Breast cancer update

Information overload about breast cancer, often inaccurate and needlessly scary, arouses intense anxiety in today's women. Fear may deter or delay those who find a breast lump from seeking medical advice and may also prevent women at risk from getting regular breast check-ups. Many are confused by the crossfire of differing medical opinions. True, mortality from breast cancer hasn't gone down much during the past 50 years despite more screening and new treatments. Yet caught in time, breast cancer can be treated in a manner that maximizes survival. Having breast cancer doesn't necessarily mean dying of it. The best way to face the problem is to know how to detect it early, what to do if a lump or breast change is found, whom to consult and -- if cancer is detected -- what the next steps usually are. This series of articles will try to banish misconceptions, explain what breast cancer is, which women are at particular risk, who needs regular breast screening and the treatments currently available.
Most PopularBreast cancer is often discovered during a routine physical examination. At a far earlier stage, it can be detected by mammographic screening. But most breast cancers are still discovered by women themselves when they feel or see a change in their breast(s) -- perhaps reflecting the reluctance of many women to get adequate check-ups. Too few women who need it get regular breast examination. Yet of all lumps or suspicious changes investigated/biopsied because of mammographic observations or physical examination only one in five is malignant. Most turn out to be benign breast thickenings or other harmless abnormalities.
Although it may miss some cancers, mammography remains the most sensitive method and today's most accurate diagnostic tool for breast cancer. Together with physical examination, it is the standard way to detect breast abnormalities. The combination of mammograms plus skilled physical examination detects most breast cancers. Alternative methods for breast cancer detection -- such as thermography (heat scanning), light-scanning and other techniques -- which showed initial promise have now been largely discarded.
Who needs regular breast screening?
While most experts now agree that periodic screening by mammography plus physical examination can cut down deaths from breast cancer in women over age 50, there's no agreement about its benefits in younger women. None of the study results so far shows definitely proven death reduction by mammographic screening in women under age 50.
The screening debate focuses on a few key issues:
* Whether mammography is sensitive enough to detect breast cancer early enough to stop its spread.
* Whether early detection and prompt removal saves lives.
* At what age(s) it might bring benefits.
It's vital to understand what screening is. Mammograms may either be diagnostic or used for screening. Screening mammography is not the same as diagnostic mammography. Screening is the detection of unrecognized disease in otherwise healthy women who have no symptoms of breast cancer. By contrast, diagnostic mammograms are done to determine whether a noticeable lump or other breast abnormality may be cancerous. There's no longer any argument about the fact that routine mammography for women over age 50 can save lives, nor that it detects small breast tumours before they can be felt, and that mammograms are excellent diagnostic tools for confirming malignancy. But the experts argue strongly about the age at which screening mammography should begin.
The results of the Canadian National Breast Screening Study (NBSS) so far show no benefits for routine mammography in women under age 50. All but one study (the New York Health Insurance Plan or HIP) show no death rate diminution from mammography in women under 50 years old. And while many U.S. health agencies now recommend regular mammograms for all women over 40 -- such as the American Cancer Society, the American Medical Association and the National Cancer Institute -- others, including most Canadian provincial health agencies, discourage routine mammographic screening in women under 50. One University of Toronto expert notes that "the improvement even in the HIP study may have arisen from the physical examinations accompanying mammography." Those against breast screening before age 50 stress that the dramatic death rate reduction seen in the over-50s has not been observed or confirmed for younger age groups. (A complete detailed list of organizations currently for & against breast screening in women under 50 is available from the Health News office.)
The advantages of mammography:
* Despite its limitations, mammography is the best available early detection tool with which to fight breast cancer;

Breast cancer update

Information overload about breast cancer, often inaccurate and needlessly scary, arouses intense anxiety in today's women. Fear may deter or delay those who find a breast lump from seeking medical advice and may also prevent women at risk from getting regular breast check-ups. Many are confused by the crossfire of differing medical opinions. True, mortality from breast cancer hasn't gone down much during the past 50 years despite more screening and new treatments. Yet caught in time, breast cancer can be treated in a manner that maximizes survival. Having breast cancer doesn't necessarily mean dying of it. The best way to face the problem is to know how to detect it early, what to do if a lump or breast change is found, whom to consult and -- if cancer is detected -- what the next steps usually are. This series of articles will try to banish misconceptions, explain what breast cancer is, which women are at particular risk, who needs regular breast screening and the treatments currently available.
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