Breast Cancer Screening

Harini Mohan, Dr. Lopamudra Das Roy

Published 2020

Warning Signs and Symptoms¹

Signs and symptoms related to breast cancer are often caught during self exams done by the patient at home on a monthly basis. If and when abnormalities present themselves, the patient should contact his/her healthcare provider as soon as possible to schedule a visit and be further tested. Now what exactly are signs and symptoms you should be on the lookout for?

A change in nipple or breast appearance such as shape, dimples, irritated surrounding skin, inverted/turned nipple, one sided swelling of the breast, one sided shrinking of the breast, and newly asymmetrical breasts.
A change in how the nipple or breast feels to the touch. This can be a change in the area’s skin texture, firmness, tenderness, and/or the discovery of a lump.
Discharge seeping from the nipples as milky, clear, or bloody. These symptoms do not determine if you have breast cancer or not but you should treat these symptoms and signs with the utmost seriousness.

Early Detection and Diagnosis ²

Early detection when it comes to cancer is the best opportunity to cure it without complications and maintain a high survival rate. In order to detect the early stages of breast cancer you should visit your doctor for clinical exams regularly while also performing self exams at home every month. Clinical breast exams are physical exams of your breast done by your physician to locate any lumps whereas self exams are done by yourself; both exams are essential for early detection. According to the National Cancer Foundation, individuals with stage 0/stage 1 breast cancer that remains localized, contained within the breast, have a relative 5 year survival rate of 100%. The three types of in situ, area of origin, breast cancer are ductal carcinoma in situ, lobular carcinoma in situ, and nipple paget disease. What does each early stage mean?

**Created by Harini Mohan, @BreastCancerHub, All Rights Reserved**

Stage 0 DCIS - A non - invasive cancer where abnormal cells are found in the lining of the breast’s milk ducts. Stage 0 cancer has not yet spread to the surrounding breast tissue outside of the lobules/ducts.
Stage 0 LCIS - Typically not considered cancer due to its non - invasive growth of abnormal cells but individuals with it have a greater risk of developing breast cancer down the line if not treated. Treatments may include hormone therapy medications like Tamoxifen, Aromasin, and Evista.
Stage 1 - Cancer is noticeable but still localized in the breast. Stage 1 cancer can be split into two categories based upon the tumor and lymph node size.
Stage 1A - Tumor in 1A is smaller than two centimeters and has not spread to nearby lymph nodes just yet. For visual purposes, two centimeters is roughly the size of a peanut.
Stage 1B - Cancer is now evident in the lymph nodes with clustered cells ranging from .2 millimeters to 2 millimeters which then can be compared to the size of a pin prick versus that of a grain of rice.

Screening and its Limitations

Screening is a crucial part in breast cancer examinations and its diagnosis but every screening has its own set of limitations and factors that may be overlooked. Mammograms are the best cancer screening method available to us at this time. They are not 100% accurate so they can lead to either false-positive/false-negative test results. Mammograms are an X-ray picture of your breast to detect breast cancer up to three years before it can actually be felt.³ How does a mammogram work? You are instructed to stand in front of the x-ray machine where a technologist will then place your breast upon the plate as another plate from above descends down to press on your breasts. This will be done from four different viewpoints as you stand still. There may be some discomfort/pain in the region during the exam.

Dense breasts affect the appearance of tissue on a mammogram. Because they have lots of supportive tissue, dense tissue, in comparison to fatty tissue, not dense tissue, the mammogram is harder to read and thus proves to be more difficult when coming up with a diagnosis.

False Positive Mammogram - A mammogram appears to be abnormal when there is no cancer present in the breast. These can be a result of a variety of factors. They tend to occur to younger women, individuals with a family history of breast cancer, dense breasts, those taking estrogen otherwise known as the main female sex hormone, and people who have had a breast biopsy done before. Even though it may come as good news that your positive breast mammogram results have now been deemed negative, false positive readings give patients unnecessary amounts of stress and anxiety that may result in other health issues down the line. False positive readings happen pretty commonly to patients during the first mammogram and over a 10 year consistent period of time. When found false positive, tests like MRIs, breast biopsies, diagnostic mammograms, and ultrasounds may be ordered but are additional costs that not everyone can afford.⁴
False Negative Mammogram - A mammogram where your test comes back negative when in reality it is positive for breast cancer. 20% of mammograms do not detect breast cancer. Dense breasts are more likely to end up with false negative mammogram results due to the difficulties it presents when screened. This results in a false sense of security and protection to develop in a patient to then be crushed by the inevitable truth.⁴
Age - Women over the age of 40 are recommended to get regular mammograms done but the reality is people younger than 40 can also contract breast cancer. In fact around 12,150 women under the age of 40 get breast cancer every year whereas an estimated 1000 pass away.⁵
Gender - Men are not encouraged the same way women are to get regular mammograms done.

Screening Limitations in Developing Countries ⁶

60% of deaths from breast cancer worldwide take place in developing countries because of their lack of resources, lack of knowledge about diagnosis and treatment, and inefficient promotion of these ideas. These countries depend on free public health systems which have yet to bring themselves up to the current speed of that in developed countries. There is only a general 57% survival rate for breast cancer in these regions as a result. What factors most limit a successful diagnosis in developing countries?

Stigma⁷ - In areas like Qatar, a country located in the middle east, society is patriarchal. The opinions of men hold the most weight in any and every household. The final decision is up to them whether it be educating the female figures in their life about breast cancer and screening or urging them to get screened. 90.7% of women in this country know of breast cancer but do not know basic knowledge about its diagnosis and treatments let alone its screening. A whopping 94.4% reported that they would have a mammogram done if recommended to them by their doctor but only 24.4%’s doctors discussed and/or recommended a mammogram. This acts a consequence to the deep rooted stigmas within societies like this where even doctors are too shy to discuss the topic of breast cancer. Without the ability to break down the breast cancer stigma even rich countries like Qatar continue to struggle.
Lack of Knowledge⁸ - A very underdeveloped district in Kenya, Kersa, has little to no knowledge about this disease nor its screenings. Without proper knowledge inhabitants of this district will continue to be unable to produce diagnoses and further treat individuals. Kersa is the perfect breeding ground for breast cancer ignorance.
BCAS - Breast Cancer Screening
CBE - Clinical Breast Exam
BSE - Breast Self Exam

Graph curated by Harini Mohan, @BreastCancerHub, All rights reserved

Conclusion

There are many ways to screen and be diagnosed with breast cancer but if caught early your chances of coming out of this situation a survivor are significant. We are making long strides but there is still a long way to go when talking about screening limitations and the effects it has upon people in both developing and developed countries. Let’s make a change. Let’s be aware.

References

Symptoms and Signs. (2019, September 27). Retrieved August 06, 2020, from https://www.nationalbreastcancer.org/breast-cancer-symptoms-and-signs
Stages 0 & 1. (2019, September 19). Retrieved August 06, 2020, from https://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1
What Is a Mammogram? (2018, September 11). Retrieved August 06, 2020, from https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm
Limitations of Mammograms: How Often are Mammograms Wrong? (n.d.). Retrieved August 06, 2020, from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/limitations-of-mammograms.html
Breast Cancer Statistics in Young Adults. (n.d.). Retrieved August 06, 2020, from https://www.youngsurvival.org/learn/about-breast-cancer/statistics
Da Costa Vieira, R., Biller, G., Uemura, G., Ruiz, C., & Curado, M. (2017, April). Breast cancer screening in developing countries. Retrieved August 06, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401614/
Donnelly, T., Al-Khater, A., Al-Bader, S., Al-Kuwari, M., Abdul Malik, M., Al-Meer, N., & Singh, R. (2017, July 21). Perceptions of Arab men regarding female breast cancer screening examinations-Findings from a Middle East study. Retrieved August 06, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521764/
Dibisa, T., Gelano, T., Negesa, L., Hawareya, T., & Abate, D. (2019, June 26). Breast cancer screening practice and its associated factors among women in Kersa District, Eastern Ethiopia. Retrieved August 06, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756780/