Making Progress: Personal diligence and medical advancements contributing to decline in breast cancer rate

More women than ever are surviving breast cancer. The National Breast Cancer Foundation reports that breast cancer death rates among women declined by 40% between 1989 and 2016. Given that breast cancer is the second most common cancer among women, second only to some skin cancers, such a large decline is encouraging.

This does not mean breast cancer is less of concern in 2021 than it was 32 years ago. The Centers for Disease Control and prevention (CDC) states roughly one in eight women will be diagnosed with breast cancer.

It is important to distinguish the difference between cancer rates and the number of deaths and new cases. Because the U.S. population is growing and aging, the number of new cases and deaths is increasing, even while the rate of deaths from breast cancer is declining. The CDC reported 254,744 cases in 2018, compared to 196,684 new cases in 1999.

Prevention Starts with Screening

The American Cancer Society (ACS) largely attributes the lower death rate to improvements in early detection. Screenings refer to the tests and exams used to find a disease in individuals who display no symptoms. One of the best screening tools is a mammogram, according to the CDC.

An ACS timeline of its own breast cancer recommendations shows that before 1980, mammograms were only recommended for women over 35 years old who a personal history of breast cancer, and women over 40 years old who had a mother or sister with breast cancer. Annual screenings were at that time recommended only for women more than 50 years old, and clinical breast exams were only recommended periodically.

Since 2015, women 20 and older get a breast exam as part of their clinical wellness checkups every three years. Women older than 40 receive a clinical exam with their checkup every year, in addition to an annual mammogram. Women older than 45 are asked to get a mammogram every year until age 55, at which point she can decide if she is more comfortable with an annual or biannual mammogram.

Imaging Advancements

Advancements in medical technology have allowed medical professionals to provide a greater array of tools for early detection. The most popular screening tests are mammograms, ultrasound and MRIs, the latter which are helpful for those with a high risk of getting breast cancer. Among many people, confusion remains about whether an ultrasound or a mammogram is a better choice.

Verywellhealth.org, an online, physician-reviewed resource to help individuals make informed health decisions, explains that mammograms remain the better choice for women who have no symptoms. While a mammogram does expose the patient to x-rays, it has several capabilities that an ultrasound lacks. Mammograms can take an image of the whole breast at once, take an image deep inside the breast and reveal microcalcifications that be indicative of a small mass. Ultrasounds are preferable for diagnostics once a lump has been found. Women with dense breast tissue should use both a mammogram and an ultrasound for increased accuracy.

There are also emerging screening technologies. Many of these are variations of injecting a substance into the bloodstream and taking images as the substance to reveal details about the breast tissue. Positron emission mammography differs in that it uses a radioactive particle to detect cancer cells.

Other tests are also being developed, including optical imaging tests that measure light that is sent through the breast tissue; electrical impedance imaging, which scan the breast for electrical conductivity; and elastography, which is done in conjunction with an ultrasound and looks for suspiciously firmer, stiffer tissue.

In conjunction with advanced imaging technology, screening recommendations reflect a growing trend of shared decision-making between physicians and their patients. Decisions may be influenced by whether a woman is considered high risk for breast cancer. The CDC has a list of red flags for high risk. These include being a carrier of the BRCA1 or BRCA2 gene mutation, radiation therapy to the chest between ages 10-30, a diagnosis of Li-Fraumeni syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome and family history.

Although advances in breast cancer screenings and early detection are moving in the right direction, these tests can only happen if a person makes the choice to go to a clinic and get screened. A person’s longevity, health and wellness is certainly worth that small effort.