I get many questions from patients and other members of the multidisciplinary team regarding the findings published last month in the British Medical Journal (BMJ) of the 25-year follow-up results of the randomized Canadian National Breast Screening Study (CNBSS). The study concluded (as they had in previous reports) that “annual mammography in women aged 40-59 years does not reduce breast cancer mortality beyond that of physical examination or usual care when adjuvant therapy is freely available.”
This study has opened the discussions about the benefits of mammography weighed against the harms. The increased anxiety caused, false negatives, and false positives that lead to additional interventions take a toll emotionally as well as financially. After consideration of this data, most of the breast cancer leaders in this country endorse the continued use of mammography for screening because it is the best tool we have at this time. An example often used is that for every 1000 women screened, 2-5 invasive cancers will be found. This will also mean that 10-50 women in this group will need additional imaging and 2-5 benign biopsy procedures will be performed for every cancer found.
As the health care community continues this debate, it is also time to consider whether blanket screening is still appropriate and if the time has come for a more individualized risk-based approach to breast cancer screening. Until then, what should women know? I propose we continue to focus on education and learning about cancer risk. The following is information from the Centers for Disease Control (CDC) focused on younger women. Please read and share this with your friends and family:
Breast Cancer in Young Women
Most breast cancers are found in women who are 50 years old or older, but breast cancer also affects younger women. About 11% of all new cases of breast cancer in the United States are found in women younger than 45 years of age.
Who has a higher risk?
Some young women are at a higher risk for getting breast cancer at an early age compared with other women their age. If you are a woman under age 45, you may have a higher risk if—
- You have close relatives (parents, siblings, or children) who were diagnosed with breast or ovarian cancer when they were younger than 45, especially if more than one relative was diagnosed or if a male relative had breast cancer.
- You have changes in certain breast cancer genes (BRCA1 and BRCA2), or have close relatives with these changes.
- You have an Ashkenazi Jewish heritage.
- You were treated with radiation therapy to the breast or chest during childhood or early adulthood.
- You have had breast cancer or certain other breast health problems such as lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), atypical ductal hyperplasia, or atypical lobular hyperplasia.
- You have been told that you have dense breasts on a mammogram.
What can I do to reduce my risk?
Breast cancer in a woman under the age of 45 is relatively rare compared to older women, but some women have higher risk for this disease. If you’re a woman in this age group, it is important that you—
- Know how your breasts normally look and feel. If you notice a change in the size or shape of your breast, you feel pain in your breast, or you have nipple discharge other than breast milk (including blood), talk to a doctor right away.
- Talk to your doctor if you have a higher risk. If you have a family history of breast or ovarian cancer or other risk factors, you should talk to your doctor about ways to manage your risk. If your risk is high, your doctor may suggest that you get genetic counseling and be tested for changes, called mutations, in your BRCA1 and BRCA2 genes. Your doctor may also talk to you about getting mammograms earlier and more often than other women, whether other screening tests might be right for you.
Centers for Disease Control and Prevention.(2014). Breast cancer in young women. Retrieved from: http://www.cdc.gov/cancer/breast/young_women/risk_factors.htm
Miller, A.B.; Wall, Claus; Baines, C.J.; Sun, Ping; To, Teresa; Narod, S.A. (2014). Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomized screening trial. BMJ 2014; 348. doi: http://dx.doi.org/10.1136/bmj.g366
By Marie Borsellino RN BSN OCN CBPN-C