Updated Breast Cancer Screening Guidelines

American Cancer Society has recently revised the breast cancer screening guidelines and they were featured in the a recent article in JAMA.

The most significant change has been the age of starting mammographic screening, which has been increased from 40 to 45 years. This change has been made after taking into account the lower incidence rate of breast cancer in this age group. Another factor which led to the delay in initiating screening was the higher number of false positive mammograms observed within this age group.

Recommendations:

  • Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
  • Women aged 45 to 54 years should be screened annually (qualified recommendation).
  • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).
  • Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
  • The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation)

These guidelines are quite different from those of the US Preventive Services Task Force (USPSTF) and this is a cause of concern & confusion among patients. The following table highlights the differences between the two guidelines:

Mammography Screening Parameter ACS USPSTF
Starting age (y) 45 50
Screening frequency Annually to age 54 y, then biennially Biennially, beginning at age 50 y
Stopping age (y) For as long as a woman is in good health and has a life expectancy of at least 10 y 75
Total lifetime mammograms if screening continued to age 74 y (n) 20 13
Lifetime risk of dying of breast cancer (%) 1.8-1.9 2.0
Lifetime risk of dying of breast cancer with no screening is 2.7%.

Do these guidelines affect Indian patients?

Well, firstly India has no screening guidelines and only opportunistic screening is practiced by a very small segment of the population. Secondly, there are some studies which say that Indian breast cancer occurs at an earlier age and therefore screening should be initiated early.

These questions be answered if proper trials on this topic are carried out in the country. For the time being, we should lay more stress on creating awareness regarding breast cancer.

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Wearable bra designed to spot breast cancer early enters clinical trials

A wearable bra claimed to detect breast cancer at an early stage is all set to enter clinical trials. What is so special about this bra? Well, it is fitted with 16 sensors, which gather data thermodynamic data from the breast, which is analyzed using an algorithm. The bra designed by a company in Navada will be put to test in a clinical trial to be held at Cedars-Sinai Medical Center.

If this product does well in the clinical trails, it could be a huge step forward in screening breast cancers. The developers claim that it will be useful in females with dense breast tissue as well. Mammography is not sensitive in ladies with dense breast tissue and this system could be advantageous in such patients.

The company plans to launch the product in India in Jan 2015 and FDA approval would follow in late 2015.

To read more about this system, please follow the link:

A wearable bra designed to spot early signs of breast cancer readies for clinical trials

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Mobile Mammography Units

On the occasion of World Cancer Day, a new mobile mammography unit was launched in Bangalore. This is a joint venture between Narayana Hospitals and is partly supported by the Nilekani family.  This is the second functional unit in the city and it will help in spreading Breast Cancer Awareness. Similar units are functional in Delhi, Mumbai, Goa and UP.

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These units not only help in conducting mammograms, which help in early detection of lesions but also create awareness regarding breast cancer by distributing educational material and training women to carry out breast self examination. With the increasing incidence of breast cancer, more mobile units are required in the country to reach out to the masses.

Breast Density Grading on Mammogram

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Image courtesy: http://www.mayoclinic.com

Breast tissue is composed of fatty (nondense) tissue and connective (dense) tissue.

Radiologists use a grading system to describe the density of breast tissue based on the proportion of fat to connective tissue.
The four levels of density are shown in these mammogram images.
From left to right: level 1 (a very fatty breast), level 2 (fatty tissue makes up more than 50 percent of breast), level 3 (dense tissue makes up more than 50 percent of the breast) and level 4 (a very dense breast with very little fat).
It is easier to interpret lesions in Level 1 & Level 2 breast densities whereas Level 3 & 4 pose a problem in identification of lesions and micro-calcifications.