It’s breast cancer awareness month and I’d like to provide you with some important information regarding breast cancer, lifetime risk, and screening opportunities. Breast cancer is the 2nd leading cause of cancer death among women, lung cancer being the first. A woman has a 1 in 8 lifetime chance of developing breast cancer regardless of family history or other risk factors. That is why it is so important for women to begin breast cancer screening at age 40 with a mammogram every 1-2 years in accordance with recommendations from the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society and the National Cancer Institute.1
Breast cancer screening with mammography has reduced the number of deaths from breast cancer. When breast cancer is detected early, it is often curable with surgery alone and 98% of women diagnosed with an early cancer will survive more than 5 years after their diagnosis. That is essentially a cured cancer, though it is important to be vigilant and have regular medical check-ups. Your health care provider should refer you for a mammogram every 1-2 years once you turn 40 years old, unless you have significant risk factors that would mean you need mammograms sooner.
Significant risk factors for breast cancer that might mean you should have mammogram screening before age 40 include first-degree relatives with breast cancer (mother, sister, daughter), a male relative with breast cancer, or multiple family members that have had various cancers including breast, colon, uterine, or ovarian. These are cancers that tend to be hereditary and your health care provider should ask about these cancers in your extended family in order to understand if you are at increased risk of an inherited cancer such as breast cancer. Health care providers should be using breast cancer risk tools such as www.cancer.gov/bcrisktool to determine the appropriate breast cancer screening for you. The U.S.Preventive Services Task Force also has a recent publication on risk assessment and genetic testing.
Self-breast exams or clinical breast exams in the health care provider’s office may or may not help in the detection of breast cancer. There is no agreed upon opinion of whether or not women should be performing their own breast exams or if providers should be as well. In general, I tell my patients that if they can remember to do a self-breast exam every month when their period starts and then pay attention to any changes in their breast tissue, that may be helpful. (The timing at the beginning of a period is important because hormonal changes affect breast tissue and it is at this time that there is least likely to be a finding of an abnormality which is actually not something to be worried about.) Of course, if you no longer have a period then I recommend the 1st day of every month.
With proper detection, breast cancer can be manageable and lives can be saved. Please see your health care provider about when to start mammogram screening, especially if you are 40 or more years young. Be well!
Q&A from Twitter:
@LeahNTorres How vigilant do we really have to be? Get BRCA test if no family history? If test shows no predisposition?
— Robyn Swirling (@RSwirling) September 16, 2014
Only after discussion with a health care provider should genetic testing be pursued. The aforementioned tool can help guide your provider in whether or not to refer you to a Genetics Counselor, an important step before any genetic testing is performed.
That is a great question! The way I would approach this, because all insurances are different, is before performing any testing, call the insurance company and ask what their policies are. I would ask these questions specifically: “Do you cover genetic testing for breast cancer?” and “Will I have coverage for breast cancer surgery and treatment if I am found to have the BRCA gene?” Then you may want to ask about premiums, annual cost adjustments, etc. After you call your own insurance company, especially if you do not like what you hear, I would call others and inquire about their coverage options.
@LeahNTorres • part v full mastectomy (+/-) • long term tamoxifen use (cataracts?) • genetic & environmental influences (e.g. downwinders)
— I’m Rich but I’m not (@ichypants) September 16, 2014
These are issues best discussed with the surgical oncologist and are individualized case-by-case. In general, tamoxifen used to reduce risk of developing breast cancer is not used longer than 5 years. That said, I found an interesting article in the Journal of Clinical Oncology that may be helpful. My review of the literature leads me to concur that there is a small risk of developing cataracts and regular eye exams should be performed, particularly in women over 50 years of age, but that the benefit of this therapy likely far outweighs the risk of cataracts.
There is no such thing as a silly question… I think. I have no evidence to support that this is true. However, if people believe this to be true, it may be a self-fulfilling prophecy because our brains are powerful things. I did find an article stating that women with more fibrocystic breast tissue may experience more pain during a mammogram, but there was no relation to caffeine intake. [Note: I did not have access to the full article and could not critique their methodology.] This was fun to research!
@LeahNTorres Just because of your bio, I’d be interested in reading about sex after breast cancer. No one ever touches that topic.
— Roxanne (TeamRoxy) (@TeamR0XY) September 16, 2014
I am so glad you asked this because you are absolutely right: we don’t talk about this. This is a very complex issue given the effects of receiving the diagnosis of breast cancer and the toll that takes on someone and their family emotionally, let alone all of the medical side effects of surgery and treatment. While I cannot go into all of the possibilities regarding this subject, I feel compelled to emphasize this: talk about it. Talk about it to your doctor, to your partner, to your family members. Our society tells us not to talk about sex, but at the same time the social messaging tells us that if we don’t want sex 24-7 there’s something wrong with us. This topic becomes much more complex in the face of the challenges of being diagnosed with breast cancer and all that comes after. Find a sex-positive health care provider who recognizes that sex during and after treatment MATTERS and is willing to help in all ways possible. Do not settle for “this is normal.” As I always say to my patients regarding the topics of sex, sexuality, and sexual activity: if it bothers you, it merits investigation and further discussion. Hopefully that helps to empower people to initiate the discussion.
- American College of O-G. Practice bulletin no. 122: Breast cancer screening. Obstet. Gynecol. Aug 2011;118(2 Pt 1):372-382.