Advice about mammography for a young woman with a family history of breast cancer
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7293.1040 (Published 28 April 2001) Cite this as: BMJ 2001;322:1040
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I use the National Cancer Institute's Breast Cancer Risk
Assessment Tool for risk stratification; this is the software tool used in
the Breast Cancer Prevention Trial with Tamoxifen. It uses the Gail model,
which includes known risk factors, such as age, personal history of breast
abnormalities, age at menarche, age at first live birth, family history,
breast biopsies, and race. I have the software both on a PC and on my
Palm PDA.
I give the patient her 5 year risk of breast cancer, and offer her
mammography if she wishes. Mammograms after the
age of 50 offer a mortality reduction of about 25%; due to
the greater likelihood of rapid progression in younger women, they should
have mammograms yearly instead of every two years.
Perhaps the time has come to offer risk stratification at the
bedside, based on multifactorial risk analysis. This is now possible. I
tend to use the Palm more often than the PC version, because of its easy
accessibility.
Michelle Greiver, MD, CCFP
Competing interests: No competing interests
I enjoyed the article. I suspect you will think my
question misses the point of your article; but I have
to know: What did this patient's mammogram show?
Thank you
Competing interests: No competing interests
The article discussed the disadvantages of using mammography for
screening patients under 50 yaers with a family history of breast cancer, I
agree it's less sensitive & less specific & carries a certain risk
to the patient.For this reason the use of other methods like ultra sound
or MRI could be beneficial.
I have 2 questions to ask:
1.How accurate an ultra sound examination can be,regarding false negative
& false positive results?
2.Can tumour markers be used for primary diagnosis & what's their role
in follow up?(can we depend upon these markers for long term follow up?
Thank you.
Competing interests: No competing interests
Radiation in ATM
An important issue is addressed by this article.
However one must remember that risk of breast cancer is increased in both
famalial and sporodic breast cancer in patients who are both homo and
heterozygous for ATM gene.
Although incidence of the this disease is very rare but one must bear in
mind about this particular history when offering a young patient with this
background.
Competing interests: No competing interests