Breast Cancer Screen Recommendations

How does the topic of breast cancer screening relate to outdoor health? In my opinion, it is one of those topics that transcend a single categorization, because it is so important and affects us all. In addition, it can tie in directly to the topic of outdoor health: take, for example, the 1999 story of the heroic medical struggle of a woman stranded at a Polar science station with a new diagnosis of breast cancer.

Prompt recognition of breast cancer may lead to early treatment, which may equate with diminished disfigurement and disability, and improved survival. So, it is essential to spread the word: breast cancer, which is the most common cancer diagnosed in women and the leading cause of deaths from cancer among women, should be detected as soon as possible for the benefit of women and their families everywhere.

Ellen Warner, MD, recently authored an excellent review article entitled “Breast-Cancer Screening” in the New England Journal of Medicine (365;11:1025-1032, 2011). She made a number of observations. First, the decision to screen a person or population for a disease takes into account the benefits against the risks and costs. Based on what is currently known, her conclusions were:

1. Women ages 50 to 69 years should have screening mammography. Within this group, mammography is more likely to be helpful in women ages 60 to 69 because the test is more likely to detect cancer in these older women. Mammography is recommended provided that the life expectancy of the patient is five or more years.
2. Women ages 70 years and older do not benefit appreciably from screening mammography.
3. Women ages 49 years and younger may benefit from screening mammography, but there is still some controversy about this. If a woman is at high risk for breast cancer (e.g., with genetic predisposition, a first-degree relative who had breast cancer before the age of 65 years, or who has had a previous breast biopsy showing “atypical hyperplasia” or ‘lobular carcinoma in situ”), then mammography would be advised.

Screening mammography is generally recommended every two years. Digital mammography is superior to film mammography, particularly when the breast tissue is dense.

At the very least, a woman contemplating a journey of more than a few months away from medical care should undergo a thorough breast and lymph node physical examination prior to the journey. Depending on her age, risk profile, and preferences, screening mammography might be indicated.