October is Breast Cancer awareness month and its round the corner! Just like gym memberships hit records high around January with new-year resolutions, breast exams and mammogram requests hit the roof in a breast health clinic in October.
We all have heard about the importance of getting breast exams and mammograms to get screened for breast cancer but wouldn’t it be assuring to know when is the most appropriate age and time to get those mammograms started so you are not late, or when can you wait few more years and more importantly are you one of those women who need to start earlier than most? These are important questions since early detection of breast cancer may lead to better outcomes.
To address these questions accurately and to know when and how often to get screened, one needs to know if they are at high or alternatively at average risk for breast cancer. When to start getting those mammograms and how often, depends on risk of developing breast cancer.
How to determine which group you belong to?
Your healthcare provider should take a detailed personal, medical and breast health as well as family history to evaluate your risk. There are risk assessment models that physicians use to further verify a woman’s risk. Gail Model is one such model and assesses breast cancer risk based on a series of questions that a woman and her health care provider should answer together. The result is a Gail Score, which estimates the risk of developing breast cancer in the next 5 years and over a women’s lifespan. A word of caution – Gail model underestimates the risk for women with a significant family history and personal history of breast cancer. There are other models that are used in such and other specific situations.
Based on medical history and input from risk assessment models, a woman is either at an average risk or at a high risk for breast cancer. Once the level of risk is determined, your healthcare provider will guide you to the best screening protocol that is right for you. Women with high risk may also need genetic counseling in addition to more rigorous screening.
American Society of Breast Surgeons updated breast cancer screening guidelines in May 2019 and based on these recommendations:
- Women with an average risk of breast cancer should start screening mammograms at age 40 and every year thereafter.
- Women with a higher-than-average risk of breast cancer should start annual screening mammograms at an earlier age and should be offered additional imaging (possibly Ultrasound/MRI) each year.
Please remember, all women age 25 and older should have a formal risk assessment for breast cancer and should know their risk category. Considering breast cancer is the most common type of cancer diagnosed in women, defining level of risk is important and can be life saving. It’s a good idea to make an appointment now and get your risk assessed. Ideally, risk assessment should be updated at regular intervals as and when your personal and family history changes. Your healthcare provider can use this information to guide you to work on factors that you can modify or improve and screening modalities that are just right for you. In addition to mammograms (Please remember to ask for 3D mammograms which generate a 3D image of the breasts), monthly breast self-exam and annual physical exams by a doctor are essential parts of an overall breast cancer screening strategy.
Talk to your doctor about developing a specialized program for early detection that meets your individual needs and gives you peace of mind. It also makes good sense to do all that you can to keep your risk of breast cancer as low as it can be. Some lifestyle choices you may want to consider are:
- Maintaining a healthy weight
- Exercising regularly
- Limiting or avoiding alcohol
- Eating a healthy diet that’s low in processed foods, sugar, and trans fats
- Not smoking
Its never too late to work on risk factors which are modifiable and can bring your risk level down – Please see my earlier articles in Voicebowl on breast health and modifiable risk factors for better overall and breast health.
Important Facts:
- 85% of breast cancer occur in women with no family history of breast cancer. Most important risk factors are being a woman and getting older – the two factors we have no control over.
- Breast density (dense breast tissue as seen on mammogram, it is not something you or your doctor can feel while performing breast exam) can be a risk factor for breast cancer. It also makes it harder for mammograms to detect breast cancer. As of June 2018, 34 states have passed legislation requiring that women be notified of their breast density with mammography results. When you get your mammogram done, be sure to have a discussion about breast density with your health care provider.
Resources:
https://www.breastcancer.org/research-news/asbrs-issues-updated-screening-guidelines
