Presentation on updated information on breast and lung cancer screening from Penn Medicine's Dr. Antje Greenfield.

1. Update On Screening For Breast
And Lung Cancer
Antje L Greenfield, MD PhD
Clinical Associate of Radiology

2. Breast Cancer
Facts
Most frequently diagnosed cancer in women
2016: estimated 246,660 new dx in women,
2,600 in men, additional 61,000 new DCIS dx
(Rate stable in white women, slight increase in AA women
since 2008)
2016: 40,890 death expected
American Cancer Society 2016

3. Should We Screen For Breast Cancer?
YES, because
decreased mortality of 36 % from 1989-2012
due to early detection with mammography
and better treatment options
= estimated 250,000 lives saved
American Cancer Society 2016

4. The Debate
What is the best balance of screening?
What age, how many women, false-
positive mammograms, negative biopsies,
overtreatment/potential harm
vs # of lives saved
Mammography
saves lives
Mammography
overdiagnoses
breast cancer

5. USPSTF Recommendations
• Women 50-74 yo : screening mammography
every 2 years
• Women before 50 yo: individual decision when
to start with screening mammo every 2 years
• Women older than 75 yo: no specific
recommendation, based on risk assessment
• No breast self exams
USPSTF update Jan 2016

6. ACS Recommendations
• Women 40-44 yo: choice of mammography
• Women 45-54 yo: annual mammography
• Women 55 yo and older: every 1-2 years
(good overall health, life expectancy 10
years or greater)
• Women with high risk profile: annual
screening mammo plus MRI, start around
30 yo
American Cancer Society 2016

7. ACR Recommendations
-Average risk (less than 15 %): screening for all
women starting at age 40 yo with annual
mammography
-Intermediate risk (15-20%): annual mammo at any
age if biopsy proven lobular neoplasia, ADH or
other factors
-High risk ( greater than 20%): BRCA gene
mutation, family history (8 year rule) , personal h/o
DCIS or invasive cancer
screen with annual mammo plus other exam such as
MRI

8. Whhhhaaattt?

9. The Real Question Is:
• How much should society spend
on saving one life?
• What is a reasonable balance of
cost and benefit?

10. What do we agree on?
• Yes, we need to screen for breast cancer
with mammography, ideally with 3D
(shows increased detection rates up to 40%
over digital mammo)-
• Women between 50-54 yo screening at least
every two years
• Individualized screening for women before
age 50 and after 55, risk factors to be
considered

11. Beyond The Differences:
• One does NOT fit all.
• Education of patients about risks, symptoms and
options for prevention and screening
• Recommendations are guidelines, need to be
individualized based on:
– Risk factors (BRCA, family history, personal medical
history)
– Breast density
– Age
– Life style (smoking, ETOH, obesity)

12. Maintain A Perspective:
• Risk of breast cancer is relatively high,
approximately 1 in 9 women
• Treatable and potentially curable when dx early
with better functional outcomes
• Premenopausal breast cancer is often more
aggressive
• Risk of radiation induced breast cancer from
mammo is extremely low (86 ca/ 11 death in
100000 in women 40-49 yo = 0.1 %) Radiology. 2011 Jan

13. Until There Is A Better Solution:
• Patient education and awareness
• Talk to your doctor
• Assess your risk profile
(http://www.cancer.gov/bcrisktool)
• Make an individual decision based on knowledge
• Reduce your risk factors and optimize your health
status
• Follow through on your personalized screening
schedule

15. Lung Cancer
Facts
2nd
most commonly diagnosed cancer (male/female)
2016: estimated 224,390 new (14% of all ca dx)
Rate declining by 3% per yr since 2008 due to decrease in
smoking and change of environmental factors and life
style
2016: 158,000 death expected (1 in 4 cancer death)
American Cancer Society 2016

16. National Lung Screening Trial
• Screening LDCT of the chest reduces the
risk of dying from lung cancer (20% lung-
cancer specific mortality benefit)
• Not all cancers will be detected
• Relatively high false-positive rate, can result
in additional testing and some invasive
procedures
• Smoking cessation has high priority in LC
prevention CA Cancer J Clin 2013

17. ACS LC Screening Recommendations
based on results of NLST
• Screening with low-dose spiral CT (LDCT) of the
chest in apparently health patients 55 to 77 yo
with at least 30 pack-year smoking history
(currently smoking or quit within 15 years)
• Shared and informed decision of patient with
physician
• Similar recommendations issued by USPSTF
American Cancer Society 2016

18. Pearls
• LDCT not appropriate for patients with
– Diagnosis and /or current treatment for
lung cancer
– Lung symptoms such as SOB,
hemoptysis, infection
– Had a CT chest within one year

19. How to determine PPY history?

20. Pearls
• LDCT radiation exposure is about
equivalent to radiation dose of a screening
mammogram
• Cost: if meeting high risk criteria usually
covered by insurance, if no coverage at
UPENN $125 self-pay rate