Breast cancer is the most commonly diagnosed cancer in women in the U.S. and the second leading cause of cancer death in American women. It accounts for 30% of all new cases of cancer diagnosed in women. A woman’s lifetime risk of developing breast cancer is 12% (1:8). Breast cancer mortality (death) rates have decreased significantly in the past 50 years. This is attributed to early detection and improvements in breast cancer treatment. Regular screening mammography starting at age 40 y/o reduces breast cancer mortality in average-risk women.
While screening provides improved health outcomes, there can also be adverse consequences. Screening can be harmful through false-positive test results and over-diagnosis of benign lesions. Additionally, cost of testing, anxiety, discomfort/pain, inconvenience, overdiagnosis and overtreatment are potential risks. Many women are concerned about the risk of radiation exposure from routine screening. The risk of radiation induced cancer is 2 per 100,000 women. The potential mortality benefit from early detection is 60 fold the risk of radiation exposure. In other words, the benefit of detecting breast cancer far outweighs any risk from radiation exposure. Balancing the benefits and risks of screening has led to controversy of opinion about uniform guidelines for breast cancer screening.
Breast cancer risk assessment is particularly important for identifying women who may benefit from more intensive breast cancer surveillance. Risk assessment and identification of women at high risk for breast cancer in the office setting allows for adequate referral to health care providers with expertise in cancer genetics and counseling, testing for germline DNA mutations (i.e. BRCA), discussion of risk reduction options, and the opportunity to identify other family members at increased risk.
The main risk factors for breast cancer are female sex and advancing age. Other factors have been found to be associated with increased risk, but most women diagnosed do not have identifiable risk factors. Other risk factors include family history of breast cancer, known gene mutation, prior breast pathology showing atypical hyperplasia or lobular carcinoma in situ, early menarche, late menopause, nulliparity, estrogen and progesterone hormone therapy, ethnicity (i.e. Ashkenazi), obesity, alcohol consumption, smoking, and dense breasts.
Currently self breast exams are no longer considered beneficial. Instead, breast self-awareness is recommended. This is defined as a woman’s awareness of the normal appearance and feel of her breasts. It means that a woman should be attuned to noticing a change or potential problem with her breasts. Additionally, women should be educated about signs and symptoms of breast cancer and advised to notify their health care provider if they notice a change. It is recommended that a practitioner performs a breast exam in intervals of every 1-3 years for women 25-39 y/o and yearly for women 40 y/o and older. A clinical breast exam by a practitioner will detect 2-6% more cases of invasive cancer than mammography alone.
Women at average risk of breast cancer should be offered screening mammography at 40 y/o. If they have not initiated screening in their 40s, they should begin screening mammography no later than 50y/o. Screening should be performed every 1-2 years based on patient health and risk factors. Biennial (every 2 years) screening mammography may be a reasonable option for women after 55 y/o. Women should continue screening mammography until at least age 75y/o. Age alone should not be the basis to continue or discontinue screening. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of at least 10 years.
If you have concerns or questions regarding your breast health, please call today to schedule an appointment with Dr. Rachel Spieldoch or a provider at McDowell Mountain Gynecology at 480-483-9011.