} FEATURE
Screenings the
importance of
This is a tale of good news and bad news. The bad news: most women can quote the statistics, 1 in 8 women will develop breast cancer. Let us look a little closer at these statistics to find some good news. It is true that 1 in 8 women will develop breast cancer, but that is in the span of a lifetime. By age 20, the risk is 1 in 1,760, by age 30 it rises to 1 in 229, and by age 40 it goes up to 1 in 69. Though not zero risk, these are not statistics one should be overly concerned about. It does start to rise to 1 out of 42 at age 50, 1 out of 29 at age 60, and 1 out of 27 by age 70. The lifetime risk is 1 out of 8. Clearly, breast cancer risk rises with age. The significant rise begins between the ages of 40-50. More bad news: the main risk factor for developing breast cancer is one’s sex followed by one’s age. These are both things women have no control over. Other factors include early menarche, late menopause, and increasing times of unopposed estrogen from fewer children and then choosing not to nurse. These are factors in which today’s women still have little control over. There have been studies linking obesity, alcohol, tobacco, and lack of exercise to breast cancer. Though not statistically relevant, living a healthy lifestyle is always helpful. There is some good news that has been found over the last decade, 10% of breast cancer is genetic in origin. The BRC-1 and BRC-2 genes can be tested for and if present, can lead to lifestyle choices and further strategies to detect and treat. Breast cancer is the second most common cancer in women just behind skin cancer. Breast cancer accounts for 1 out of every 4 cancers detected in women. It is no longer a death sentence diagnosis. Cancer survival is statistically monitored by what is called 5 year survival by which one colloquially can call a ‘cure”. Depending on the staging of breast cancer, the difference in survival is primarily a factor of the size of the tumor. Ductal carcinoma-in-situ, kind of like a pre-cancer, has a 100% 5 year survival with proper surgical treatment. Remarkably a tumor up to 2 cm or
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Inside Medicine | Holiday Issue 2017
by Paul Fry, MD
a Stage 1 Cancer also has a 100% 5 year survival. A tumor up to 5 cm, about the size one would start to palpate a “lump”, the 5 year survival is near as high, 97%. Stage 3 Cancer, usually a tumor larger than 5 cm or with lymph node involvement, the 5 year survival is still good, 72%. Sadly, once metastatic, the 5 year survival falls to 22%. These statistics are indeed a tale of good and bad news. Compared to other cancers, the survival rate is much better. For instance, Lung Cancer 5 year survival is only 10-15%. Colon Cancer is at 40-50% but falls to only 5% if metastatic. Pancreatic Cancer has only a 5% 5 year survival. Clearly the earlier and ultimately smaller the tumor is detected, the better the survival. The key is early detection. The goal is to detect a tumor before it could be detected by self-exam or physician exam. Screening mammography is the main tool for this early detection. Screening mammography began to be implemented in the late 1980s to the 1990s. Since 1990 there has been a 38% decline in mortality from carcinoma. Though beyond the scope of this article there have been studies directly linking the decrease in mortality to the increasing utilization of screening mammography. Though one of the most common cancers, we are fortunate in that breast cancer is one of the slowest growing cancers. This has allowed us to implement a screening program with a frequency calculated to detect new cancers or changes in size of a cancer between screening tests. The average breast cancer “doubling rate”, the time to double the number of cancer cells, is 282 days, this is just under one year. This is the amount of time one should be able to see interval changes in breast densities or to first detect new lesions. Ideally, with yearly mammograms, a new or growing tumor would be detected in this interval. Mammography is a low dose X-Ray of the breasts. Mammograms are only performed at special facilities that meet both government regulatory and professional society accreditation. A radiologist who is specially
