Screening

Screening tools commonly used include the patient's history, self and physician exam, mammography and ultrasound.

Mammogram recommendations:

1. Baseline mammograms are recommended in the United States at age 35.

2. Every year beginning at age 40.

3. In high risk patients, mammograms are recommended 5 years prior to the first case of breast cancer in the close family.1

Limitations in mammography are secondary to dense breast tissue overlying lesions frequently seen in women <30 years old and older women on hormone replacement.2 Mammogram is associated with a false negative rate of 10-15%. This false negative rate is increased to 25% in women less than 40 years old.

The benefit of mammogram is the detection of lesions that are not yet palpable. Screening by mammogram can detect groups of microcalcifications that indicate ductal carcinoma in situ (DCIS). If the microcalcifications are linear or ductal, this indicates comedo type which has a worse prognosis. If they are sand-like, then cribiform or papillary is more common. These latter two have a better prognosis. This allows mammogram to detect cancer prior to invasion.

Ultrasound is also used to determine if a palpable lesion is cystic or solid. Benign lesions are very circumscribed. Malignant lesions are asymmetric with a lesion that is taller than it is wide and with irregular borders. Malignant lesions are hypoechoic and have posterior shadows. This technology is very helpful in women with dense breasts. The limitation with ultrasound is that microcalcifications are not viewed. Another limitation is that the technique is operator dependent and time consuming. Some cancers are visualized on ultrasound that are not seen on mammogram.

MRI is not used as a screening tool, but is used to determine recurrence vs. scar in lumpectomy patients. Recurrences have increased vascularity as seen on MRI.

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