every six months, or are there other options?

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