Self examination for breast cancer – is it enough?
Breast cancer is the most common type of cancer affecting women. It is the most frequent reason why women, that are less than 65 years old, are dying. Overall, it is the second commonest cause of death in women after lung cancer. The average lifetime risk of breast cancer in American women is 12.3% or 1 in 8 women. The incidence of this disease is highest in women of higher social and economic status though the death rate is higher in lower economic status due to the delay in diagnosis. This delay may be related to the lack of awareness of screening necessity, distant diagnostic facilities or worst treatment.
The overall mortality from breast cancer has also seen declined recently due to better screening, which results in early detection of the disease. Screening is defined as a method for early detection of breast changes in normal population which has no symptoms or signs of breast cancer.
Methods of examination for breast cancer
- Breast self-examination (BSE) – screening by BSE has been advocated since the early part of the last century. Today, it is promoted by many medical societies, breast cancer groups and media as an effective screening tool. It is an appealing method of screening because it is inexpensive and non-invasive. Yet its efficacy in reducing breast cancer mortality has not been demonstrated in various clinical trials. It was found that almost twice as many breast biopsies with benign results were performed in the BSE groups when compared to other people. This indicates that screening by BSE is not without risk, as it can generate significant anxiety among women. Also, false-positive and false-negative results may invite considerable costs and risks. Nevertheless women should be encouraged to be aware of their breasts since this may help in the detection of cancer between routine screenings.
- Clinical breast examination (CBE) – screening by CBE differs from screening by BSE as it requires to be performed by trained personnel. Since the advent of mammography screening, the role of CBE as a screening modality has diminished though about 5–10% of all breast cancers are detectable by CBE. For women between 20 and 39 years, CBE is recommended every 1 to 3 years. For women above 40 years, annual mammography and CBE is recommended. CBE readily detects cancers larger than 1 cm. Although screening by CBE is effective in detecting breast cancer, its impact on breast cancer mortality is not known. It might be particularly useful in developing countries, where mammography screening is not affordable and breast cancer mortality rates are rising.
Mammography – a screening mammogram involves two x-ray images of each breast, one from the top and the other from the side. Clinical trials have shown that this screening method reduces the rate of death from breast cancer. Because a woman’s risk of developing breast cancer increases with age, the efficacy of mammography screening for older women remains an important issue.
- Ultrasound screening – breast ultrasound is mainly used to assess specific abnormal findings discovered either during CBE or mammography. It is also used as a supplement to mammography screening for women at increased risk for breast cancer and for those with dense breasts (young females) where the sensitivity of mammography is diminished. Screening with mammography and ultrasound is associated with a higher breast cancer detection rate when compared to screening with mammography alone.
- Magnetic Resonance Imaging (MRI) – though MRI is more sensitive method than mammography, the latter is more specific in diagnosis of breast cancer. American cancer society (ACS) issued guidelines for the use of MRI as an adjunct to mammography in breast cancer screening. They recommended breast MRI screening for genetic mutation carriers, their first-degree relatives who have not undergone genetic testing, women who have received radiation treatment to the chest (for Hodgkin’s disease) and women with an approximately 20–25% or greater lifetime risk of breast cancer.
Breast cancer is one of the most common type of cancer affecting females. Breast self-examination increases the awareness of this cancer though it does not reduce the death rate. Nevertheless, it is worth to conduct it regularly and if there is any suspicion on self- examination, clinician should be consulted for further investigation.