Breast Cancer Screening

Breast Cancer Screening


BreastCancer Screening


BreastCancer Screening

Cancerrefers to uncontrollable cell division to form lumps, tumors andmasses that interfere with the normal body function. Breast cancer isthe uncontrollable multiplication of cells in the breast. It ischaracterized by signs such as a lump in the breast, pus or blooddischarge from the nipple, pain in the breast, loss of breastsymmetry, dimpling of the breast and swollen lymph nodes especiallythose in the axilla(, 2015).Screening of women at risk is recommended to rule out abnormalitiesin the breast for timely intervention. Screening is also a diagnostictool(“, 2010).This paper discusses breast cancer screening guidelines with theassociated evidence and application to the population using theNational guidelines.

Themajor screening tests for breast cancer are clinical breastexamination, mammography, and MRI of the breast(“, 2010).According to the Guideline Development Team (GDT), each of thesetests has a unique evidence base for improving the outcome of breastcancer. The GDT forward recommendations as evidence-based A, B, C,and D or consensus-based. Evidence-Based A refers to when theintervention has enough evidence of benefits outweighing the harm andcosts. In Evidence-Based B the intervention has substantial evidenceof benefits outweighing costs and harms and could lead to a betteroutcome. In Evidence Base C the benefits and the damages balance.Evidence Base D refers to when the intervention is ineffective withmore harms than benefits. Finally, consensus-based depends on theshared decision making with benefits being determined by the team(, 2011).

Womenaged 40-49 years have recommendation grade C meaning screening shoulddepend on the patient’s circumstances. Routine mammography forasymptomatic women aged 50-74 years has more advantages than damagesand risks. It also improves health outcomes giving it anEvidence-Base of B. Above age 75, it is recommended that mammographyshould be done after a consensus. According to,“factors such as life expectancy, the preference of the woman, andphysician views should be considered before recommending one.”Therefore, mammographic screening in women above 75 years hasconsensus-based evidence. Below 40 years, it is not recommended tohave one. However, it can be done after a consultation, thus, givingit a consensus-based evidence. Screening every 1 to 2 years shouldalso be based on an agreement in all the parties involved.

ClinicalBreast Examination (CBE) has consensus-based evidence (,2011).A clinician should do a breast exam to an asymptomatic woman afterconsulting her and after weighing the benefits against the harms.Women at risk of breast cancer are recommended to have a clinicalbreast exam annually. Magnetic Resonance Imaging screening for breastcancer in asymptomatic women with no risks is discouraged. Therefore,it should be done after shared decision making between the patientand the clinician. Women with ahigh genetic predisposition to breastcancer are encouraged to do CBE often. Despite the MRI being a betterdiagnostic tool for breast cancer, there is no evidence of the testhaving a direct effect on morbidity/mortality. Therefore, an MRI hasa consensus-based evidence.

Screeningfor breast cancer should consider factors such as personal history,family history, and genetic predisposition. Patients with a personalhistory of ductal or lobular carcinoma in situ or breast biopsy,smoking and alcohol use are at increased risk, therefore, shouldstart yearly mammographic and MRI screening at 40 years. This hasEvidence-Base B of improving outcomes. Patients with a first-degreerelative diagnosed with breast cancer should be screened from age 40years with MRIs and mammograms as this has Evidence-Base B ofimproving outcome. Women with BRCA gene have an increased risk ofdeveloping breast cancer, therefore, should screen yearly usingmammographs and MRIs starting at 40 years (The Guide to ClinicalPreventive Services, 2014).

Inconclusion, clinicians should not subject patients to unnecessaryscreening tests, but should weigh the benefits against the harms andcosts. The National Clearinghouse Guidelines assess the variousscreening tests with their benefits and harms to come up with theevidence of the test impacting on the clinical outcome. Cliniciansshould consider the recommendations forwarded and conduct theirscreening tests in line with them.


BreastCancer Screening. (2010). Journalof Obstetric, Gynecologic, &amp Neonatal Nursing,39(5),608-610. doi:10.1111/j.1552-6909.2010.01177.x,.(2015). AmericanCancer Society Guidelines for the Early Detection of Cancer.Retrieved 5 September 2015, from,(2011).NationalGuideline Clearinghouse | Breast cancer screening clinical practiceguideline..Retrieved 3 September 2015, from

TheGuide to Clinical Preventive Services 2014. (2014). Recommendationsof the U.S. Preventive Services Task Force,15-18. Retrieved September 5, 2015, from,t,it/am=PiOeBjD37_1BrDMAaJc-UmHv_fe4T4qffR7uuzcBJHsB8H-z_wfwf_Be9IUE/rt=h/d=1/t=zcms/rs=AHGWq9CVMgjQ0ha5xuuFEhUD6lebuMe3uA