Breast cancer remains the most commonly diagnosed cancer among women other than skin cancers. The American Cancer Society currently estimates that invasive breast cancer will afflict 231,840 US women each year with 40,620 deaths. In response, The National Science Foundation (NSF) and National Cancer Institute supported development of a safe, low cost screening program that provides an effective means to detect small, early breast cancer without increasing false positive alarms. Known as MammaCare, scientists at the University of Florida conducted an extensive series of studies confirming that the sense of touch, when properly trained, can reliably detect the difference between small breast cancers and normal breast structures. The MammaCare Foundation’s mission is to make the training program and technology available to all women and their practitioners for early breast cancer detection.

Early breast cancer detection is positively correlated with survival and a breast lump that can be felt is the most common first symptom. When the lump is small, less than <1cm (pea sized) and has not spread, the patient’s 15 year survival exceeds 88% according to a recent landmark study. The table below illustrates the association between tumor size, spread and survival. It is not surprising that failures in diagnosing breast cancer represent the most frequent cause of successful malpractice claims in the United States.

 Tumor Size (mm) Tumor Size Comparison Survival after 15 Years
(negative lymph nodes)
Survival after 15 Years
(positive lymph nodes)
1-10 mm Pea – Almond 88.7% to 94.9% 71.2% to 89.6%
11-20 mm Pecan 86.2% to 92.4% 63.4% to 76.8%
21-50 mm Walnut 73.4% to 83.6% 40.4% to 53.8%

Adapted from “Tumour size predicts long-term survival among women with lymph node-positive breast cancer,” by S.A. Narod, 2012, Current Oncology, 19(5), 249-253.

Decades of evidence show that early breast cancer detection of breast cancer, combined with advances in treatment, are the key to long-term survival and quality of life. Large-scale screening programs in the United States and abroad have decreased the number of late-stage cancers detected. However, conflicting screening recommendations have created confusion about when to start screening, what the best methods are and the frequency of mammograms.

Detecting Interval Cancers – Palpation

Recent research indicates that skilled palpation, through clinical exam or self-awareness procedures such as self-exams, serve an important function in the detection of a significant proportion of breast cancer referred to as interval cancers. Interval breast cancers are defined as breast cancers detected between scheduled screening mammograms. These cancers are most often found through touch – by a woman herself, by her partner, or by a clinician. Screening recommendations for mammograms vary by agency, with some intervals as long as two years between appointments. Without proper palpation-based skills/awareness, interval cancers can grow for as long as two years before potentially being detected by a scheduled screening mammogram.

Understanding that early breast cancer detection is correlated with better treatment outcomes and long-term survival, researchers have focused on interval cancer detection in recent years:

Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program. J Natl Cancer Inst 2011.Jun 22;103(12):942-50. Epub 2011 May 3 Kirsh VA, Chiarelli AM, Edwards SA, O’Malley FP, Shumak RS , Yaffe MJ, Boyd, NF

…77% of these were true interval cancers, detected clinically in the 1–2 year interval between screening examinations…

A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec;200(6):712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B.

Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors… resulting in more aggressive therapy

Breast Cancer in Young Women

While breast cancer among women under 50 is less common, its occurrence is often marked by more aggressive and deadly forms of cancer. Mammograms are not recommended for screening women under 50 years of age, limiting their options and leading to cancers that present at later stages with poorer survival outcomes. Palpation-based screening options are the primary tool available to typical-risk women under 50, and many agencies recommend “breast self-awareness” to young women without concrete strategies for achieving this awareness. The MammaCare Method® of Breast Self-Exam is an option for women beginning in their 20s to establish an evidence-based exam technique to promote awareness of the normal look and feel of their breasts.

Mammograms and Clinical Breast Exams

Mammograms (breast x-rays) remain the most frequently used screen although alone they are not sufficient. A substantial portion of breast cancer is not visible on mammograms and mammograms are inadvisable for screening young women and women of any age with dense breast tissue. Clinical breast exams, expertly performed by trained hands, can detect small breast cancers and cancers missed or invisible on mammograms. A recent national study of 89,000 Canadian women study examined over 25 years either by the hands of trained nurses plus self-exams or by mammograms alone found there was no difference in the total number of cancers detected or the in the life span of women in either group.

Physicians and nurses perform clinical breast exams on an estimated 20 million U.S. women each year although the quality of the physical examination remains variable. Standards now exist for proficient clinical and personal exams and they are leading to more thorough and effective exams. A report in the Journal of the American Medical Association on the effectiveness of clinical breast exams concluded that its efficacy is dependent on precision and accuracy. The authors stated:

Our recommendation incorporates practices from the MammaCare method because its components have been validated in independent investigations of CBE technique.

References

Barton, M. B., Harris, R., & Fletcher, S. W. (1999). Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? Journal of the American Medical Association, 282(13), 1270-1280.

Centers for Disease Control and Prevention. (2014). Breast Cancer in Young Women. http://www.cdc.gov/cancer/breast/young_women/

Gui, G.P. et. al. (2001). The incidence of breast cancer from screening women according to predicted family history risk: Does annual clinical examination add to mammography? European Journal of Cancer, 37(13), 1668-1673. Abstract

National Cancer Institute. (2015). Breast Cancer Screening Concepts. http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page4

Narod, S.A. (2012). Tumour size predicts long-term survival among women with lymph node-positive breast cancer. Current Oncology, 19(5), 249-253. Full-text and table

Young Survival Coalition. (2015). Statistics and Disparities. http://www.youngsurvival.org/breast-cancer-in-young-women/learn/statistics-and-disparities