Breast Cancer W/U

Epidemiology
1.4 million new Breast ca/yr. Nearly of all Cancer cases and nearly 1/8th of all Cancer deaths.

Risk Factors
Age: Genetic predisposition BRCA: RR 3-7 Estrogen Exposure Age at Menarche<12: RR 1.5

OCP, HRT: RR1.2

ETOH, 2-5 drinks/day: RR1.4 Hx of aypical hyperplasia on bx: RR 3.7

Who gets a Mammography?

Consensus: 50-69 yo F.
Less strong a consensus for 40-49 or over age 70
Frequency: Large US F Database >65yo (Braithwaite et al) study showed no added benefit for annual screening vs biennial screening, so guidelines suggest q 2 years. Large Cohort (Hubbard et al) showed significant decrease in false positives with biennial 61%->41% while only mild increases in Late stage breast cancer diagnosis 21%->25% for the starting at 40 yrs of age group, but only 19.6-> 21.9 % for the starting at 50 yrs of age group

Protective Factors
Breast feeding >16 mo RR:0.7 Exercise Parity, Aspirin, Once a week for >6 months. RR 0.8 Oophorectomy

Mammography

When to use MRI?

Note: MRI has higher sensitivity but lower specificity than Mammography. MRI + Mammography for high risk breast cancer > or equal to 20-25 %lifetime risk(based primarily on fam hx) <15% risk. Do not get MRI.

Other: Thermography, although effective is not recommended as breast cancer screening.