During the last few decades, breast cancer has become the top cause of cancer deaths in females all over the world, the Indian scenario is no different. An estimated 70,218 women died of breast cancer in India, in the year 2012, the highest in the world. These alarming numbers certainly evoked a necessity to design an intervention that can keep a check on these startling rates.
American Cancer Society and other similar organizations framed selection criteria to identify ‘at risk’ categories based on certain factors to encourage breast screening for early detection. In the case of breast cancer when the female practice screening tests, chances of finding cancer in a stage when it is small and confined within are much higher. Both of these factors assure successful outcomes. Small and restricted tumors are easy to treat with zero complications.
Who is at average and high risk of breast cancer?
According to guidelines from the American Cancer Society
|S No||Average Risk||High Risk|
|1||No personal history of breast cancer||have a personal history of breast cancer|
|2||Strong family history of breast cancer||a strong family history of breast cancer|
|3||a BRCA gene||a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)|
|4||Has not had chest radiation therapy before the age of 30||Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves|
|5||Had radiation therapy to the chest when they were between the ages of 10 and 30 years|
|6||Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes|
|7||Having “extremely” or “heterogeneously” dense breasts as seen on a mammogram|
The BRCA gene test uses DNA analysis to detect mutations in either one of the two breast cancer predisposition genes — BRCA1 and BRCA2. People who inherit mutations in these genes are at an increased risk of developing breast cancer and ovarian cancer compared to the overall population.
- Women between 40 and 44 have the option to start screening with a mammogram every year.
Mammograms are X-Rays of the breast that can help find breast cancer much earlier than its physical representation. Cancer detected through mammograms can be managed without surgery through chemo and Radiation therapy. This test, however, is not perfect and can miss some cancer therefore it needs further diagnostics to support its detection.
- Women 45 to 54 must get mammograms every year.
- Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
- Clinical breast exams are not recommended for breast cancer screening among average-risk women at any age. They can practice self-examination through hands. Clinical breast Exam is only recommended if self-examination typically reveals any clue about breast cancer. You can yourself keep aware, any changes in your breast other than normal need to be reported and consulted. Usually, a lump in the breast can be easily found by a clinical exam.
- MRI can be used in conjugation with a mammogram to confirm the diagnosis
- Breast Ultrasound is also helpful in the early detection of breast cancer.
Apart from the screening, there are a series of risk assessment tools that include
- Collecting information regarding family history in first-degree relatives (parents, siblings, and children) and second-degree relatives (such as aunts and cousins) on both sides of the family
- The use of any of the risk assessment tools and its results should be conferred by a woman with her doctor.
National Comprehensive Cancer Network has defined yet another series of guidelines for females at high risk which are a little different from ACS but yet focus on the importance of biannual screening of breast through the diagnostics stated above.
An example of the importance of screening is Hollywood celebrity Angelina Jolie who had a preventive double mastectomy because of the presence of the BRCA1 gene. She also had a family history of breast cancer. She chose to put forth the last option first. Regular breast screening is based on a similar outline, that when breast cancer is detected through screening, we can target 100%breast conservation. In most cases, it can be successfully managed by radio and chemotherapy alone without any need for surgery at all. We chant ‘prevention better than cure’ because it is preemptive and less expensive. Skipping important steps of screening and intervention by jumping over to the last resort is all the more encumbering both to the person and society.
Dr. Anshuman Kumar, Director & Senior Consultant – Oncology, Surgical Oncology | Dharamshila Narayana Superspeciality Hospital, Delhi