Existing guidelines for breast cancer risk assessment and potential interventions are applicable to most women over the age of 20. Annual clinical breast examination by a medical provider starts at age 20 even in the absence of any risk factors for breast cancer. Annual clinical breast examinations should continue regardless of age by any medical examiner providing primary breast care to women.
High risk patients for developing breast cancer such as those with a strong family history require special screening for breast cancer. Women with a positive family history of breast cancer have an increased risk of developing breast cancer during their lifetime. Familial breast cancers constitute 15% to 20% of all breast cancers. One half of women with familial breast cancer history have a mutation in a heritable gene called BRCA1 and BRCA2. Women who carry a BRCA1 or BRCA2 gene mutation are considered to be at a higher risk of developing breast and ovarian cancer. The BRCA1 and BRCA2 serve as susceptibility genes to promote tumorigenesis. Patients with BRCA1 or BRCA2 gene mutations should undergo genetic counseling and be screened with breast MRI scans which have shown to be superior over other screening modalities. Clinical breast examinations on these high risk patients should be performed twice per year.
Screening mammograms are performed on women who have no signs or symptoms indicative or suspicious for breast cancer.
The evaluation of a breast complaint requires a diagnostic work-up. A diagnostic work-up is more intensive than a screening evaluation based on risk factors for breast cancer. Screening for breast cancer includes:
Breast examination by medical provider
Magnetic resonance imaging (MRI)
Screening mammography is the preferred examination for asymptomatic woman at risk for breast cancer. Current recommendations for screening mammography in women without a family history of breast cancer include a baseline mammogram between ages 35 and 40 followed by a biennial mammogram between ages 40 and 49 and annual mammograms after age 50.
If a screening mammogram reveals any change from a previous mammogram, then a diagnostic mammogram with additional images and at times magnified images are required. Comparison with previous mammograms are of paramount importance. The appearance of microcalcifications on a screening mammogram must be further investigated. The size, number, location and configuration (clusters) of microcalcifications requires further diagnostic studies.
It is extremely important to understand that a mammogram is not a fail-safe technique. A patient may have a breast cancer and the mammogram be negative because it fails to show a radiographic detectable abnormality.
Interpretation of mammograms have been standardized. The American College of Radiology (ACR) has established a Breast Imaging Reporting and Data System (BI- RADS) to facilitate comparison between mammographers. BI-RADS assessment categories are as follows:
Category 0: Need additional imaging evaluation
Category 1: Negative
Category 2: Benign finding, noncancerous
Category 3: Probably benign finding, short interval follow-up suggested
Category 4: Suspicious abnormality, biopsy considered
Category 5: Highly suggestive of malignancy, appropriate action needed
The higher the BI-RADS, the greater the risk that a mammographic finding will be associated with a breast cancer on biopsy. Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasonography are also adjuvant methods of screening for breast cancer. The higher the risk for breast cancer, the more procedures may be required to screen a particular woman.
If you (or a loved one) are suffering from complications due to a failure to timely diagnose, delayed diagnosis or misdiagnosis of breast cancer, or the recommended screening guidelines were not followed, let Dr. Borten and our Boston area medical malpractice attorneys at Gorovitz & Borten evaluate your case. We can help you assert your rights and get the compensation you deserve.
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