25 Years of Progress in the Detection and Treatment of Breast Cancer

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But much of the progress we’ve made could be lost, if we abandon our vigilance in screening. Despite scientific advances, one sobering fact remains: ALL women are at risk of developing breast cancer. One in eight women will eventually be diagnosed with this potentially deadly disease.

And just because you don't have a family history of breast cancer, it doesn't mean you’re not at risk. Seventy-five percent of women with newly-diagnosed breast cancers have no family history or any other significant risk factors, like the breast cancer gene. Although the incidence of breast cancer increases as you get older, age isn't necessarily protective; 20 percent of all breast cancers occur in women under 50. 

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There is only one test that has been shown in multiple clinical studies to reduce the risk of dying from breast cancer: screening mammography. To save the most lives, Intermountain Healthcare and I stand with the U.S. Preventive Services Task Force, the American Congress of Obstetrics and Gynecology, the American Cancer Society, the American College of Radiologists, and the American College of Surgeons in recommending that women begin annual screening mammography at the age of 40.

Although this is contrary to the some recently-published, controversial guidelines, our recommendations are supported by the results of multiple clinical trials and other scientific studies. Thousands of lives would be lost if women didn’t start annual mammography screenings at age 40.

In addition to traditional film screen and 2D mammography, here are six detection and treatment advancements that have improved patient care in the past 25 years. These advancements can save lives, provided women get screened in time to take advantage of them:

  1. 3D mammography, also known as digital breast tomosynthesis, is a type of mammogram that improves radiologists' ability to detect breast cancers that may be obscured by overlying tissue. It is acquired along with a 2D digital mammogram, but only adds a few seconds to the overall exam time. It also reduces the number of women called back for additional tests. 
  2. MRI, the most sensitive imaging exam in the detection of breast cancer, is reserved for women with a greater than 20–25 percent lifetime risk of developing the disease. It also is helpful in defining the extent of disease in women already diagnosed. Because it results in more false positive interpretations, it’s used primarily in women who fit certain risk criteria.
  3. Non-surgical, or image-guided needle biopsies have replaced open surgical biopsies in the diagnosis of breast cancer.  For the most part, only those women with breast cancer or high-risk lesions undergo surgery. 
  4. Sentinel lymph node biopsies, performed at the time of cancer surgery, allow surgeons to biopsy just one lymph node for diagnosis, instead of  removing all of the axillary lymph nodes. 
  5. Advances in pathological testing of tumor markers has greatly improved diagnostic accuracy, often determining which patients will benefit from chemotherapy and what sort of treatments may be most beneficial.
  6. Targeted chemotherapy personalizes the care we offer each of our patients, so they don’t receive more or less treatment than they need. 

Any woman — regardless of her age — with a breast lump or other concerning symptoms should consult her primary care provider for a clinical breast exam. This may be followed by a mammogram, ultrasound, or both. Other worrisome symptoms include skin changes/itching involving the nipple-areolar complex, clear or bloody nipple discharge, thickening, or a change on self-examination. Don't ignore these signs. 

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Far too many women still die from breast cancer. By detecting it at its earliest, most-treatable stage, the death rate will continue to plummet. We do not yet have the knowledge to prevent cancer, but we certainly have the tools to minimize its impact. And the best tool we have is screening mammography. If you’re 40 or older, and haven't had a mammogram in over a year, schedule one today. It may save your life. 

To continue the downward trend in breast cancer deaths, we must ensure that screening continue to be covered by insurance. A congressional mandate that requires insurance carriers to provide annual screening benefits, starting at age 40, will expire on December 31, 2017, unless our representatives act to extend it. Be proactive: Let your government leaders know you support insurance coverage for annual screening beginning at age 40. When the time comes, and the issue is on the congressional docket, let your voice be heard!