October is Breast Cancer Awareness Month. Breast Cancer will strike 1 of every 8 women (12.4%) and is the second leading cause of death in women (the first is lung cancer). The death rate, however, has declined by almost 40% in the last 25 years. That reduction may be attributed to improved chemotherapy regimens and to better surveillance with mammograms and other tests. Below are links to the American Cancer Society and Komen Foundation for more information.
Now is a good time to review the American Cancer Society’s recommendations for surveillance (as presented on the ACS web site) :
American Cancer Society screenings recommendations for women at average breast cancer risk
These guidelines are for women at average risk for breast cancer. A woman at average risk doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as BRCA), and has not had chest radiation therapy before the age of 30. (See below for guidelines for women at higher than average risk.)
Women between 40 and 44 have the option to start screening with a mammogram every year.
Women 45 to 54 should get mammograms every year.
Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
All women should understand what to expect when getting a mammogram for breast cancer screening – what the test can and cannot do.
Regular mammograms can help find breast cancer at an early stage, when treatment is most successful. A mammogram can find breast changes that could be cancer years before physical symptoms develop. Results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found early, are less likely to need aggressive treatment like surgery to remove the breast (mastectomy) and chemotherapy, and are more likely to be cured.
Mammograms are not perfect. They miss some cancers. And sometimes a woman will be need more tests to find out if something found on a mammogram is or is not cancer. There’s also a small possibility of being diagnosed with a cancer that never would have caused any problems had it not been found during screening. It‘s important that women getting mammograms know what to expect and understand the benefits and limitations of screening.
Clinical breast exam and breast self-exam
Research has not shown a clear benefit of physical breast exams done by either a health professional or by yourself for breast cancer screening. There is very little evidence that these tests help find breast cancer early when women also get screening mammograms. Because of this, a regular clinical breast exam and breast self-exam are not recommended. Still, all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
American Cancer Society screening recommendations for women at higher than average risk
Women who are at high risk for breast cancer based on certain factors should get an MRI and a mammogram every year. This includes women who:
- Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (such as the Claus model – see below)
- Have a known BRCA1 or BRCA2 gene mutation
- Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%.
There’s not enough evidence to make a recommendation for or against yearly MRI screening for women who have a moderately increased risk of breast cancer (a lifetime risk of 15% to 20% according to risk assessment tools that are based mainly on family history) or who may be at increased risk of breast cancer based on certain factors, such as:
- Having a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
- Having “extremely” or “heterogeneously” dense breasts as seen on a mammogram
If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is more likely to detect cancer than a mammogram, it may still miss some cancers that a mammogram would detect.
Most women at high risk should begin screening with MRI and mammograms when they are 30 and continue for as long as they are in good health. But a woman at high risk should make the decision to start with her health care providers, taking into account personal circumstances and preferences.
Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.