Breast Cancer Breast self-examination, clinical breast examination by a care giver, and mammography have been advocated as useful screening tools. Only screening mammography alone and screening mammography with clinical examination have been evaluated in randomized controlled trials. MRI is being assessed and is more accurate than mammography in women at high risk due to genetic predisposition or in women with very dense breast tissue. A number of trials have suggested that annual or biennial screening with mammography or mammography plus clinical breast examination in normal-risk women over the age of 50 decreases breast cancer mortality. Each trial has been criticized for. | Chapter 078. Prevention and Early Detection of Cancer Part 9 Breast Cancer Breast self-examination clinical breast examination by a care giver and mammography have been advocated as useful screening tools. Only screening mammography alone and screening mammography with clinical examination have been evaluated in randomized controlled trials. MRI is being assessed and is more accurate than mammography in women at high risk due to genetic predisposition or in women with very dense breast tissue. A number of trials have suggested that annual or biennial screening with mammography or mammography plus clinical breast examination in normal-risk women over the age of 50 decreases breast cancer mortality. Each trial has been criticized for design flaws. In most trials breast cancer mortality rate is decreased by 20-30 . Experts disagree on whether average-risk women age 40-49 should receive regular screening Table 78-3 . The significance of the screening effect in women aged 40-49 depends on the statistical test used. An analysis of eight large randomized trials showed no benefit from mammography screening for women aged 40-49 when assessed 5-7 years after trial entry. However a small benefit emerged 10-12 years after study entry. What proportion of this benefit is due to screening after these women turned 50 is not known. In randomized screening studies of women aged 50-69 the mortality decline begins about 5 years after initiation of screening. Nearly half of women aged 40-49 screened annually will have false-positive mammograms necessitating further evaluation often including biopsy. The risk of false-positive testing should be discussed with the patient. No study of breast self-examination has shown it to decrease mortality however it is recommended as prudent by many organizations. A substantial fraction of breast cancers are first detected by patients. Self-examination leads to increased biopsy rate without reducing breast cancer mortality. Genetic screening for .
