Cancer Advice

Breast cancer is the most common form of cancer among women and second leading cause of cancer death among American women. In 2009, approximately 194,280 patients are estimated to be diagnosed with invasive breast cancer and 62,280 of carcinoma in situ. An estimated 40,610 will die of this disease. For a woman of average risk, the incidence of breast cancer is one in eight.

 

Screening of asymptomatic women has been accredited for the decline in mortality from breast cancer. Current recommendations from the American Cancer Society for women at normal risk are: 1) annual mammography at age 40. The age at which testing must be stopped should be individualized, taking into account the potential risks and benefits of screening as part of overall health and longevity, and 2) clinical breast exam every 3 years women in their 20s and 30s and annually for women 40 and older. The evidence to support mammography screening population is derived from both randomized and several non-randomized clinical trials. Eight randomized trials totaling hundreds of thousands of patients understand the health insurance of New York, four studies from Sweden, one of the United Kingdom and two from Canada. The BCDDP USA (breast cancer detection demonstration project), the largest study of mammography and clinical breast examination has also shown that screening reduces mortality from breast cancer.

During the last decade, advances in digital mammography, and include techniques of computer-aided detection. Film (not digital) mammography has been estimated at about 65-80% of sensitivity to the specificity required by 90%. Investigators DMIST (Digital Mammography Imaging Screening Trial) reported that the overall diagnostic accuracy of digital and film mammography is similar. However, digital mammography is more accurate in women younger than 50 years, women pre-menopausal or peri-menopause, and those with radiologically dense breasts. film mammography Two years later, another major study from the digital mammogram read with the software of computer-aided detection. The authors found that the specificity of diagnosis decreased significantly from 90.2% to 87.2% with computer-aided detection, while the sensitivity does not change. The rate of biopsy increases of 19.7%. Thus, the technology more expensive does not necessarily translate into better results.

In women at high risk of developing breast cancer, screening may also involve the breast ultrasound and / or MRI (magnetic resonance imaging). Risk factors include high BRCA gene carriers, personal or family history of breast cancer, prior atypical as ADH (atypical ductal hyperplasia chest irradiation) and LCIS (lobular carcinoma in situ), and before. Ultrasound can be useful in dense breasts. Ultrasound screening can lead to biopsy in 2% -4% of women whose carcinoma was found in 10% to 16% of these biopsies. The Imaging Network Trial 6666 CAB is the evaluation of ultrasound screening in women at high risk. Breast MRI has also been recently used by clinicians in many patients at high risk. In previous reports, MRI led to a biopsy in 7% -18% of women whose breast cancer was detected in 24% -88% of these biopsies. We do not yet know if the ultrasound or MRI reduces mortality from breast cancer in high-risk population, beyond that obtained by mammography screening. Currently, breast MRI is also indicated in women with breast cancer newly diagnosed unilateral. A recent publication has shown that MRI can detect breast cancer that is missed by mammography and clinical examination for 3.1% of cases. The sensitivity of MRI of the contralateral breast was 91%, the specificity 88%, and negative predictive value of 99%.

Despite evidence s.