There are three screening methods for breast cancer in widespread use: breast self exam (BSE); in which the patient is taught how to do periodic exams at home, clinical breast exam (CBE); in which a health care provider performs a breast exam, and mammography. BSE and CBE have not been shown to decrease the mortality from breast cancer, however are still considered useful in screening for the disease.
Regular mammogram screenings are associated with a reduced risk of death from breast cancer, especially for women who have been diagnosed with invasive disease, and the overall breast cancer mortality decrease since 1989 is in part attributed to the widespread use of mammography (39). CBE and BSE teaching occurs at all health centers and clinics within the CNTJSA, and mammography is performed at the Wilma P. Mankiller Clinic in Stillwell, and at the Claremore Indian Hospital.
BSE and yearly CBE with mammogram screenings are recommended by most national guidelines for all women aged 40 and older who are at average risk for breast cancer. This screening strategy is therefore being adapted by the CNTJSA.
According to recent national studies, re-screening rates are below average for women enrolled in the National Breast and Cervical Early Detection program (40). Therefore for early detection, improved communication is vital in getting these women in and encouraging them to have regular mammogram screenings every 1 to 2 years.
In women with a family history of breast cancer, there are no national consensus guidelines on screening. Expert opinion and common practice are to teach BSE, as well as start annual CBE and mammography beginning when the patient is five years before their youngest relative was diagnosed with breast cancer.
In patients with hereditary breast cancer syndromes, national consensus guidelines recommend monthly BSE beginning at age 18, a CBE every three to six months; beginning at age 25, and an annual mammogram beginning at age 25 (43).
Once a breast cancer is suspected, the diagnostic workup may include any of the following diagnostic studies:
Spot Compression Mammogram – A specialized X-ray of the breast to detect any irregular density or masses that may exist on mammogram.
Stereotactic Needle Biopsy- a specialized needle biopsy performed under mammogram guidance to biopsy where suspicious calcifications are seen.
Fine Needle Aspiration (FNA) – a fine needle is inserted through the surface into the possible mass or suspicious tissue, and fluid or cells are removed for cytologic examination.
Needle Core Biopsy – a wide needle is used to remove portions of the mass or suspicious tissue for histological examination (incision biopsy).
Chest X-ray – an x-ray of the chest to detect any irregular density or nodular lesions
Excision Biopsy – the removal of the entire mass, lump or nodule, which is then examined for histology by a pathologist.
Estrogen Receptor Assay (ERA) – a laboratory test conducted on breast cancer tissue to determine how it responds to endocrine therapy or removal of ovaries. ERA negative tumors will not respond to hormone therapy.
Progesterone Receptor Assay (PRA) – a laboratory test conducted on breast cancer tissue to determine how it responds to endocrine therapy or removal of ovaries. PRA increases the reliability of ERA results. Positive PRA tumors will respond more effectively to hormone therapy.