In honor of Breast Cancer Awareness Month, we will discuss the latest statistics, screening and diagnosis techniques:
The Numbers Tell (Some of) the Story
Currently, 1 out of 8 women living in the United States will receive a diagnosis of breast cancer sometime in their lives1. While those statistics seem grim, the bright side is that they reflect improved screening methods that catch breast cancer in its early stages, when treatments are more effective. The flip side is the failure to diagnose breast cancer in its early stages can be devastating in terms of prognosis.
Early detection and treatment for localized breast cancer carries a 98% 5-year survival rate. Once cancer has spread to distant parts of the body, 5-year survival drops to 24%.2 A closer look at the statistics also reveals that, while breast cancer rates have risen steadily since the 1950’s, including sharp increases in the 70’s and 80’s due, in part, to widespread use of post-menopausal hormone replacement therapy, incidence has declined since 2000 as many women have elected to forego HRT1
However, despite advances in detection and treatment, breast cancer remains the second leading cause of cancer deaths among women1. And, though the majority of new cases are diagnosed in women over 50 years of age, most of the improved treatment results have been in women younger than 502.
Race also plays a complex role in breast cancer statistics, with Caucasian women considered to be at greatest risk, while African American women suffer the highest mortality rates from the disease.2 Socioeconomic disparity accounts for a portion of the racial divide in breast cancer mortality;3 women of higher economic status often put off having children until later in life, which increases breast cancer risk, while women of lower economic status tend to delay seeking health care due to financial concerns, resulting in cancer being detected at more advanced stages. Racial biases of health care providers have also been shown to influence how treatment options and decisions are presented to patients.3 Underscoring these socioeconomically and racially-based influences on breast cancer mortality, one study found that U.S military women, who have equal access to full health and equal care, show no racial differences in the stage at which breast cancer is diagnosed.3
A further breast cancer challenge for African-American women is that the disease process manifests differently in women of African descent. University of Chicago researchers discovered that breast cancers in African women arise from different types of cells compared to those typically seen in Caucasian women and are associated with a more aggressive disease pattern.4 These types of cancer cells do not dependent upon estrogen for their growth and, as a result, do not respond to hormone-affecting drugs, such as tamoxifen.4
Screening Recommendations and Options
Ongoing controversy among experts regarding which screening methods provide the best tradeoff between effectiveness, safety and cost leave many women confused and anxious. While science works to reduce the incidence and impact of this devastating disease, knowledge and action are your best defenses for minimizing risk.
Mammography is considered the gold standard for breast cancer screening. The American Cancer Society recommends yearly mammograms starting at age 405. However, the U.S. Preventive Services Task Force recommends against starting mammogram screening in women of average risk who are younger than 50. Instead, the task force advises having mammograms every other year between the ages of 50 and 74.6
Who to believe? One of the reasons for the disagreement between these authorities has to do with false positive results. Modern mammograms are very good at finding suspicious-looking masses but not as good at distinguishing whether they are cancerous tumors, benign tumors, non-cancerous cysts, dense breast tissue or something else. False positives account for up to 61% of breast cancer diagnoses via mammogram, with the majority occurring in women between the ages of 40 and 497. They also lead to unnecessary and expensive biopsies. These procedures are themselves associated with a certain degree of risk and 70 to 90 percent turn out to be benign8. Some women even undergo needless radiation, chemotherapy and hormone treatments stemming from false positive mammograms.7
High Risk Considerations and Second Tier Tests
If you carry the BRCA1 or BRCA2 gene, have a first degree relative with a history of breast cancer or if you were treated with radiation to your chest for another health condition early in your life you are considered to be at higher risk for breast cancer. Additionally, if a large proportion of your breast tissue is dense you may have up to 5 times increased risk for developing breast cancer9. In these and certain other instances your doctor may recommend additional screening options, instead of or in combination with mammography, such as MRI, PET scan or ultrasound.
MRI is more sensitive than mammography and it is the best method for classifying types of cancer when cancer is detected8. On the down side, it is also far more expensive, the machines are more cumbersome and less portable and the procedure takes more time than mammography, making it less useful as a screening tool for the general population. Opinions and study results vary regarding the rate of false positives resulting from MRI versus mammography9, with some evidence pointing to higher rate of false positives and some concluding a lower rate. There is also some controversy with regard to the ability of MRI to detect a form of early breast cancer known as ductal carcinoma in situ, or DCIS, which is characterized by tiny calcium deposits that show up readily on mammography, and detection of which is acknowledged as a major contributing factor to the decline in breast cancer mortality10,11.
PET scan, a type of CT scan, excels at distinguishing whether a lump is benign or cancerous and may soon replace biopsy as the method of choice for diagnosing suspicious lumps on mammography12. PET scans can look at lymph nodes to see if cancer has spread, saving patient and doctor from surgery to remove and biopsy lymph nodes. These scans are also being considered as a means for detecting early-stage breast cancer and for gauging the effects of cancer treatment13.
From the perspective of patient health, the main appeal of ultrasound is that it is radiation-free. Ultrasound is also pain-free. Currently, ultrasound is used as an adjunct to mammogram and its best asset is for distinguishing a solid mass from a fluid-filled cyst. It is also useful for evaluating dense breast tissue, or for women who are pregnant or who have breast implants. One thing ultrasound does not do is detect calcified areas typical of certain types of cancer14.
Your personal risk factors for breast cancer are the most important components for determining the best and most appropriate screening method for you. Knowing your risk profile, keeping informed as new options arise and discussing your preferences with your health care provider will ensure that you receive the best possible preventive care and, if necessary, the most effective treatment, throughout all stages of your life.
If you suspect your health has been compromised by inappropriate medical treatment or advice, please contact our top-rated medical malpractice lawyers at 312-527-4500 for a Free Consultation.