Messages about breast cancer screening are conflicting and confusing. Can I wait until age 50? Every year or every other year? Professional organizations have differing opinions, but many continue to recommend annual mammograms starting at age 40.
The extremely important and often-overlooked “fine print” about these recommendations is that they apply to women who have an AVERAGE RISK of getting breast cancer. Women who have a higher-than-average risk require a different plan.
So, how does a woman know her risk? Here are important questions to help you become a “know-it-all” about your breast cancer risk. Use these questions in partnership with your healthcare provider as a guide to begin a discussion about your screening plan.
- Do I have relatives on either side of the family with breast cancer? Up to 30 percent of breast cancers have a genetic component, meaning they occur because of something that runs in the family. It’s important to know who had breast cancer and at about what age they were diagnosed. Gather this information about your parents and siblings, grandparents, aunt and uncles, and cousins on both sides of your family.
Share this information with your healthcare provider to help estimate your lifetime risk for breast cancer. Specialists such as genetic counselors can perform a comprehensive breast cancer risk assessment for you. Consider asking for a referral or find a genetic counselor in your area at www.findageneticcounselor.com.
Could my family be carrying a gene mutation that predisposes some of us to breast cancer, and perhaps other cancers?
About 10 percent of breast cancers are caused by specific inherited gene mutations. Depending on the particular gene mutation, risks for other types of cancers may be increased as well. For example, the BRCA1 and BRCA2 genes, which many of us know about thanks to Angelina Jolie, are associated with very high risks of breast and ovarian cancer, as well as prostate and pancreatic cancer. Many other genes have been implicated in hereditary breast cancer as well.
How do you know if you should be tested for these gene mutations? Share your family history with your healthcare provider. You may wish to use an online tool like the one offered by Bright Pink. Ask your doctor if you are a candidate for genetic testing or ask for a referral to a genetic counselor. Genetic counselors can help you make an informed choice about whether testing is right for you, which type of test you should choose, how the test results will affect you and your family members, and the financial implications of the test.
Even patients who test negative for all known hereditary breast cancer genes may still be at higher-than-average risk. It’s important that genetic test results be interpreted by an expert in the context of the patient’s personal and family history of cancer.
What is my breast tissue density?
The density of normal breast tissue varies widely among women. The density is identified by how white the breast tissue appears on a mammogram. The dense part of the breast tissue is double trouble; women with dense breasts are more likely to get breast cancer, and the cancer is more difficult to see on a mammogram because cancer also appears white, often described as a “snowball in a snowstorm.” Mammograms are still extremely useful in these women but may miss some cancers. If you are told you have dense breasts, ask if you should consider other forms of imaging, such as ultrasound.
The best way is to know your density is to have a mammogram. Most women should consider a baseline mammogram at age 40, or earlier if you have other risk factors.
There are other risk factors for breast cancer that are not covered here. Bright Pink has a useful online tool that can help you assess your risk. Involve your doctor and/or a genetic counselor as well.
Personalized Breast Cancer Screening Plan
Once you understand your risk, it’s time to develop a personalized breast cancer screening plan, in conjunction with your healthcare provider. Consider questions such as:
- At what age should I start breast cancer screenings? Talk with your doctor about the various guidelines that exist and which ones make sense for you given your values and personalized risk profile. Many breast cancer experts recommend that most women begin at age 40. Women with certain gene mutations and/or specific patterns of cancer in the family may need to begin earlier – sometimes as early as in their 20’s.
- How often should I be screened? Again, recommendations vary but many experts suggest that most women undergo breast cancer screening annually. High risk women may do more than one type of screening exam in a year’s time period.
- What are the available screening technologies? Mammography – Traditionally considered the “gold standard”
- 3D mammography/tomosynthesis – a new type of mammography that improves cancer detection and reduces false positive results that require additional imaging
- Breast MRI – uses a contrast agent and typically reserved for patients at high risk; may find things that mammography or ultrasound might miss
- Screening breast ultrasound – especially useful for patients with dense breast tissue who don’t meet criteria for breast MRI; may find things that mammography might miss
- Are there things I can do to reduce my risk for breast cancer? There are medications that may reduce risk in some women. Preventive surgery is an option for women at very high risk.
Of course, if you notice anything suspicious, see your doctor right away, regardless of your age or other risk factors. This includes a lump, thickening, swelling, pain, skin changes, nipple changes or nipple discharge. Although knowing your risk is extremely important, 70 to 80 percent of breast cancers occur in women without any significant risk factors.
They say no one likes a know-it-all, but when it comes to your health, being one is essential; it might save your life. Please share this message with women you love.
Mary Freivogel, MS, CGC, is a past-president of the National Society of Genetic Counselors and a Senior Manager of Clinical Service Lines at Invision Sally Jobe Breast Centers.
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