Antinuclear

• Mother knows best in advising a second opinion on breast cancer screening
• Boost in demand for breast cancer checks
• Breast cancer test not failsafe, women warned

The problem of screening younger women for breast cancer is an important health issue.

All too frequently we see women between 30 and 50 years of age presenting with a palpable clinical lump which turns out to be cancer and often at a rather late stage. Furthermore, when compared to the older more typical age group, young women with breast cancer usually have more aggressive high-grade disease. Frequently, even if a mammogram has been performed, nothing has shown up, often because the cancer cannot be distinguished from the normal dense breast tissue which most young women naturally have in preparation for lactation.

As women get older the breasts tend to involute and become more fatty, so mammography then does a much better job – hence the national screening program is aimed at women over 50 years. That said, though, a proportion of women have significant density persisting even beyond menopause.
Mammography, which uses X-rays, is something we try to avoid in younger women because radiation can actually cause cells to undergo malignant change. Guidelines generally recommend avoiding mammography at least until the mid-30s and there is still debate about whether routine screening mammography is worthwhile in the 40-to-50 age group.

The inconvenient truth here is that the sensitivity (detection rate) of X-ray mammography falls to well under 50 per cent in the densest breasts, so only half the cancers that may be present are likely to be detected.

The issue is topical at the moment as several US states have recently legislated that radiologists must tell women if they have dense tissue and explain that as a result mammography will be less effective.

Interestingly this all came about from the efforts of a young woman who was diagnosed with breast cancer and, quite reasonably, wanted to understand why it had not been seen on her recent mammogram. This case is having repercussions in Australia as radiologists are reconsidering the way they approach breast density as well……

To my mind, it is what we call the NPV, the negative predictive value, of breast MRI which is the most valuable in giving reassurance. When a good-quality, well-performed and competently reported MRI returns a normal result, the risk of breast cancer being diagnosed in the next 12 months (an interval cancer) is less than 1 per cent; and we cannot say that for any other breast imaging test.

The downsides of MRI? Cost, of course, is the main one,………

While mammography is still a very useful test, it has limitations, and having had a recent mammogram does not definitively exclude cancer. So, any change in the breasts, particularly a painless lump, requires a timely trip to the GP.  http://www.canberratimes.com.au/comment/radiologist-issues-a-caution-on-breast-cancer-screening-for-young-women-20131225-2zwro.html#ixzz2oapXxyMs