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Breast Health & Disease Archive
Gene tests for all women with breast cancer could save money — and lives
Research we're watching
Doing genetic tests on all women with breast cancer, as compared with the typical practice of just testing those with a family history of the disease, is worth the extra cost, according to a study published online Oct. 3, 2019, by JAMA Oncology. The study authors say their findings should prompt the expansion of genetic testing to all women diagnosed with breast cancer. It's clear that testing breast cancer patients for genetic variants that raise breast cancer risk (such as BRCA1, BRCA2, and PALB2) would enable doctors to identify more women who carry these variants and who might benefit from preventive strategies. But researchers wondered whether doing so would be too costly. To answer that question, they used a computer model to analyze data from more than 11,000 women. They found that not only would the cost of testing all American women with breast cancer be balanced out by later savings on health care services, but also that just one year of testing could prevent an estimated 9,700 new cases of breast and ovarian cancer and 2,400 deaths.
Image: voinSveta/Getty Images
What is the test?
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar. Ultrasound was developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible.
The doctor or ultrasound technician first coats a small area of your skin with a lubricant to reduce friction. He or she then places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor.
Excisional Biopsy of the Breast
What is the test?
In an excisional biopsy of the breast, the surgeon makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast's shape. It's a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask your surgeon about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.
How do I prepare for the test?
You'll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you'll be asked not to eat anything after midnight on the day before the surgery.
Large Core Needle Biopsy of the Breast
What Is It?
A biopsy is a tissue sample removed from the body and examined under a microscope. In a breast biopsy, a doctor removes tissue from a suspicious area so that a pathologist can determine whether the tissue contains cancerous cells.
At one time, surgeons only performed biopsies by making an incision in the breast and removing the suspicious tissue along with some normal tissue from around it. These surgical biopsies leave scars and may change the size and shape of the breast.
Stereotactic Biopsy of the Breast
What is the test?
Stereotactic biopsy of the breast is a special type of large core needle biopsy. It is one method of guiding the biopsy needle to the desired location in the breast. Core needle biopsy can also be guided by ultrasound or by the standard x-ray techniques used in mammography. Large core needle biopsy is often the diagnostic method of choice to evaluate abnormalities that are visible on a mammogram but cannot easily be felt by hand.
Core needle biopsy may not be suitable for women who have:
Wire Localization Biopsy of the Breast
What is the test?
A wire localization biopsy is a type of surgical biopsy.
Sometimes an abnormal area will be seen on the mammogram that clearly should be tested for cancer or completely removed from the breast, but this area is not easily felt as a lump on examination. The mammography department can help your surgeon to find the area more easily by using a technique called "wire localization."
High risk for breast cancer? You might benefit from preventive medication
Research we're watching
Women at high risk for breast cancer might benefit from taking medication to prevent the disease, says a new recommendation from the U.S. Preventive Services Task Force (USPSTF), a national group of experts. Medications such as tamoxifen (Nolvadex), raloxifene (Evista), and aromatase inhibitors have been shown to help prevent invasive, estrogen receptor-positive breast cancer, but they can cause serious side effects, such as other cancers and blood clots. For some women, the potential benefits of these drugs outweigh those risks. The USPSTF, however, recommends against routine use of these medications for women who are not at high risk for breast cancer, because the potential benefit is much smaller. Women who are over age 35 and are at high risk for breast cancer or who have had previous benign breast lesions (such as atypical ductal or lobular hyperplasia or lobular carcinoma in situ) might want to discuss this recommendation with their doctor. The USPSTF encouraged doctors to weigh the risk of breast cancer against potential drawbacks of the medications and the individual woman's risk for adverse effects.
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Dense breasts on a mammogram? What to know and do
Mammograms look for signs of breast cancer. They can also provide information on whether a woman has high breast density, which slightly increases risk for developing breast cancer. Here’s what you need to know and do if you’re notified about this risk factor.
Dealing with high-density breasts
The FDA may require mammography facilities to notify patients about this breast cancer risk factor, but women don't know what to do with this information.
Do you know how dense your breasts are? If you don't, a new proposal by the FDA may mean you will soon find out.
The agency proposed a change that, if approved, will require mammography facilities to send letters informing women about their breast density — a measure of the proportion of active tissue versus fat in their breasts (see "The FDA proposal").
Newer breast screening technology may spot more cancers
Digital breast tomosynthesis may also reduce the number of unnecessary and nerve-racking callbacks for additional testing.
If you're in your 40s, you may want to consider switching from digital mammography to digital breast tomosynthesis (DBT) for your next breast cancer screening, say the authors of a study published online February 28 by JAMA Oncology.
A review of more than 170,000 screening mammograms using the two technologies determined that DBT — sometimes referred to as 3D mammography — did a better job at accurately detecting cancers in women of all ages. The advantages were most pronounced for women in their 40s. DBT was also better at finding cancers in women with high breast density, which can make cancers more difficult to spot on screening exams. High density indicates a larger proportion of active tissue in the breast and is a risk factor for breast cancer.
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