Breast Cancer

The lower recommended starting age for screening reflects rising cancer diagnoses among younger women and persistently high mortality rates among Black women.

A combination of outreach measures tailored to the needs of rural Midwest women increased recommended screenings by as much as 6-fold.

Race- and ethnicity-specific starting ages for screening would help prevent early breast cancer mortality among Black women, according to authors of a new study.

Breast cancer survivors rely on their primary care clinicians as resources integral to their recovery and return to optimal function. Physiatrist Sean Smith, MD, offers details.

In this Medical News Minute, Dr Bobby Lazzara reviews a study on the influence of media bias on far-reaching medical decisions in the general public.

October is Breast Cancer Awareness Month and Pregnancy and Infant Loss Awareness Month. Check here for a brief roundup of the latest women’s health news.

Women who exercise may lower their risk, although those who have received hormone replacement therapy may not get the same benefit. Organized programs can help.

Outcomes are poorer for young women and others with breast cancer when blood sugar levels reflect prediabetes or undiagnosed diabetes. What can you do?

We see survivors of breast cancer in primary care practice every day. Here, 8 guideline recommendations to help you ensure their continued health.

This case highlights medication errors that can result from drug interactions noted with the use of tamoxifen or other chemotherapeutic agents.

ROCKVILLE, Md. -- The FDA has approved the osteoporosis drug raloxifene (Evista) for prevention of invasive breast cancer in high-risk or osteoporotic postmenopausal women.

A 51-year-old woman has had a progressiverash on the trunk, proximalarms, and legs for 2 weeks, followingthe latest round of chemotherapy forbreast cancer. Around the time thatthe rash erupted, she was also takinglevofloxacin for a productive cough.Cutaneous lupus erythematosus wasdiagnosed years ago, but she hasbeen disease-free for the past 5 years.Chemotherapy is being withheldpending diagnosis of the rash.

A 73-year-old man is admittedto the hospital with pulmonary tuberculosis.A 3-drug fixed combination-isoniazid, rifampicin, and pyrazinamide-and ethambutol are given.Within an hour, a global urticarialrash erupts (A and B).

For 2 weeks, a 58-year-old woman has experienced increasingfatigue with activity. She has needed to nap duringthe day, has not been able to perform her usual activities,and has missed 3 days of work. She also complains of“muscle aches”-mainly in her back. She denies headache,dyspnea, fever, hot or cold intolerance, and alteredmentation.

Any discussion of theutility and reliabilityof mammography mustfocus on what is good forindividual patients-not onwhat the results of a Europeanpublic health researchproject have determined isgood for society as a whole.What is good for most patientsis annual screeningmammography beginningat age 40 years (and for patientsat very high risk forbreast cancer, mammogramsbeginning much earlier,and possibly performedmore frequentlythan once a year).1

The scientific literatureon screeningmammography can be confounding.This poses a continuingdilemma for bothpatients and clinicians. Nevertheless,objective analysisof the available data canprovide reasonable guidelinesfor the primary careclinician who must decidewhether screening mammographyhas benefit foran individual patient.

Although mammographyis still generallythought to be advantageous,a number of problemswith this screeningtool have recently beenbrought to light. Some ofthe latest studies suggestthat mammography maynot be as effective as washoped at decreasing mortalityfrom breast cancer.Moreover, the quality ofmammography itself hasbeen questioned-both theprocessing of films andtheir interpretation by radiologists.1 Errors can occuras a result of inadequateexposure or insufficientpenetration of the film. Radiologistswho have lesstraining in mammographyor who read a lower volumeof mammograms maymake more errors in interpretation.There are clearvariations between mammographycenters in ratesof false-positive and falsenegativeresults. While theanxiety and costs associatedwith false-positives areimportant, higher rates offalse-negatives are of mostconcern.

Mammography is auseful tool. However,it has limitations. Until recently,it had been viewedas the ultimate diagnostictest, capable of detecting allbreast cancers in their earliest,treatable stages. Thissimply is not true. Evenwhen performed by themost capable institutionsand radiologists, mammographyhas a sensitivity of80% to 85% for the detectionof breast cancer. This hasbeen established by numerousstudies.1,2

Breast cancer causesmore deaths than anycancer except lung cancer inwomen of all ages. In womenbetween the ages of 40and 59 years, it is the leadingcause of cancer death.1

Breast cancer remainsa significant healthconcern for women. Amongwomen at average risk,breast cancer will develop in1 of 8, and 1 in 30 will die ofthe disease.1 Although therehas been recent excitementabout the potential of geneticscreening to predict individualbreast cancer risk, itis important to keep in mindthat nearly 75% of women inwhom breast cancer hasbeen diagnosed have hadno risk factors other thansex and age.2

We have to let patientsknow that theimpact of mammography isnot that large-especiallyin women aged 40 to 49years. We simply do notknow whether early detectionof breast cancer leadsto improved outcomes inthis age group.

For more than a decade,screeningmammography hasbeen the subject ofintense public scrutinyand debate. Probably atno time has this debatebeen more heated thanduring the last 3 years,which saw the publicationof the now-famous “Danishstudy” as well as a majorexposé of poor quality controland radiologic interpretationerrors in the mammographyindustry (Box).

The incidence of hypertension, diabetes, certain types ofcancer, and other chronic diseases is disproportionatelyhigher in African Americans than in white Americans. Thestatistics presented in the Table illustrate the magnitudeof this disparity. For other diseases, such as breast cancer,the incidence is lower but mortality is higher in AfricanAmericans.

A 73-year-old man is admittedto the hospital with pulmonary tuberculosis.A 3-drug fixed combination-isoniazid, rifampicin, and pyrazinamide-and ethambutol are given.Within an hour, a global urticarialrash erupts (A and B).

Highlights:➤What to tell your patients about thebenefits-and risks-of mammography.➤A realistic look at cancer screening: Arewe overstating the benefits?➤Which screening strategies you canrecommend with confidence.➤How best to bring the patient into thedecision-making process.