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Imaging Surveillance of Women With a Personal History of Breast Cancer

Plain Language Summary Following successful treatment of first breast cancers, women remain at risk of cancer recurrence in the treated breast and also new cancers in the other breast (second breast cancers), which are associated with increased rates of cancer detection in other parts of the body and with death from breast cancer. Imaging surveillance after breast cancer treatment aims to detect second breast cancers before…

Screening Women With Known or Suspected Cancer Gene Mutations

Plain Language Summary Women with certain genetic mutations (eg, BRCA1 and BRCA2 ) or with familial risk (without a known gene mutation but with a strong family history of breast or ovarian cancer) are at an elevated risk of developing breast cancer; from 57% to 65% in women with a BRCA1 mutation and from 45% to 49% in women with a BRCA2 mutation. The risk of…

Screening for Breast Cancer in Women With Dense Breasts

Plain Language Summary Mammography is the only screening test that reduces death from breast cancer in randomized trials. However, it does not detect all cancers that are present. One of the reasons that mammography misses cancers is that dense areas on the image can obscure cancers. Both breast cancers and breast density show up as white on mammograms so it is more difficult to identify cancer…

Screening Women in Their 40s

Plain Language Summary Women in their 40s face conflicting breast cancer screening guidelines that are based on different interpretations of research and considerations of the benefits and harms of screening. How well mammography screening reduces death from breast cancer was evaluated in eight randomized controlled trials (RCTs) of women in their 40s. Neither the individual trials, nor an estimate that combined results of all of the…

Breast Cancer Screening in the Older Woman

Plain Language Summary It is not certain if mammograms benefit women aged 70 or older. While the chance of breast cancer increases with age, breast cancers tend to grow more slowly among older women. Experts think that a small breast cancer found on an older woman’s mammogram would not have caused problems for 5 to 10 years and some of the breast cancers found would never…

Challenges and Opportunities in the Implementation of Risk-Based Screening for Breast Cancer

Plain Language Summary There is widespread interest in trying to change the interval at which women undergo breast cancer screening based on their actual risk of breast cancer. This risk-based screening may improve the proportions of breast cancer detected early and possibly reduce the number of women who need to be screened with reduction in the associated harms of overdiagnosis. Risk factors are already used to…

Challenges in Understanding and Quantifying Overdiagnosis and Overtreatment

Plain Language Summary Overdiagnosed breast cancer is breast cancer detected by screening that would not have caused any health problems had it been left undetected and untreated. Without screening, it would not ever have been detected. Overdiagnosed breast cancers are “real” cancers, in that they meet current professional standards for cancer diagnosis (ie, they are not false-positives), but detecting and treating these cancers does not improve…

The Role of Microsimulation Modeling in Evaluating the Outcomes and Effect of Screening

Plain Language Summary Microsimulation is a process where complex processes are modeled on computers programmed to combine information about separate components of the process into an overall picture. For breast cancer screening this means combining information about the epidemiology of breast cancer, the use and accuracy of screening to detect tumors earlier, and the response of breast cancer to treatment at different times to draw conclusions…

The Importance of Observational Evidence to Estimate and Monitor Mortality Reduction From Current Breast Cancer Screening

Plain Language Summary The benefits and harms of breast cancer screening have been debated for many years. One reason this debate continues is continuing uncertainty about the magnitude of these benefits and harms. In the past, decision makers have relied on randomized controlled trials (RCTs) to give us the best estimates of the benefit of screening—the breast cancer mortality reduction attributable to screening. However, these RCTs…

Weighing the Benefits and Harms: Screening Mammography in the Balance

Plain Language Summary Breast cancer affects millions of women worldwide. Screening mammography has the potential to detect breast cancer early, leading to more effective treatment, reduced chance of metastasis, and better survival and quality of life for the patient. Large trials performed in the 1970s and 1980s showed that breast cancer mortality was lower in women who were invited for mammography screening. This led to widespread…

Estimates of Screening Benefit: The Randomized Trials of Breast Cancer Screening

Plain Language Summary The benefits of mammography screening have been studied in nine randomized controlled trials comparing women screened with those not screened. Randomized controlled trials are regarded as the strongest type of study to determine whether screening is effective because they provide the most reliable results about the differences in outcomes between screening and nonscreening groups. It is important to appreciate the differences between the…

Breast Cancer Screening: Balancing Evidence With Culture, Politics, Money, and Media

Plain Language Summary Culture, politics, money, and media intersect to influence the interpretation of scientific evidence, directly affecting the lives of women. Before venturing into detailed chapters reviewing the scientific evidence on breast cancer screening, we begin this textbook with an overview of the history of the breast, of breast cancer screening, and of the perfect storm of politics and science surrounding this topic. We examine…

Coping With the High Cost of Cancer

A breast cancer diagnosis can sometimes lead to financial hardship. The National Cancer Institute recognizes financial hardship, also known as financial distress or financial toxicity, as the negative impact of the “costs” of cancer care on the lives of cancer patients and their loved ones. There is a growing amount of research to suggest financial hardship among cancer patients is increasing in prevalence. There are many…

Genetics and Prevention

In the United States, one in eight women (13%) will develop invasive breast cancer during her lifetime. In 2021, it was estimated that 281,550 new cases of invasive breast cancer would be diagnosed in women in the United States, and 49,250 women would be diagnosed with noninvasive or in situ disease. It was expected that 43,600 women in the United States (about twice the seating capacity…

Breast Cancer Palliative Care

Breast cancer is an incredibly complex disease, and when metastatic or terminal, it becomes even more complex. The difficulties clinicians encounter with this disease go far beyond the malignancy. It includes, in many cases, particularly young women, families, including children directly affected by the disease. The course and management in these complex situations start with therapy directed at the breast cancer, although this also includes symptom…

Breast Cancer Survivorship in Community Oncology Practice

Breast cancer is the most commonly diagnosed cancer among women. Recent improvements in healthcare, including earlier detection and effective treatment strategies, have significantly improved survival rates. With more than 3.8 million breast cancer survivors in the United States, the 5-year survival rate is 90% and the 10-year survival rate is 80%. Therefore, most patients diagnosed with breast cancer will become long-term survivors. Breast cancer predominantly affects…

Nutrition

Introduction Nutrition care is essential not only in after care or survivorship but also as a supportive resource throughout diagnosis and treatment of breast cancer. Patients often request nutrition advice early on in their care. Breast cancer patients in particular show interest in learning more about diet and lifestyle. Many want to learn all they can to ensure a good outcome. In our system, we focus…

Physical Therapy for Patients With Breast Cancer

Key Points Cancer physical therapy is the evidence-based, reimbursed medical care used to specifically examine, assess, and treat impairments related to cancer and cancer treatment. Though physical therapy is readily available to patients, it remains underutilized in most cancer programs. If a cancer physical therapy program is focusing solely on patients with lymphedema or postoperative breast surgery, it is missing the vast majority of its potential…