May is Women’s Health month and serves as a reminder for screening, prevention, and early detection of breast cancer, which is the most common type of cancer in women and the second leading cause of cancer death in women, followed only by lung cancer. Invasive ductal carcinoma accounts for 80% of breast cancers, with the potential for spread into the axillary lymph nodes, and metastasis to brain, bone, and liver. The goal of imaging is early detection in the precancerous ductal carcinoma in-situ (DCIS) stage, now much improved with the use of magnetic resonance imaging (MRI) of the breast, which increases the sensitivity of breast cancer detection from 40% to 95% from traditional mammography screening alone. Lifetime risk of developing invasive breast cancer is about one in eight, or 13%, of women. In recent years, there has been a progressive decline in the mortality rate from breast cancer as a result of increased awareness, early screening, early detection with new imaging technologies in high risk patients, and improved treatment methods.

 

Risk factors for developing breast cancer include gender, family history, hormonal, environmental, and lifestyle factors.

• Gender is the biggest risk because breast cancer occurs mostly in women.

• Family history has long been established as a significant risk factor for breast cancer. Both maternal and paternal relatives are at risk. The risk is highest if the affected relative developed breast cancer at a young age, had cancer in both breasts, and is a first-degree relative (such as a mother, sister, or daughter). About 5-10% of breast cancers are believed to be hereditary, as a result of the genetic mutations, BRCA1 and BRCA2, which increases the lifetime risk of developing breast cancer to 40-85%.

• Hormonal changes, such as women with early menarche or late menopause, are associated with slightly higher risk of developing breast cancer.

• Radiation exposure to the breast (before the age of 30) is associated with a significantly higher incidence of breast cancer compared to the general population.

• Lifestyle considerations for developing breast cancer include high dietary intake of fat, obesity, alcohol use, and lack of exercise.

• Proliferative or hyperplastic changes in the breast (such as atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in-situ) are associated with increased risk of latent development of breast cancer.

 

Breast cancer diagnosis is a multi-disciplinary approach, including clinical breast examination, diagnostic testing (mammography, possibly ultrasonography or MRI), and biopsy. The American Cancer Society recommends the following screening guidelines and prevention methods:

• Regular monthly patient self-breast examination.

• Clinical breast examination by a trained health-care provider, once every 3 years beginning at age 20, and then annually after age 40. The clinical breast examination should include visual inspection and careful palpation for a lump or thickening in both breasts, axilla, and supraclavicular lymph nodes.

• Annual screening mammograms beginning at age 40; earlier than age 40, in high risk women and family history of breast cancer.

• Combined annual MRI and mammography screening in high risk women beginning at the age of 30 (the latest ACS recommendation).

• Personal history of newly diagnosed breast cancer requires close short-term follow-up every 3-6 months for up to 2-3 years until a new stable baseline is established.

• Lifestyle modification, including obesity reduction, increased physical activity, reducing alcohol intake, and limiting hormone replacement all have been shown to reduce the risk of developing breast cancer.

Surgical planning now includes 3D Breast MRI with computerized assisted detection (CAD) for non-invasive and fast imaging for staging of breast cancer into multiple quadrants of the breast, establishing tumor size and margins, involvement of axillary lymph nodes, and chest wall. MRI detects multifocal/multicentric breast cancers in 8% and contralateral breast cancers in 5% of newly diagnosed breast cancer cases, otherwise missed by conventional methods. MRI lowers the potential cancer re-excision rate from 40% to less than 10%, even when surgical margins are apparently clear on pathologic specimens. MRI also can be used for presurgical chemotherapy or to monitor the progress of neoadjuvant chemotherapy. 

In summary, the outlook for breast cancer continues to improve due to increased public awareness, better screening protocols, and advances in diagnostic imaging and therapy. Modern imaging has significantly improved the detection of noninvasive cancers, associated with a very high cure rate. Breast MRI has significantly improved staging of breast cancer and lowered the re-occurrence and re-excision rates. Breast cancer is now a highly treatable disease. The best chance for successful therapy and cure is through early detection.

 
 

 

Vincon Diagnostic Center
3D Breast MRI/3D Breast Ultrasound
Digital Mammography



5732 Canton Cove
Winter Springs, Florida 32708
(407) 699-7787

www.vincondiagnostic.com