Early education on self-breast exam and early screening is extremely important in achieving good outcomes. Self-exam and physician examination will detect
Therefore, if a clinically noted mass is followed by a negative mammogram the work up should then include a breast ultrasound and/or a fine needle aspiration cytology and close interval examinations. The modality of Magnetic Resonance Imagining (MRI) is a method of examining the breasts that is far more sensitive in picking up smaller tumor than Mammogram. MRI is widely used in Europe but has not taken on in the US yet. It is more expensive as a screening tool in the USA, but since it is so widely used in Europe it is actually less expensive there. Even with open biopsies of suspicious masses the diagnosis of a malignancy is one in about five biopsies performed. This may seem costly but the morbidity and mortality of missing a malignancy is even more so.
Screening should start with a baseline mammogram at age 35, or younger if there is a strong family history. Annual examinations should be performed once a woman reached 40 years of age, and self examination should be encouraged monthly starting at the age of twenty. Disease prevention & early screenings is the mainstay of a preventive medical practice despite the somewhat conservative recommendations made by medical specialty societies and the managed care industry. Oftentimes the risk-benefit ratio for
An important thing for women to remember is a positive family history alone increased lifetime risk of
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By JP Saleeby, MD