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Breast cancer is the most common type of cancer for women in America, and women face a one in eight lifetime chance of developing this disease, according to cancercare.org.
Fortunately, if detected early, the 5-year survival rate (the standard way to measure prognosis) for women with breast cancer is 98 percent. And women who have been diligent with screenings join a distinguished and thankful troupe of cancer survivors.
Mammograms and Self Detection
One of the most lauded developments in breast cancer detection is the mammogram, which has been around since the 1960s. Women who are older than 40 should have a mammogram every year, but 13 million of women in this age group have never had this simple 20 minute screening exam, according to The Breast Cancer Site.
"Mammograms decrease the death rate by a minimum of 30 percent, some say 50 percent," says Debbie Saslow, PhD, director of Breast and Gynecologic Cancer of the American Cancer Society (ACS). This statistic translates into living a longer life for many.
A mammogram, which continues to be the gold standard in breast cancer detection, is an X-ray of the breast used to detect and evaluate breast changes. The exam is not always pleasant. A women's breast is placed between an X-ray plate and a plastic plate and then compressed for a few seconds.
Another easy (and completely free) way to detect breast cancer is by performing a breast self exam (BSE). BSEs aren't stressed as much as they used to be in the past-and are considered an optional detection technique. Dr. Saslow says women can do them once a month or as infrequently as they want to, but they should be familiar with their breast so they can detect any abnormalities.
"A lot of women have found lumps this way, but BSEs haven't been found to reduce the impact of breast cancer," Dr. Saslow explains. "At a minimum, women need to know what feels right and what's normal for them. If you notice a change-a lump, change in skin or nipple discharge-you should seek medical care pretty promptly."
Women who have a high risk of getting breast cancer (have family members with breast cancer at a young age) can also take extra measures, including MRIs and genetic testing.
High-risk women are encouraged to get MRIs done once a year along with their mammogram. An MRI is not recommended as a screening technique on its own, as it can miss some cancers a mammogram can detect.
A MRI scan produces detailed, cross-sectional pictures of the breast using a combination of magnets and radio waves. Although an MRI is more expensive than a mammogram, most insurance companies will pay for these tests for high-risk women.
Another technique is a genetic test to see if a woman carries the BRCA1 and BRCA2 genes. These tests are aimed toward women who have a strong family history of breast cancer.
The price of these tests can vary, and some are not covered by health insurance. However, it could be worth it if it brings a sigh of relief to a concerned patient.
"The greatest potential benefit these tests can bring is if someone in a woman's family tests positive for the genes, and the woman tests negative. Then she knows she is at an average risk," Dr. Saslow explains. "If she has high anxiety about this, it can be such a relief to her."
On the other hand, just because a patient tests negative for the mutation in these genes doesn't mean she has no chance of getting the disease. Additionally, just because someone tests positive doesn't mean she will get breast cancer either.
Testing positive can lead to lifestyle changes, taking a drug like Tamoxifen (which can lessen risks by 50 percent, Dr. Saslow adds) or even a breast mastectomy.
Before getting tested, women who have a history of breast cancer in their family should consult a genetic counselor. "Women should see a professional who can help her make the best decision," Dr. Saslow recommends. "It's a really complex issue."
Other Screening Techniques
Other screening techniques, such as thermography and a newer breast test on the market, claim to detect unhealthy breast tissue or fluid before cells form malignancies.
The first technique, breast thermography, measures heat in the tissue, using infrared rays, says Neil Hirschenbein, MD, medical director of La Jolla (CA) Institute of Comprehensive Medicine.
Digital infrared imaging can help find heat produced by increased blood vessel circulation and metabolic changes associated with a tumor's genesis and growth, according to breastthermography.com. By being able to show temperature variations in the breast, this procedure can help spot pre-cancerous stages.
During this exam, a patient is left alone in a cool room for 15 minutes so her body reaches a temperature matching the special temperature conditions of the room. Lastly, the patient is positioned in front of an imaging system to get her breasts, upper chest and underarms imaged. There is no radiation exposure during this procedure, Dr. Hirschenbein stresses.
After the images have been analyzed by a physician, they are graded from TH 1 (normal uniform non-vascular breast) to TH 5 (severely abnormal breast).
If the breast is found to be fairly normal, the woman can schedule an appointment for another thermogram in a year. If there are questionable results, a physician can talk to a patient to discuss her lifestyle and what type of changes, such as supplement use, can be made to return the breast to normal. If the breast is found to be abnormal, the physician will order additional tests to be done, such as a mammogram or an MRI, to find the abnormality's location. The thermogram will be done again in 3 to 6 months.
"When they come back, some women who have had a 5 go down to a 2 because of lifestyle changes," Dr. Hirschenbein notes.
A thermogram may be good for women younger than 40 who have a history of breast cancer. In addition, younger women often have denser breast tissue that makes it more difficult for mammography to be effective, according to the American College of Clinical Thermology.
"One of the nice things about it is because it doesn't have radiation, you can potentially start it much earlier than you'd feel comfortable starting a mammogram," Dr. Hirschenbein notes.
Unfortunately, breast thermography is not covered on many insurance plans. Dr. Hirschenbein says costs vary depending on the facility; a thermography exam at his facility costs $285.
Not everyone believes in thermography's utility. A study that came out around the time the screening first became available, for example, analyzed women who had both a mammogram and a thermogram. The study found women with normal mammograms but abnormal thermograms, drawing the conclusion that thermography drew a lot of false positives.
However, Dr. Hirschenbein says what the researchers didn't realize is thermograms can yield abnormal results before a mammogram can. He notes the researchers followed the women with abnormal thermograms, and they did eventually develop breast disease.
On the other hand, the ACS says no studies have found that breast thermography is a proven technique to detect breast cancer.
Ideally, Dr. Hirschenbein says mammograms and thermograms should be used together. "We have some women who are concerned with the discomfort of a mammogram or the radiation of them," he says. "Some women say it wasn't their favorite way to spend the afternoon. Some women like the idea of alternating the two procedures or using mammograms less often."
Another newer technique is the HALO Breast Pap Test, developed by NeoMatrix Inc. and approved by the FDA in 2005. This test is an automated, noninvasive diagnostic test that takes five minutes. Using a combination of massage and suction, the procedure involves a woman putting her breast into the machine's cups, where nipple aspirate fluid (NAF) comes to the surface from the milk ducts (where 95 percent of all breast cancers originate, according to the company that offers the product.)
If the patient produces fluid, the sample is sent to a lab and analyzed for cellular growth. Only about half of all women produce fluid, says Dana Shapiro, CT(ASCP), director of operations - OB/GYN Division at Acupath Laboratories Inc, one of approximately 20 medical labs nationwide analyzing HALO Breast Pap Test biomarkers.
If a woman produces no fluid, it means she is at a normal risk of developing breast cancer. If she does produce fluid and it contains normal cells, her risk for breast cancer is twice the normal risk. If the fluid contains abnormal cells, her risk is 4 times to 5 times the normal risk.
"Like the cervical Pap test, the HALO Breast Pap Test can identify abnormal cells years before a larger, potentially cancerous lesion might develop. Because of that, this simple test is key to improving breast cancer outcomes. The test can be done in your doctor's office as part of your annual well-woman visit," Shapiro explains. "It detects abnormalities before mammography will even pick it up, and it could be years before you develop a lump."
If the woman receives an abnormal result, she can consult with her doctor on how to reduce her risk and a plan for continued monitoring. She can possibly lower her risk through lifestyle changes, such as diet and exercise, or even through other strategies such as chemoprevention by taking the medicine Tamoxifen or having a prophylactic double mastectomy.
"To have a meaningful impact on breast cancer mortality, the focus must be changed from 'detect and treat,' to 'screen for risk and prevent,'" Shapiro says.
Just as with thermograpy, no studies have yet found the HALO technique is a proven technique to detect breast cancer, but these technological advancements may bring us closer to detecting cancer earlier. And for one in eight women, these detection advancements could mean a life free of harsh life-saving cancer treatments, such as chemotherapy, radiation and surgery.
Amanda Koehler is an associate editor with ADVANCE newsmagazines, the parent company that produces magazines for health care providers as well as this patient resource center.
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