Screening, does it catch cancer early

Oh well Kira. I knew there must be a catch. Any diagnosis I have now would be my third.

Hi ladies and gents, How likely is BC to hide in an MRI with contrast?

Bonnie- breast pain doesn't mean bc. Before I got bc I had breast pain and nothing was found. It was chalked up to raging hormones. The fact that you don't have bc is cause for celebration! I'd say keep up with your annual checks and self checks.

One thing that I do want to mention is not only can MRI give false positives but can miss as well. 3 cm of my bc was hidden in MRI with contrast. It said 4 cm. It wasn't until sx that they found 3 cm more that hid very well in my dense breast. Luckily I had it in my head that I was going to do bmx otherwise my breasts were big enough (DD/DDD) where I was offered lx. At 7 cm I would have been having another sx to just take them out. Wasn't about to just do lx with it that large.

Wrenn that wasn't my question. I like many on here still haven't figured out the source of pain. Not to mention I have read about women on this site who have had neg. mammos, ultrasound and MRI only to find out otherwise. I posted my question in hopes that I would've gotten an answer and feel if you don't have it for me, then don't comment.

Would someone like to make sense of this?

AbstractThis abstract is available on the publisher's site.Access this abstract now Data from the Surveillance, Epidemiology, and End Results registry show that smaller breast cancers, like many of those detected by mammography, are disproportionately biologically favorable in natural history.

DOWNLOAD CITATIONPERMISSIONSSPECIAL REPORTAre Small Breast Cancers Good because They Are Small or Small because They Are Good?Donald R. Lannin, M.D., and Shiyi Wang, M.D., Ph.D.N Engl J Med 2017; 376:2286-91June 8, 2017DOI: 10.1056/NEJMsr1613680Share:Data from the Surveillance, Epidemiology, and End Results registry show that smaller breast cancers, like many of those detected by mammography, are disproportionately biologically favorable in natural history.Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.SOURCE INFORMATIONFrom the Department of Surgery, Yale University School of Medicine (D.R.L.), Yale University School of Public Health (S.W.), and Yale Comprehensive Cancer Center (D.R.L., S.W.), New Haven, CT.Address reprint requests to Dr. Lannin at the Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT 06520, or at donald.lannin@yale.edu.Access this article: Subscribe to NEJM | Purchase this articleMEDIA IN THIS ARTICLEFIGURE 1Biologic Characteristics According to Tumor Size.FIGURE 2Breast Cancer–Specific Survival among Women 40 Years of Age or Older, According to Tumor Size and Biologic Features.

Primary Care

Written by Tricia C Elliott MD, FAAFP

As the molecular structure of breast tumors continues to become more evident, and with the significant increased use of mammography for breast cancer screening in women ≥40 years of age at average risk, the overdiagnosis and overtreatment of breast cancers appears to also be occurring. Previous studies estimate the overall rate of overdiagnosis for invasive tumors is 22%.

Lannin and Wang determined the impact of biologic factors such as grade and hormone receptor status, along with evaluating mean lead times in three prognostic groups for best and worst survivals: biologically favorable, biologically unfavorable, and intermediate.

Prognostic Group (based on biological factors)

ER=Estrogen receptor status

PR=Progesterone receptor status

They focused primarily on the characteristics of favorable and unfavorable tumors, and correlation with the size of the tumor. In women ≥40 years of age with small tumors (under 1 cm), many of these were favorable tumors. The larger the tumor, the greater chance it is unfavorable. Findings show that tumor size also depends on the biologic factors of the tumor, not solely on when the cancer was detected. Many small tumors with favorable biologic features do not progress to large tumors within a patient's lifetime. Large tumors may preferentially develop from small tumors with unfavorable biologic factors. Tumor size and biologic factors influence prognosis.

Mammography has been very good for detecting tumors; however, with the overuse of mammography, we are detecting many tumors with favorable biologic features and may be overdiagnosing and overtreating certain cancers that may benefit solely from excision (without chemotherapy) or watchful waiting. Also, as age increases over 40 years of age into age 70 and 80, the overdiagnosis of favorable, small tumors increases significantly. Overdiagnosis can cause unnecessary anxiety and fear in patients.

As primary care clinicians counseling our patients on breast cancer screening and detection, multiple factors can contribute to a shared decision between clinician and patient. When a tumor is detected, tumor size and biologic features may be factors in the decision-making process. Stage, size, age, and biologic factors matter and may help avoid overdiagnosis and overtreatment in patients. Many small breast cancers may be good because they meet the favorable biologic profile, and they may be small because they are favorable. More studies are needed to help develop future guidelines for clinicians and patients.