Breast Cancer - Screening

Breast self-exam

Breast self-examination (BSE) was widely discussed in the 1990s as a useful modality for detecting breast cancer at an earlier stage of presentation. A large clinical trial in China reduced enthusiasm for breast self-exam. In the trial, reported in the Journal of the National Cancer Institute first in 1997 and updated in 2002, 132,979 female Chinese factory workers were taught by nurses at their factories to perform monthly breast self-exam, while 133,085 other workers were not taught self-exam. The women taught self-exam tended to detect more breast nodules, but their breast cancer mortality rate was no different from that of women in the control group. In other words, women taught breast self-exam were mostly likely to detect benign breast disease, but were just as likely to die of breast cancer. In 2003, the American Cancer Society relegated structured BSE to an 'optional' method of detecting breast cancer, citing self awareness as more important than structured self exams based on recent research.

Genetic testing

A clinical practice guideline by the US Preventive Services Task Force :

• "recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2)" The Task Force gave a grade D recommendation.
• "recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing." The Task Force gave a grade B recommendation.

The Task Force noted that about 2% of women have family histories that indicate increased risk as defined by:

1. For non–Ashkenazi Jewish women, any of the following:

• "2 first-degree relatives with breast cancer, 1 of whom received the diagnosis at age 50 years or younger"
• "3 or more first- or second-degree relatives with breast cancer regardless of age at diagnosis"
• "both breast and ovarian cancer among first- and second- degree relatives"
• "a first-degree relative with bilateral breast cancer"
• "a combination of 2 or more first- or second-degree relatives with ovarian cancer regardless of age at diagnosis"
• "a first- or second-degree relative with both breast and ovarian cancer at any age"
• "a history of breast cancer in a male relative."

2. "For women of Ashkenazi Jewish heritage, an increased-risk family history includes any first-degree relative (or 2 second-degree relatives on the same side of the family) with breast or ovarian cancer."