Guidelines for Promoting Early Cancer Detection
Aside from certain forms of skin cancer, breast cancer is the most common type of the disease diagnosed among women. According to the American Cancer Society (ACS), however, it doesn’t have to be. Most masses seen on a mammogram and most lumps that found during breast examinations are benign and non-life-threatening, but finding breast cancer early (and receiving subsequent evidence-based treatment) remains the most critical path to preventing deaths for those who develop breast cancer. Nurses can play an essential role in helping their patients and members of their communities be more mindful of the importance of early detection and regular screenings and exams.
Current Guidelines for Early Cancer Detection
Screening tests are typically used to find cancer before a person has developed any symptoms. While most breast cancers are found in women aged 50 years or older, today’s ACS guidelines encourage nurses and other healthcare providers to begin suggesting that women consider mammogram screenings each year starting at age 40. By age 45, women should have an annual mammogram, and screenings should continue as long as the patient remains in good health and is expected to live at least another ten years.
Regardless of how often or how early any patient is advised to begin routine screenings, ACS officials stress that providers share important education related to the purpose of and expectations associated with mammograms for purposes of breast cancer screening – what the test can and cannot do. For example, despite the benefits and effectiveness of the tests, they can miss the presence of some cancers and may not always be conclusive, resulting in some patients requiring additional testing to determine if cancer is indeed present.
Of equal importance is understanding that when cancer is found early and contained it is more successfully treated. Women should also know how their breasts usually look and feel, and report any breast changes to their healthcare provider immediately.
Genetic Impacts & The BRCA Factor
Some women, whether due to family history, genetic tendencies, and/or other factors, can be considered high risk for cancer development and should be screened with MRIs as early as age 30. Though this is said to be a small number of patients, according to the ACS the guidelines also state that those women who do undergo MRI screening should do so in addition to a mammogram because an MRI could miss some cancers that a mammogram would detect even though they are more likely to detect cancer than a mammogram.
Additionally, certain individuals may require earlier cancer screenings due to a genetic predisposition to breast cancer — mutations to one (or both) of the breast cancer (BRCA) susceptibility genes (BRCA1 and BRCA2). Typically, these genes help to protect from a cancer forming. However, a gene mutation results in cells being more likely to divide and change rapidly, which can lead to cancer.
Women might be at increased risk of BRCA mutation(s), and thus be candidates for BRCA gene testing if they have:
- a personal history of breast cancer diagnosed at a young age (premenopausal or young than age 50),
- a history of triple negative breast cancer diagnosed at age 60 or younger,
- a history of bilateral breast cancer,
- a personal history of breast cancer and one or more relatives with breast cancer diagnosed at age 50 or younger, and many other characteristics.1
Mutations notwithstanding, breast cancer can also affect younger women who are otherwise healthy. According to the Centers for Disease Control and Prevention (CDC), about 11% of all new breast cancer cases in the United States are diagnosed in women younger than 45 which underlines the importance of effective communication with patients of any age who may benefit from earlier than “normal” screening timelines. The CDC offers a BRCA tool as a resource that nurses can utilize to help women understand their risks for having a BRCA1 or BRCA2 gene mutation
In January of this year, the U.S. Food and Drug Administration also expanded the approved use of Lynparza to include the treatment of patients living with certain types of breast cancer that have spread and whose tumors have a specific inherited genetic mutation, making it the first drug in its class (poly ADP ribose polymerase inhibitor) approved to treat breast cancer.3
Other Screening Measures
Ultrasound is also recommended for examining breast changes, including lumps not seen on a mammogram, or changes in women with dense breast tissue and can often determine the difference between fluid-filled cysts that are unlikely to be cancerous and solid masses, according to the ACS. Ultrasound can also help guide a biopsy needle so that cells can be removed and tested for cancer. New research by the University of Chicago Medicine and the University of Washington suggests that MRI scans twice per year instead of one annual mammogram alone is more effective at detecting early breast cancers in young women with a high-risk genetic profile. The study results, also claim that intensive efforts to find small early cancers can be crucial to improving outcomes among women with high-risk genetic mutations.4
New research based out of Nigeria, also claims revolutionary results, citing for the first time, that DNA contributed by Sub-Saharan African women has been thoroughly evaluated with innovative genomics technology to understand better the genetic bases for breast cancer in African populations, whose people are more likely to develop and to die from triple-negative breast cancer, according to researchers with the University of Chicago.5
Additionally, a new method for early screening has been developed by researchers at Ben-Gurion University of the Negev and Soroka University Medical Center that uses commercially available technology that tests breath and urine.6
Nurses must also remain cognizant that breast cancer can occur in men as well. According to the National Cancer Institute, breast cancer may be diagnosed in men of all ages, but is more likely to be found in those between the ages of 60 and 70.
While male breast cancer makes up less than 1% of all cases of breast cancer, the types of breast cancer among men include:
- infiltrating ductal carcinoma, cancer that has spread beyond the cells lining the ducts in the breast;
- ductal carcinoma in situ, abnormal cells found in the lining of a duct (also known as intraductal carcinoma);
- inflammatory breast cancer, cancer that causes the breast to appear red and swollen; and
- Paget’s disease of the nipple, a tumor that has grown from ducts beneath the nipple onto the surface of the nipple.
1. BRCA gene test for breast and ovarian cancer risk. Mayo Clinic. 2018. Accessed online: www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815
2. Know: BRCA tool. CDC. 2018. Accessed online: www.cdc.gov/cancer/breast/young_women/knowbrca.htm
3. FDA approves first treatment for breast cancer with a specific inherited genetic mutation. FDA. 2018. Accessed online: www.fda.gov/newsevents/newsroom/pressannouncements/ucm592347.htm
4. For women with genetic risk, twice-a-year MRI beats mammograms. University of Chicago Medical Center. 2018. Accessed online: www.eurekalert.org/pub_releases/2018-09/uocm-fww091218.php
5. Easton J. Sequencing genomes of Nigerian women could help prevent many lethal breast cancers. UChicago Medicine. 2018. Accessed online: www.uchicagomedicine.org/cancer-articles/sequencing-genomes-of-nigerian-women-could-help-prevent-many-lethal-breast-cancers
6. New breath and urine tests detect early breast cancer more accurately. American Associates, Ben-Gurion University of the Nege. 2018. Accessed online: www.sciencedaily.com/releases/2018/04/180425120253.htm