By Dr. Debra Patt, MD MPH MBA, Texas Oncology
As a breast cancer specialist, I encounter women each day in my practice with new breast cancers. It is my personal and professional goal to improve outcomes in breast cancer and reduce its impact across the globe. Breast cancer is very common, the most common non-skin cancer among women, and the second leading cause of cancer death among women, and it is frequently preventable. Someone you know has breast cancer. They may not know it yet, but it is likely true. Statistically it is likely that you will know someone impacted by breast cancer as one out of every eight women are affected by breast cancer during their lifetime. While breast cancers usually occur in women over 50, I have many patients in their 20s, 30s and 40s that are affected by the disease. Because breast cancer is so common, and mortality associated with it is often preventable, it is important for every woman to follow these simple steps to reduce their risk. Early detection not only saves lives, but frequently eliminates the need for more aggressive treatment and its associated side effects. It is important to know this for your own health and for the health of your friends and family.
1. Know Your Risk. If one out of eight women will be affected with breast cancer in her lifetime, 12% of women on average are at risk of developing breast cancer. Not all women carry the same risk. If you have a strong family history of breast cancer or other cancers your risk may be higher. By talking with your doctor about the cancers that have occurred in your family you can predict if you are at average or above average risk. For some women, particularly if they have close relatives who have breast or ovarian cancer, genetic screening for genetic mutations that could convey a higher lifetime risk of breast cancer may be appropriate. For these women, the lifetime risk of breast cancer may be as high as 70-90%, especially among women who carry a BRCA or BRCA like gene mutation.
There are other women who are also at risk of developing breast cancer. For example exposure to chest radiation increases your risk of breast cancer. Some procedures like having had abnormalities in the breast requiring biopsy before, may also increase your risk of having breast cancer. For women with higher risk, screening should occur at an earlier age and more frequently, and interventions to reduce the risk of cancer may be considered. Women should talk to their doctors to help them understand if they are at average or increased risk.
2. Undergo Appropriate Screening. Once a woman understands her risk, she needs to undergo screening for breast cancer based on her unique risk of developing the disease. Monthly self-breast examination is recommended for all women. Know your breasts, contact your doctor with any abnormalities, and have a clinical breast exam at least once a year. Women of average risk for breast cancer should undergo annual mammography beginning at age 40 and continuing throughout adult life. When a woman is older than 55, she can consider mammography every other year, although annual mammography is still recommended. The benefit of mammography is that it is a radiograph—a picture—that shows abnormalities in the breast that require further investigation. Frequently mammography shows breast cancers that are not found on breast exam. Mammography is not the same for every woman as the clarity of the picture can be altered by breast density. As dense breasts can appear cloudy or difficult to see, mammography will be a less sensitive tool to detect occult breast cancer. Some women benefit from 3-dimensional mammography as it increases the sensitivity of mammography detected breast cancer by forty percent. For some women that have a higher risk for breast cancer, additional and more frequent screening may be necessary.
3. Talk to your Doctor. Changes in the breast are common among women. Women frequently have changes that accompany menstruation that return to normal when the menstrual cycle is complete. Ask your doctor about your changes on exam so you can begin to distinguish what is normal and what requires further investigation. Your doctor can also help design a screening strategy that is most appropriate for you, based on your risk characteristics, and help you decide if additional genetic testing, is indicated.
It is a great time to be a cancer specialist. I often tell patients and their families that I feel like an infectious disease doctor in the 1930s with the advent and medical use of new antibiotics to newly treat and cure disease’s that were previously thought to be incurable. Our abilities to target cancer with new precision medicines and harness the body’s own immune system has dramatically altered the landscape of cancer care. I have many patients in my practice that 10 years ago would have had a limited lifespan, and now a decade later are living with cancer managed as a chronic disease. Medical progress aside, the best way to improve the outcomes in breast cancer remains prevention and early detection. In the words of Ben Franklin, “An ounce of prevention is worth a pound of cure.” The chance to have a good outcome with breast cancer are improved dramatically with early detection. Encourage and advocate for the women in your life to know their risk, screen appropriately, and talk to their doctor.