Hormones 2016

Breast disorders
Ultrasonography can be used to diagnose breast abnormalities and to
stage breast cancer. If mammography detects one or more masses,
ultrasonography is used to further evaluate them (eg, to determine whether
they are solid or cystic). Ultrasonography is also used to evaluate
abnormalities detected by MRI. Ultrasonography can be used before staging
to identify abnormal axillary nodes that may require core biopsy.
MRI can be used to diagnose breast abnormalities and, before surgery, to
accurately determine tumour size, chest wall involvement, and number of
tumours. MRI is also used to identify abnormal axillary lymph nodes (to
help stage breast cancer). For women at high risk of breast cancer (eg,
with a BRCA gene mutation or a calculated lifetime risk of breast cancer
of ≥ 15 to 20%), screening should include MRI in addition to clinical breast
examination and mammography. MRI is not considered appropriate for
screening women with average or slightly increased risk (Kosir, 2013e)
Screening
Screening includes mammography, clinical breast examination (CBE) by
health care practitioners, MRI (for high-risk patients), and monthly breast
self-examination (BSE).
Mammography, done annually, is recommended for women ≥ 50; it reduces
mortality rate by 25 to 35% in this age group. Mammography is more
accurate in older women, partly because with aging, fibroglandular tissue
in breasts tends to be replaced with fatty tissue, which can be more
easily distinguished from abnormal tissue. However, there is considerable
disagreement about screening for women 40 to 50 years; recommendations
include annual mammography (American Cancer Society), mammography
every 1 to 2 yr (National Cancer Institute), and no periodic mammography
(American College of Physicians). Concerns about screening too soon or too
often include increased radiation exposure and overdiagnosis of tumours
(eg, ductal carcinoma in situ (DCIS)) that may not develop into invasive
cancer during the patients lifetime. Young age at the time of radiation
exposure increases the risk of cancer. On balance, most experts recommend
screening mammography every 1 to 2 years for women aged 40 to 50.
Only about 10 to 15% of abnormalities detected on screening mammography
result from cancer, and false-negative results may exceed 15%.
Accuracy depends partly on the techniques used and experience of
the mammographer. Some centres use computer analysis of digitized
mammography images (full-field digital mammography) to help in
diagnosis. Such systems may be slightly more sensitive for invasive cancers
in women < 50 when results are interpreted by radiologists, but probably
not when interpreted primarily via computer detection.
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