Patient Education Breast and Ovarian Cancer Screening and detection The goal of screening for cancer is to find it as early as possible, when it is easiest to cure. This handout describes the symptoms of breast and ovarian cancer and ways to screen for these diseases. Breast Cancer Screening and Detection One in eight women (12.5%) who live to be 90 years old will get breast cancer. The American Cancer Society and National Cancer Institute recommend this screening schedule for women at average risk for breast cancer: Discuss the benefits and drawbacks of breast self-exam with your healthcare provider starting at age 20. Ask your provider to teach you how to do a breast self-exam, and review this at your annual check-up. Tell your healthcare provider right away about any breast changes. Have a clinical breast exam with your healthcare provider at least every three years from ages 20 to 39 and once a year after age 40. Have a mammogram once a year starting at age 40. Women at Increased Risk Women who have an increased risk of breast cancer may benefit from starting screening at an earlier age and/or adding other types of screening to their schedule. You may be at increased risk if you had an abnormal breast biopsy or you have a strong family history of breast or ovarian cancer. Talk to your healthcare provider about your personal breast cancer risk and what screening schedule is right for you.
Page 2 Other possible signs of breast cancer include: Swelling or thickening of part of the breast. A change in the size, shape, or symmetry of the breast. Skin irritation, dimpling, or puckering. Redness or scaliness of the skin or end of the nipple. Nipple pain, the nipple turning inward, or pointing in a new direction. Liquid (other than breast milk) coming out by itself from the nipple. A lump in the underarm. Being Aware of Symptoms of Breast Cancer The most common sign of breast cancer is a new lump or mass, especially one that does not shrink after your next period. Most breast lumps are not harmful, but all changes should be checked carefully. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded or even flat. So ask your doctor to check anything that is unusual. Screening for Breast Cancer Checking your own breasts for lumps, thickening, skin dimpling, and other changes is a breast self-exam (BSE). Many women think their breasts are generally lumpy, and are concerned because of this. They believe BSE will not be helpful. A normal breast gland is lumpy, so having lumps is not abnormal. The goal of doing BSE regularly is to know what your own breasts normally feel like, so that you know if there is a change, a new lump or thickening that was not there before. A complete BSE involves both looking at and feeling your breasts. If you are familiar with what your breasts look and feel like, you can do a good BSE in only 5 to 10 minutes. Many women are not sure how to do a BSE. Ask your healthcare provider to teach you. The best time to do a BSE is after your period, when your breasts are least tender. If you no longer have periods, do it on the same day each month. Women who are breastfeeding should do their BSE after their breasts are emptied. Breast cancers do not change in days or weeks, so finding a new lump is not a medical emergency. If you find something new, you have time to make an appointment and get the lump fully checked. And keep in mind, most breast lumps are harmless. A breast exam done by a qualified healthcare provider is a clinical breast exam (CBE). Healthcare providers follow the same steps as you would for a BSE. A mammogram is an X-ray photograph of the breast. Most cancers can be seen on a mammogram, and they often can be seen long before a lump can be felt. During a mammogram, your breast is pressed between two plates to flatten and spread the tissue. Then a special camera takes an X-ray of each breast from two different angles. The pressure lasts only a few seconds. Very low levels of radiation are used, and having mammograms does not increase your risk of developing breast cancer. Breast cancer may show up on mammograms as a white mass, an abnormal shadow, an area where the tissue looks different, or a cluster of micro calcifications (tiny calcium deposits that look like specks of salt on the film). Mammograms may not be as useful in screening if you have dense breasts. The dense tissue is whitish on the films, making it harder to see a cancer.
Page 3 Many centers that specialize in mammography use computer-aided detection (CAD) to read mammograms. With CAD technology, a computer program scans the mammogramfilm after the radiologist has read it. The computer marks any regions of interest. The radiologist then reviews the computer markings and decides whether the highlighted areas are suspicious and need follow-up, or are a normal feature, like a blood vessel, and no cause for concern. The radiologist still does the final interpretation of the mammogram. Studies are still being done to learn if CAD improves the ability to find breast cancer with mammography. Digital mammography uses X-rays like regular mammography, but the breast images are recorded into a computer instead of onto film. If there is a suspicious area, the radiologist can use the computer to zoom in and take a closer look without needing to take more images. Digital mammography has advantages, like ease in storing the electronic images. The National Cancer Institute is sponsoring a study to see whether digital mammograms are as good as, or better than, standard mammograms. Breast ultrasound uses sound waves to create a picture of the breast. At the start of a breast ultrasound, gel is applied to your breast. This helps the ultrasound transducer, which sends out sound waves and picks up the reflected echoes, to see the breast tissue under the skin. The transducer is pressed gently in the gel across your breast. A computer analyzes the echoes and shows a picture on the screen. Breast ultrasound is often used to follow up on abnormalities seen on a mammogram or found by CBE, or in follow-up for women with dense breasts. It is an excellent tool for telling the difference between a fluid-filled cyst (benign) and a solid mass (which may be cancer). Ultrasound is not used for routine breast cancer screening. Breast ultrasound does not show the level of detail that a regular mammogram does. And, ultrasound does not show micro calcifications. Breast magnetic resonance imaging (MRI) uses powerful magnetic fields and radio waves to create images of the breast. During a breast MRI, you lie face down on a special table where a magnetic field is created. You need to keep still during the exam, because motion blurs the images. A liquid called Gadolinium DTPA is injected into a vein in your arm before or during the MRI. This gives clearer images and highlights any abnormal areas in the breast. A breast MRI usually takes 30 to 60 minutes. If you have claustrophobia, a breast MRI may be difficult. Breast MRI is now used along with mammography and breast ultrasound to diagnose breast cancer. It is also used to determine the stage of a diagnosed breast cancer, help decide treatment, and for follow-up after treatment. Researchers are studying whether breast MRI is useful for screening women who have a high risk of developing breast cancer. MRI may be especially helpful in young women, because it gives clear images of the breast from almost any angle, and it may find small abnormalities that might be missed with other exams. But MRI (like other screening methods) can t always tell cancer from abnormalities that aren t cancer, which can lead to unnecessary breast biopsies and worry. MRI does not show micro calcifications. And breast MRI costs more than a mammogram.
Page 4 To Learn More Detailed information about BSE: www.komen.org/bse/ Or www.breastcancer.org To order a shower card to remind yourself about BSE: Call 1-800-877-8077 Detailed information about mammography and other imaging techniques: imaginis.com/breasthealth/ mammography.asp Information about the ovarian cancer screening trial: epi.grants.cancer.gov/ovarian Or call 1-800-328-1124 Ovarian Cancer Screening and Detection Ovarian cancer is much less common than breast cancer. One in 58 women (1.7%) who live to be 90 years old will get ovarian cancer during their lifetime. Routine screening for ovarian cancer is not currently recommended for women at average risk of ovarian cancer. Screening for ovarian cancer is only discussed with women at unusually high risk of getting ovarian cancer. You may have an increased risk if you have a strong family history of breast or ovarian cancer. Talk to your healthcare provider if you think you are at high risk of developing ovarian cancer. Being Aware of Symptoms of Ovarian Cancer Ovarian cancer can cause any of the symptoms listed here. However, these symptoms can also be caused by harmless conditions. If any of these symptoms persist for more than a week or two, see your healthcare provider. Possible Signs of Ovarian Cancer Include: Swelling, discomfort, or pain in your abdomen. Indigestion or loss of appetite; feeling full after a few bites of food. Constipation or diarrhea. Unusual fatigue. Unusual shortness of breath with activity or rest. Back pain. Frequent, difficult, or painful urination. Unplanned weight gain or loss. Changes in menstrual pattern or flow, cramps, or unusual vaginal discharge. Masses in your abdomen. Screening for Ovarian Cancer Pelvic exams are recommended every 1 to 3 years for most women. During this exam, your healthcare provider will feel your ovaries. If an ovary is enlarged, an ultrasound may be done to learn more. Pelvic exams probably won t pick up small abnormalities in the ovary.
Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC and SCCA Clinic staff are also available to help at any time. For general questions about breast cancer screening: Breast Health Care Center 206-598-5500 For questions about high-risk screening: Breast and Ovarian Cancer Prevention Program 206-616-5241 Pap smears are also recommended every 1 to 3 years. Pap smears screen for cervical cancer, but are not helpful in finding ovarian cancer. Most women with advanced ovarian cancer have an abnormal CA-125 blood test. But half of women with early ovarian cancer (cancer that has not spread outside the ovary) have normal CA-125 levels, and CA-125 can be abnormal in healthy women for reasons not related to cancer. This makes CA-125 a poor screening test for ovarian cancer, and it is not recommended for most women. Elevated CA-125 results may lead to more tests or even surgery. Researchers are working hard to develop new blood tests to find ovarian cancer. Clinical trials will show if new blood tests are good at finding ovarian cancer early. Transvaginal ultrasound is used to learn about the size and character of the ovaries. Ultrasound can find masses as small as 1 cm and can tell the difference between cysts and solid masses. Color-flow Doppler ultrasound can also identify patterns of blood vessels and blood flow associated with tumors. However, many ovarian cysts are normal and occur as part of the menstrual cycle, and other masses occur that are not cancer. So transvaginal ultrasound has many false-positive results (abnormal results that are not related to cancer). An abnormal ultrasound result may lead to more ultrasounds, other tests, or surgery. Ideally, screening for ovarian cancer should be done as part of a research study designed to tell us more about the best use of these tests. Contact the to find out if there is an ovarian cancer screening trial open to you. Early Detection Is Best By doing regular breast self-exams, being aware of symptoms of breast and ovarian cancer, and following an exam schedule tailored to your needs, you give yourself the best possible chance of catching breast or ovarian cancer early. Breast and Ovarian Cancer Prevention Program Box 357720 1959 N.E. Pacific St. Seattle, WA 98195 University of Washington Medical Center and Seattle Cancer Care Alliance 06/2002 Rev. 03/2004