Breast Cancer Screening: Common Questions and Answers.

Breast cancer is the most common nonskin cancer in women and accounts for 30% of all new cancers in the United States. The highest incidence of breast cancer is in women 70 to 74 years of age. Numerous risk factors are associated with the development of breast cancer. A risk assessment tool can be used to determine individual risk and help guide screening decisions. The U.S. Preventive Services Task Force (USPSTF) and American Academy of Family Physicians (AAFP) recommend against teaching average-risk women to perform breast self-examinations. The USPSTF and AAFP recommend biennial screening mammography for average-risk women 50 to 74 years of age. However, there is no strong evidence supporting a net benefit of mammography screening in average-risk women 40 to 49 years of age; therefore, the USPSTF and AAFP recommend individualized decision-making in these women. For average-risk women 75 years and older, the USPSTF and AAFP conclude that there is insufficient evidence to recommend screening, but the American College of Obstetricians and Gynecologists and the American Cancer Society state that screening may continue depending on the woman's health status and life expectancy. Women at high risk of breast cancer may benefit from mammography starting at 30 years of age or earlier, with supplemental screening such as magnetic resonance imaging. Supplemental ultrasonography in women with dense breasts increases cancer detection but also false-positive results.

Awareness of Breast Cancer Risk Factors, Symptoms and Breast Self-Examination Among Omani Female Teachers: A cross-sectional study.

OBJECTIVES: This study aimed to assess knowledge of breast cancer (BC) risk factors, warning signs and symptoms and breast self-examination (BSE) practice among Omani female teachers in Al-Dhahira Governorate. METHODS: A cross-sectional sample of female teachers aged 20-50 years was collected from January to December 2018 from three wilayats (provinces) in Al-Dhahira-Ibri, Dhank and Yunqal. A questionnaire that included the Breast Cancer Awareness Scale and demographic characteristics was administered. Data were analysed using descriptive statistics, regression analysis and Pearson's Chi-square test. RESULTS: A total of 478 female teachers were included in the study (response rate: 72.4%). The majority of participants (60.5%) had good overall knowledge about BC while 19.9% of participants had excellent overall knowledge. Only 9% of participants demonstrating excellent knowledge of BC risk factors. More than half of the participants (56.1%) reported excellent knowledge in screening methods. Unfortunately, only 57% of the female teachers indicated practising BSE. Knowledge of BC symptoms was closely divided between excellent and good levels (45.8 and 42.5%, respectively). BSE practice was significantly (P <0.05) correlated with overall knowledge of BC and its symptoms and screening methods, but not with knowledge of BC risk factors. CONCLUSION: This study revealed unsatisfactory overall knowledge of BC risk factors, symptoms, screening methods and BSE practice among female Omani teachers in Al-Dhahira Governorate. These findings constitute a challenge to healthcare providers to continue developing awareness of BC and providing health information to the public.

Assessment of knowledge and practice of breast self-examination among reproductive age women in Akatsi South district of Volta region of Ghana.

BACKGROUND: Breast cancer is the primary cause of cancer death among women globally, responsible for about 425,000 deaths in 2010. This study assessed the awareness, knowledge and practices of breast self-examination as a method of prevention and early diagnosis of breast cancer among reproductive aged women in Akatsi South district in Volta region of Ghana. METHODS: This study was a cross-sectional study involving 385 women between the ages of 15-49 years. Data were collected with a structured questionnaire and variables included socio-demographic characteristics, breast cancer knowledge, breast self-examination knowledge and practice. Descriptive statistics were used to analyze and present the data and chi square test of significance was used to determine association between socio-demographic variable and practice of breast self-examination. RESULTS: The mean age of the women was 24.54±7.19. Only 3.1% of women had no formal education and 58.9% were single. Although 88.3% of the respondents were aware of breast cancer, 64.9% of the respondents had good or sufficient knowledge of breast cancer and only 94(37.6%) practice BSE. Over 50% of the respondents did not know how to perform BSE. There was a significant association between knowledge on breast cancer and practice of BSE (χ2 = 36.218 p = 0.000). The higher the age of a participant, the lower practice of breast self-examination and this was significant (χ2 = 11.324, p = 0.003). CONCLUSION: Breast self-examination is a key strategy to early detection of breast cancer and subsequently critical for effective treatment and cure of the disease. The findings in this study have shown significant low levels of awareness and practice of breast self-examination among women in Akatsi South district of the Volta region. This pattern may be similar to other rural communities across the region. The need to create awareness and to educate women, especially rural women, on importance of breast self-examination as preventive measure for breast cancer is paramount.

Interventions Promoting Breast Cancer Screening Among Turkish Women With Global Implications: A Systematic Review.

BACKGROUND: Breast cancer is a major health concern and remains the most common malignancy in women worldwide and in Turkey. Mammography, clinical breast examination (CBE), and breast self-examination (BSE) are recommended methods to detect early breast cancer in women. Many strategies have been developed to increase the rates of mammography, CBE, and BSE among Turkish women. Despite the benefits of breast cancer screening, these modalities are still underutilized by the majority of Turkish women. AIM: To systematically review the scientific evidence on the effectiveness of various strategies aimed at improving screening behaviors for breast cancer in Turkish women. METHODS: A systematic review of the literature published between 2000 and 2015 was conducted, searching 10 databases of Ovid MEDLINE, PubMed, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO, Web of Knowledge, Scopus, Google Scholar, ULAKBIM Turkish Medical Database, and Council of Higher Education Thesis Center. RESULTS: Twenty-three studies were included in the final review. The majority of the studies investigated the effects of multiple strategies to improve BSE. Group education comprised educational sessions, printed and audiovisual materials, which significantly improved BSE, CBE, and mammography screening rates at 3 months, 6 months, and 12 months after the intervention. One-to-one education demonstrated no significant difference in BSE rates at 6-month and 12-month follow-up. However, one-to-one education demonstrated significant differences in CBE and mammography rates at the 3-month follow-up. LINKING EVIDENCE TO ACTION: The use of group education comprising a multicomponent intervention demonstrated an increase in breast-screening behaviors among Turkish women. Further research investigating the duration of educational interventions is needed in order to suggest a "dose response."

Knowledge and awareness of breast cancer among rural women in Umuowa Orlu Local Government Area Imo State, South East, Nigeria.

BACKGROUND: Many women with breast cancer present at the health institutions with advanced multiple nodal involvements have poor prognostic outcome. Knowledge and awareness of breast cancer may promote health-seeking behavior, thus early diagnosis and increased survival rate of breast cancer cases. The objective of this study was to assess the level of knowledge and awareness of women on breast self-examination (BSE) in Umuowa, which would guide future intervention program on breast cancer prevention and control in the community. METHOD: Descriptive survey design with the aid of a questionnaire served as an interview schedule for the study on 349 Women in Umuoawa, Orlu Local Government Area (LGA) of Imo State. Descriptive and inferential analysis was done using Statistical Package for Social Sciences. RESULTS: The main outcome measure was the level of awareness on breast cancer. With a Pearson's correlation coefficient (R) of 0.569 and a Spearman's rank correlation coefficient (r) of 0.600 and a P value of 0.000 < 0.05, a correlation between educational attainment and BSE awareness was established. The correlation coefficient being positive, the result showed that with increase in educational attainment, the awareness of BSE increased and vice versa. Thus, there was a positive relationship between educational attainment and the awareness of BSE. One hundred and four (29.8%) respondents showed that breast cancer is an illness caused by ancestral forces. Their knowledge of the risks factors for breast cancer was also low. Their major source of information on breast cancer was through health care providers followed by friends/relatives. CONCLUSION: There is a need to scale up health education programs to remove myths regarding breast cancer and improve health-seeking behavior among the rural women.

Predictors of breast self-examination performance among Jordanian university female students.

Breast cancer is considered one of the main types of cancer among female worldwide and in Jordan also. Early detection of it will improve the prognosis and decrease the mortality rate also. Thus, this study was conducted to assess the predictors of breast self-examination performance among Jordanian university female students. Across-sectional design was utilised in this study. A sample of 100 participants was completed the study survey (The Champion's Health Belief Model Scale). The main results or regression analysis showed that confidence (ß = .71, p < .0001) and perceived barriers (ß = -.061, p = .0004) were significant predictors of breast self-examination performance. In summary, other variables of Health belief model were found not be significant indicators of BSE performance in this study. However, the HBM is considered a valid framework to assess the predictors of breast self-examination knowledge, attitude, beliefs and barriers among Jordanian college female students.

[Effectiveness of supervised breast self-examination as educational strategy]. / Efectividad de la autoexploración mamaria supervisada como estrategia educative.

BACKGROUND: Breast cancer is the leading cause of death from cancer in the female population; consequently, there are multiple prevention campaigns. Within these campaigns, a special emphasis is given on promoting monthly breast self-examination; however, many women have never received formal education on proper method of self-examination. OBJECTIVE: To establish if the educational intervention we propose improves the breast self-examination technique. MATERIAL AND METHODS: A descriptive longitudinal study that included 52 women aged 20-40 years, attending a Family Medicine Unit of the Mexican Institute of Social Security, who were evaluated about self-examination technique before and after educational intervention, measured on a scale of 0 to 16. Statistical analysis was made with descriptive statistics and Student's t test. RESULTS: The mean age was 30.76 ± 5.87 years. The mean baseline score was 3.13 ± 2.55. The final average score after a month of the educational intervention was 10.69 ± 2.74, which represents an increase in average score of 7.55 ± 3.53. There was a significant increase in assessment scores after the educational intervention (p < 0.001). CONCLUSIONS: "Supervised breast self-examination" technique showed an increase in the ability of self-examination in patients. It can be considered an effective complementary method of teaching breast self-examination.

Breast self examination and mammography in cancer screening: women health protective behavior.

BACKGROUND: Breast cancer (BC) is one of the leading causes of death among women. Secondary prevention may enable early detection, but this is suboptimal among all Iranian women. METHODS: This was a descriptive, analytic cross sectional study on 385 women 35 years old or more with no history of BC. Participants were selected by simple randomized method and were assessed through a two-part self-administered questionnaire and a self-examination checklist with content validity and test-re-test reliability. RESULTS: 14.8% of women carried out breast self examination (BSE). Among them 5.7% was done in adequate timing and 9.4% performed it on a regular basis. The average age of BSE onset was 20.1 ± 7.6 and mean of Score was 6.25 ± 2.26 (2-11). 2.3% of participants performed BSE poorly, 7.5% fairly and 1.6% performed it well. 25.84% of samples had a history of mammography that 13% of whom received it as a result of prescription. The average age for mammography was 36 ± 7.2 (20-50) years and the frequency of mammography was 1.8 ± 1.4 (1-8) of times. Due to the low percentage of breast cancer preventive behaviors, in this study knowledge towards breast cancer was also measured because they are factors that are crucial in performance. CONCLUSION: The results highlight the need to educate Iranian women to recognize the risk factors to promote early detection of breast cancer. Creation of health behavioral by focused educational programs might cause decrease of breast cancer prevalence.

ACR appropriateness criteria palpable breast masses.

A palpable breast mass is one of the most common presenting features of breast carcinoma. However, the clinical features are frequently nonspecific. Imaging performed before biopsy is helpful in characterizing the nature of the mass. For women with clinically detected breast masses, the vast majority will require evaluation with ultrasound. Diagnostic mammography is the initial imaging modality of choice for women aged ≥ 40 years; ultrasound is typically necessary unless a definitively benign mass is identified as the etiology of the clinical finding. For evaluating women aged <30 years and women who are pregnant or lactating, ultrasound is used for initial evaluation. For women aged 30 to 39 years, either ultrasound or diagnostic mammography may be used for initial evaluation. MRI is rarely indicated to evaluate a clinically detected finding. Biopsy is indicated for masses with suspicious features. Short-term follow-up is a reasonable alternative to biopsy for solid masses with probably benign features suggesting fibroadenoma. Correlation between imaging and the clinical finding is essential. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Controversies regarding mammography, breast self-examination, and clinical breast examination.

The number of women diagnosed with breast cancer continues to increase, but mortality rates have substantially declined. Much of the credit for this decline has been attributed to early detection from mammographic screening. However, there are significant controversies about the effectiveness of all screening tools for breast cancer, concerns about the potential harm that can result from screening, and questions about the appropriateness of screening recommendations. One of the greatest barriers to achieving consensus is the lack of agreement about the purpose of screening efforts. This article reviews many of the current controversies and attempts to clarify the arguments.

[Breast self-examination as main technique for breast cancer prevention]. / La autoexploración mamaria como principal técnica de prevención del cáncer de mama.

Breast cancer is the most common malignancy in women. Breast self-examination stands out as the main preventive measure, since almost 95% of breast tumours are detected by the woman herself through this technique. Nursing is the group most closely related to health education appropriate guidelines to perform the technique correctly: monthly technical realization, recognition of abnormalities in the breast, go to the doctor for possible doubt about changes in them, etc.

Quality of breast cancer early detection services conducted by well woman clinics in the district of Gampaha, Sri Lanka.

BACKGROUND: Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality. AIM: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: The study consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE) coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003- 2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services. The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values, which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire. RESULTS: CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35- 90%). The items that were lacking included dust bins, notice boards, stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities, punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breast self-examination (BSE) were substandard in 7- 20 clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ≥70%, the cut off set for satisfaction. CONCLUSIONS: Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSE.

Breast cancer screening update.

Breast cancer is the most common non-skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to reduce breast cancer-related mortality. There is general agreement that screening should be offered at least biennially to women 50 to 74 years of age. For women 40 to 49 years of age, the risks and benefits of screening should be discussed, and the decision to perform screening should take into consideration the individual patient risk, values, and comfort level of the patient and physician. Information is lacking about the effectiveness of screening in women 75 years and older. The decision to screen women in this age group should be individualized, keeping the patient's life expectancy, functional status, and goals of care in mind. For women with an estimated lifetime breast cancer risk of more than 20 percent or who have a BRCA mutation, screening should begin at 25 years of age or at the age that is five to 10 years younger than the earliest age that breast cancer was diagnosed in the family. Screening with magnetic resonance imaging may be considered in high-risk women, but its impact on breast cancer mortality is uncertain. Clinical breast examination plus mammography seems to be no more effective than mammography alone at reducing breast cancer mortality. Teaching breast self-examination does not improve mortality and is not recommended; however, women should be aware of any changes in their breasts and report them promptly.

Breast lump detection: who is more accurate, patients or their GPs?

AIMS: A breast lump is the most commonly presenting complaint given by GPs when making a referral to the local breast unit. This does not necessarily mean that this was the breast symptom for which the woman consulted her GP. This study aimed to assess the accuracy of women and their GPs in detecting true breast lumps. MATERIALS AND METHODS: Between October 2008 and March 2009, the patients' symptoms, the signs elicited by the GP and the examination findings of the specialist breast clinician (BC) were recorded and compared for every consecutive new referral to the symptomatic breast clinic. A true lump was considered to present if it was detectable by the BC. RESULTS: Of the 282 referrals, 228 (81%) were for a lump. Women were 95% sensitive and 59% specific in detecting a true lump. GPs were 98% sensitive and 34% specific. Forty-six patients were referred by their GP with a lump but denied that one was present in themselves. Cancer was diagnosed in four of these women, three of whom suffered from dementia. DISCUSSION: Patients' and GPs' breast assessments are highly sensitive in detecting breast lumps. The specificity of GPs' assessments is low. The results reflect the high level of awareness that breast cancer usually presents as a lump and the priority given to not missing cancer. In the subgroup of cognitively unimpaired women referred with a lump, but who themselves deny that one is present, the patient will be correct and the GP incorrect in their assessment in 96% and 95% of patients respectively. CONCLUSION: If a woman consults her GP with breast symptoms, but has not found a lump, it is safe for her GP not to find one either. Such patients can be reassured and reviewed after a month with a view to referral, if symptoms persist.

[Systematic breast self-examination is not a useful screening procedure, except in hereditary or familial increased risk of breast cancer]. / Systematisch borstzelfonderzoek is geen nuttige screening, behalve bij genetisch of familiair verhoogd risico op borstkanker.

Population screening for breast cancer in the Netherlands in women 50-75 years ofage shows a reduction in mortality in this age group, which is the goal of screening. In a recent statement, the Dutch Cancer Society did not advise breast self-examination for women in general, because a meta-analysis had not shown a reduction in mortality, irrespective of the positive findings on self-examination in many retrospective studies. However, breast self-examination may be advised to a small group of women with familial or hereditary breast cancer, especially carriers of the BRCA1 gene mutation, in whom a high percentage of rapidly proliferating grade III carcinomas are found.

RETIRED: Breast self-examination.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Simulation of breast cancer screening: quality assessment of two protocols.

Healthcare professionals must make breast cancer screening decisions without the help of clear answers in current medical knowledge. This study used computer simulation to evaluate two screening protocols. The American Cancer Society (ACS) protocol comprising self-breast examination, professional breast examination and annual mammography was evaluated versus annual mammography alone. The effective frequency of mammography and the cost in the ACS protocol doubles the cost of mammography alone. Breast self-examination and clinical breast examination contributes to increased cost without any added health effects. These study results could be applied by healthcare professionals to assist their decision making for breast cancer screening.