March 26, 2019

It's Time to Reevaluate Breast Cancer Screening

“Therese taylor was fifty-two when she had her first clinical breast exam, in the office of a new family doctor. He recommended that she go for a mammogram. After she shrugged the suggestion off, protesting that she wasn’t interested, he told her he’d found a lump in her right breast. Suddenly, she was confronting the thing that every woman dreads. So she complied. She went for the mammogram a few days later, in the first week of October 2011. No lump in the right breast was visible on the X-ray. Little white specks showed up in several places in the image of the left breast, however—flecks of calcium that indicate the presence of malignant cells. These “microcalcifications” meant that she needed to see a surgeon. Ten slow, anxious days after a biopsy, the surgeon had her back in his office and gave her the diagnosis. She had dcis.

dcis—or ductal carcinoma breast cancer—is diagnosed when malignant cells are confined within the milk ducts of the breast. When a tumour breaks through the walls of the ducts and invades surrounding tissue, it becomes invasive breast cancer. On a mammogram, dcis can look like a string of calcium specks, sometimes lined up, sometimes following a squiggly path, and sometimes spread more diffusely, in a feather-like pattern. It can occur in different parts of the same breast. The calcium results from cancer cells dying off. Sometimes dcis is a solid tumour within the milk duct, but it’s rarely large enough to feel, and because of this, almost all dcis is diagnosed as a result of a mammogram.

The condition was first described a century ago by the surgeon and pathologist Joseph Colt Bloodgood at Johns Hopkins University, but it was only when mammography screening started to become popular in the 1980s that dcis was routinely detected. Because of mammography, the incidence of dcis in the United States increased more than sevenfold from the mid-1970s to the end of the 1990s. Today, it’s estimated that between 20 and 30 percent of cancers detected in screening mammograms are dcis. In the United States, over 50,000 new cases of dcis are diagnosed every year, most in women between the ages of fifty and sixty.”

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