Abnormal mammogram: How concerned should I be about breast cancer?
I had an "asymmetry" area of concern in the upper inner quadrant near the breast bone with an enlarged lymph node. I have to follow up with a spot compression and ultrasound. I have been having pain that radiates to my back for the past several months. Am in my late 30s but haven't exactly lived the most healthy lifestyle. How concerned should I be about cancer. The follow up ultrasound is scheduled for a week from now.
Cancer - 3 Answers
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1 :
You should not be too concerned. 75% of all breast cancers occur in postmenopausal women and about 11% occur between 35-44 years old. Your situation is not unusual, especially if this is your first mammogram. 80% of lumps suspicious enough for biopsy are not cancer. They are just wanting to get a better look at the situation.
2 :
you should not be too concerned. you should just be known to the facts that all women could be at risk including you and that you are aware that you should see a doctor for check up regularly. done.
3 :
Film mammography — Film mammography can clearly detect asymptomatic early stage breast cancer. US surveillance data from 1996 to 2001 found that breast biopsy was performed within one year of screening mammography (n = 1,664,032) in 1.6 percent of women [23] . Overall, breast cancer was diagnosed within one year of screening in 8815 women (0.53 percent); 78 percent of the invasive breast cancers were lymph node negative. The clinically important question, however, is whether screening with mammography decreases breast cancer mortality. Nine randomized controlled trials, including more than 650,000 women, have been conducted and reported mortality data. All used mammography with or without clinical breast examination [24] . Results of all trials showed a protective effect among women ages 50 and older; a meta-analysis found a significant 34 percent reduction in breast cancer mortality by seven years of follow-up [25] . A systematic review of screening mammography including studies of fair quality or better concluded that, after 14 years of follow-up, the summary relative risk for breast cancer mortality was 0.78 (95% CI 0.70-0.87) for women 50 years of age and older, and 0.85 (95% CI 0.73-0.99) for women 40 to 49 years of age [26] . Other analyses have also concluded that screening with mammography decreases breast cancer mortality [27-31] . Strong evidence for an effective screening test is demonstration by randomized trials of a decrease in all-cause, as well as disease-specific, mortality. All-cause mortality is rarely documented because the required sample size for such a study is so large. Breast cancer screening was associated with reduced all-cause mortality in an analysis of four randomized studies in Sweden. The four trials followed 247,010 women for a median of 15.8 years; age-adjusted relative risk for total mortality was 0.98 (95% CI 0.96-1.00) [27] . It is unclear whether the results of careful randomized controlled trials are replicated in the community setting. One case-control study of women in six community health plans did not show a statistical difference in screening rates (clinical breast exam and mammography) for women who died of breast cancer compared with control patients matched for age and breast cancer risk, although there was a trend towards screening benefit among higher risk women [32] . However, the authors pointed out that study limitations make it difficult to draw firm conclusions from this report. Another study using statistical modeling suggested that the decrease in breast cancer mortality due to screening is more modest than that found in the trials [10] . Full-field digital mammography — Full-field digital mammography is similar to traditional film-screen mammography except that the image is captured by an electronic detector and stored on computer [33] . Digital mammography has several potential advantages over film: ability to manipulate the image for clearer definition, easier storage and retrieval, lower average radiation, and potential for real-time remote radiological interpretation (teleradiology). However, it is expensive, with systems costing 1.5 to 4 times as much as film systems. Several studies have found little difference in cancer detection rates between digital and film mammography [34-37] . The largest study, DMIST, which involved 49,528 asymptomatic women, found that the overall diagnostic accuracy of film and digital mammography was similar [37] . Digital mammography was more accurate for premenopausal and perimenopausal women, and for women with dense breasts [38] . A cost-effectiveness analysis using the DMIST data found that using digital, in place of film, mammography screening in all women age ≥ 40 years was not cost-effective, with each quality-adjusted life year (QALY) gained costing $331,000 [39] . Targeting screening with digital mammography to women ≤ 50 years of age was cost-effective ($26,500 per QALY gained). The authors concluded that using digital mammography screening for all women "may result in health gains for younger women (especially those with dense breasts), possibly at the expense of older women (especially those with nondense breasts)." Another screening study comparing digital and film mammography, the Oslo II study, found that the rate of breast cancer detection among 24,000 women aged 45 to 69 was significantly higher for full field digital mammography [40] . The positive predictive value was the same for both technologies. The overall cancer detection rate was 0.59 and 0.38 percent for digital and film mammography respectively; detection rates of invasive cancer were higher for digital mammography, but rates were essentially the same for ductal carcinoma in situ. In general, film mammography remains an acceptable screening modality for all women. Digital mammography, when available, may offer a small screening advantage in women younger than 50 years old.
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