When it Comes to Breast Cancer, Ask the Right Questions
About 1 in 8 women will develop invasive breast cancer. This year alone, an estimated 231,840 new cases of invasive breast cancer will be diagnosed in the U.S. October is Breast Cancer Awareness Month, and it’s a great time to review your risks, ensure you’re up to date on your screenings and learn about treatment options available.
Before you speak with your doctor about breast-cancer screening, it’s important to know your risk. Being female and getting older are your biggest risk factors. You are at higher risk if there’s a history of breast cancer in your family or have a known BRCA1 or BRCA2 genetic mutation. But approximately 85 percent of breast cancers occur in women who have no family history of breast cancer.
Additional health risks that may contribute to breast cancer include: starting periods at a young age, having your first baby after the age of 30 or never having children, being obese, and having dense breasts. Knowing your risks can determine whether you should get screened for breast cancer sooner than is generally recommended.
In 2009, the U.S. Preventive Services Task Force recommended some big changes in its screening guidelines — most notably bumping the age from 40 to 50 for average-risk women to begin routine breast-cancer screening.
Routine screening includes mammograms every two years until age 74. The guidelines also stated that breast self-exams have little value, based on findings from a 2014 paper published in the journal of Obstetrics & Gynecology.
However, the American Cancer Society continues to recommend a mammogram every year for women age 40 and older, continuing for as long as they are in good health. The society’s guidelines also recommend clinical breast exams every three years for women ages 20-39, and list breast self-exams as an option.
To patients, we stress that early detection is key and recommend screenings based on their risk level. For average risk, we recommend starting routine screenings at age 40 and continuing every year as long as you are healthy. A routine screening involves a mammogram and a clinical breast exam, which is an examination of your breast by your doctor. For those at high risk, we recommend having a conversation with your physician earlier. Certain women should start screenings as early as 30, which may be with mammography and breast MRI. Additionally, we tell patients that if there is any cause for concern, such as pain, a lump or discharge, don’t ignore it and make an appointment with your doctor as soon as possible.
We also discuss how patients can make positive lifestyle changes that can help lower their risk: maintaining a healthy weight, eating fresh fruits and vegetables, getting regular exercise, cutting out smoking, limiting alcohol intake and minimizing hormone therapy.
If you’re unsure of where to start or what risk level you are, here are some questions to ask your primary care provider at your next visit:
- What testing should I get at my age?
- What do I need to know about my family history that could put me at higher risk for breast cancer?
- What can I do to prevent breast cancer or decrease my risk?
When it comes to screenings, patients commonly ask about the BRCA1 and BRCA2 genetic mutation. People are not tested for it routinely unless there is a family history strongly indicating multiple members of your family carry the genetic mutation. People who have mutations in BRCA1 and BRCA2 genes are at a much higher risk of developing breast cancer. Some choose preventive surgery known as prophylactic mastectomy, the removal of both breasts to prevent breast cancer. For women at high risk, studies suggest this lowers the risk by 90 percent.
If you are diagnosed with breast cancer, the earlier it is identified the better. Treatment options include surgery with or without radiation. Chemotherapy, hormone therapy and targeted drug therapy may be used as additional treatments. Breast cancer can be a scary topic, but reliable information is your best defense. We recommend consulting with your primary care provider to address any concerns about breast health.
Patricia Lewis, MD, practices family medicine at PacMed Northgate. Connie Emerson, MD, practices diagnostic imaging-breast imaging at the PacMed Diagnostic & Wellness Center for Women at the Beacon Hill clinic.