Screening for breast cancer

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Thousands of women die every year from breast cancer. A woman has a one-in-nine chance of having breast cancer sometime in her lifetime.

Who's at risk?

Your risk of getting breast cancer increases as you get older or if your mother, sister, or maternal grandmother had breast cancer. Sometimes the family risk is inherited in a breast cancer gene called BRCA1 and BRCA2. There is a test for these genes, however, it is not practical to test all women as only a small number of women with breast cancer have BRCA1 or BRCA2.

Western women (e.g., from North America) have a rate of breast cancer five to seven times higher than women from Asia. You also have a higher risk if you have had breast disease with dsyplasia (abnormal cells) or fibroadenomas (benign breast lumps).

Hormones can affect breast cancer. If you had your first menstrual period before age 12, if your first pregnancy was after age 30, or if you did not breastfeed, you have a higher risk of breast cancer.

Menopause actually protects a woman from breast cancer. This may be because less of the hormone estrogen is circulating in the body.

High estrogen levels in the body have been associated with a greater risk of breast cancer. Women that use the birth control pill have a slightly increased risk of breast cancer, however that risk disappears 10 years after the pill is stopped.

More breast cancer occurs in women who drink alcohol or who have smoked cigarettes for over 30 years. You also increase your risk of breast cancer if you don't eat vegetables.

Finding cancer before it kills

About 70 per cent of women treated for breast cancer are still alive 10 years later. Your chance of being cured is better the earlier you discover breast cancer. That is where screening comes in. Breast cancer may take years to develop and screening can help detect the cancer early on when treatment is most effective.

Breast self-examination (BSE)

BSE basically means a woman inspects and palpates (feels) her own breast and armpit for any suspicious lumps. BSE still has controversy surrounding it. The Canadian recommendations for BSE are that health care professionals should not teach it or promote it to women. In other words, there is no need for most women to do the BSE. This is based on the evidence of several large clinical studies that have shown that there are no benefits to BSE.

However, despite this information, the Canadian Cancer Society and the American Academy of Family Physicians are still recommending women do BSE.

Doctor's exam

Your family physician or gynecologist may examine your breasts during your regular physical examination. If a suspicious lump is found, your doctor may order an ultrasound or mammogram of the breast. Sometimes, the doctor will recommend a needle biopsy or aspirate. This is where a needle is inserted into a suspicious lump, and a sample is taken out and looked at under a microscope.

Mammograms are special X-rays of the breast that can detect breast cancer when it is very small. In Canada, women may have their first screening mammogram before age 50 if they have risks for breast cancer. Canadian recommendations are that women over age 49 have a screening mammogram done every two years. Women at higher risk may be offered mammograms every year. Talk with your family physician about your risks.

This column is for reference and education only and is not intended to be a substitute for the advice of an appropriate health care professional. The author assumes no responsibility or liability arising from any outdated information, errors, omissions, claims, demands, damages, actions, or causes of actions from the use of any of the above.

Dr. Pinette is a Metis family physician in Manitoba and host of APTN's Medicine Chest. Contact Dr. Pinette at pinette@shaw.ca.