This presupposes early diagnosis through screening programs, combined with proper clinical follow-up by a highly specialized breast doctor.
It is estimated that during a woman’s lifetime the chance of developing breast cancer reaches 12% -13%. This percentage refers to women at medium risk who constitute the majority of cases, ie the so-called sporadic cancer. But there are other population groups, the so-called high risk, in which the probability of occurrence is significantly higher and therefore, need a different and individualized approach.
Prevention is based on a simple, non-invasive, low-cost, highly sensitive and specialized test. It is divided into primary
(eg vaccines), secondary (eg PSA for prostate cancer in men) and tertiary (any form of treatment reduces the chance of recurrence in patients diagnosed with cancer).
There is no primary prevention for breast cancer. It is recommended to avoid alcohol, smoking and maintain a normal weight.
In addition, mammography as a means of secondary prevention has a proven benefit. Studies have shown that breast cancer mortality has decreased by 39% from 1989 to 2015. This reduction has been attributed to the implementation of systemic treatment as well as population screening programs with mammography.
In clinical practice, the use of mathematical models helps to calculate the likelihood of developing breast cancer, as well as to classify patients as moderate or high risk. The most common model used is the modified Gail 2 model or NCI Breast Cancer RiskAssessment Tool. It is noted that there are other mathematical models used to identify high-risk women, and knowledge of the BRCA1 / 2 gene mutation is also important.
In selected cases (eg dense breasts) the test should be completed with a breast ultrasound. In addition, 3D digital breast reconstruction (tomosynthesis) is gaining more and more ground in the screening of women, especially those with dense breasts. Tomosynthesis appears to increase the possibility of detecting breast cancer and reduce the false negative results of mammography.
Preventive control
For moderate-risk patients, screening is performed annually with a digital mammogram from the age of 40. The clinical examination of the breast should be done every 3 years for women 20-30 years old and annually for those over 40.
In contrast, in high-risk patients (with a family history, genetic predisposition, individual history of breast cancer, etc.) screening consists of:
• clinical examination every 6-12 months from the age of 25 or 10 years before the age of onset of breast cancer in the youngest relative.
• annual MRI examination from the age of 25 and annual mammography from the age of 30.
• Breast ultrasound in case of inability to perform MRI and as an additional examination for mammography (dense breasts).
Women at high risk for developing breast cancer should discuss with their doctor the benefits and limitations of starting an earlier mammogram, the need for additional tests (eg MRI), or the increase in frequency of examinations.
In addition to improving survival rates, screening also increases the chance of breast preservation as it can detect smaller, non-palpable breast lesions.
Writes:
Irini Karyda Breast Surgeon
Director of Breast Center HYGEIA
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