Breast cancer is the second most common cancer in the world and is fatal for more than a half million woman annually.   Early detection and treatment of breast cancer are positively associated with survival and a breast lump that can be felt is the most common first symptom. When the cancer is small, less than <1cm (pea sized) and has not spread, the patient’s 15 year survival exceeds 88% as indicated in the table below.

It is not surprising that failures in diagnosing and treating  breast cancer represent the most frequent cause of successful malpractice claims in the United States. In response the US National Cancer Institute and  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.

 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.

Evidence confirms that early breast cancer detection, combined with advances in treatment, are the key to long-term survival and quality of life. While large-scale screening programs have decreased the number of late-stage cancers, conflicting screening recommendations have created confusion about when to start screening, what the best methods and frequency of screenings.

Interval Cancers – found after mammogram by clinical exams and self-exams

Recent research studies also found that skilled clinical or self-exams detect  breast cancer after and between screening mammograms.  Referred to as interval cancers, they are detected after a screening mammogram has found no signs of cancer.  These “interval” cancers are most often found through touch – by a woman herself, by her partner, or by a clinician.

Understanding that early breast cancer detection is correlated with better treatment outcomes and long-term survival, researchers have focused on better 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 a substantial portion of breast cancer is not visible on mammograms and they are inadvisable for screening women younger than 40 years old and women of any age with dense breast tissue. Clinical breast exams, performed by trained hands, can detect small palpable breast cancers and cancers missed or invisible on mammograms. A recent national study of 89,000 Canadian women examined over 25 years examines  by the hands of trained nurses as well as 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 practice varies among practitioners who have not been trained. Standards now exist for proficient clinical and personal skills 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