Enough with the FEAR and UNNECESSARY BIOPSIES already!
The ACS’s recent recommendations for breast cancer screening that were released this week may state they interpret statistics, but as a breast surgeon, my partners and I look into the eyes of these young women who’s lives have been saved by early detection and they are not statistics!
Thankfully we now have advanced imaging in 3 D Tomosynthesis mammography, automated whole breast ultrasound and MRI when appropriate. Clinical breast exams and breast self exam are important to identify the 20% of cancers that are not found on imaging!
The Facts about screening mammography speak for them selves.
- Breast cancer is the single leading cause of death for women ages 40-49 in the United States So why would we delay a baseline mammogram and annual screening to women over 45?
- There are some aggressive breast cancers (the minority) that will occur between screenings (that’s why breast exams do matter). We call these cancers interval cancers as they often occur in the interval between mammograms and can grow rapidly. They are the triple negative breast cancers and the Her2 neu positive breast cancers. These cancers can both be treated and cure is possible, but that require aggressive chemotherapy and often radiation therapy.
- A benign diagnosis from a breast biopsy is not an “unnecessary” biopsy; it is fortunate for that patient that she does not have cancer. Many aggressive breast cancers mimic benign growths in the breast such as fibroadenomas and complex cystic masses. It takes a minimally invasive breast biopsy to tell them apart.
- According to the AACR (American Association of Cancer Researchers) , the total number of breast cancer cases in the United States is forecast to be 50% greater in 2030 than it was in 2011 (that is an increase from 283,000 in 2011, to 441,000 breast cancers diagnosed annually in 2030 ) Mostly ER+ tumors which are related to lifestyle choices. (the ones we find on screening mammography)  I ASK WHY CUT BACK SCREENING NOW?
- In a 20 year mammography screening study, Laszlo Tabar found that women aged 40–49 years, who were offered screening mammography compared to women not being screened there was a significant 48% reduction in death from breast cancer.
- >75 % of all breast cancer is found in women without a family history! The notion that women with a family history should have access to higher levels of screening is insane as all women are at risk and the majority of breast cancers will occur in women without a family history.
- We finally have a tool for screening dense breasted patients with automated whole breast US. If you are told that your breasts are dense, insist on an ABUS. An automated whole breast ultrasound is a specific screening tool for women woth dense breasts and there is no radiation exposure with this test. There is legislation in place to inform you if your breasts are dense when you receive a screening mammogram so read your letters carefully. A standard hand held US done on both breasts is not the same as an ABUS. Be an informed consumer.
- We need more dedicated breast imagers who specialize in advanced breast imaging. These are specialists who dedicate their career to early detection and diagnosis of breast cancer. They can decrease unnecessary biopsies and call backs when they have the latest technology and fine the cancers at an early stage.
- What they did get right is stopping screening in the nursing home bound elderly who have a life expectancy < 10 years
Just the facts!
So what can you do as an educated empowered woman to decrease your risk of breast cancer?
Fear paralyzes and knowledge empowers so go forth with knowledge. There are modifiable risk factors and non- modifiable risk factors.
- The first and greatest risk factor is having been born a woman. (Cannot change that)
- DO NOT SMOKE (Do I really have to remind you in 2015?)
- We cannot change our family history! But you need to ask you relatives if there are family members who have had breast cancer. (Ask at what age they were diagnosed and do not forget, men get breast cancer too so be specific) In addition a family history or ovarian cancer, colon cancer, melanomas and pancreatic cancers may place you family at higher risk for known genetic mutations, so be informed. (Ask your doctor if you qualify for genetic testing or visit https://www.myriad.com/patients-families/disease-info/breast-cancer/)
- Have your first child before the age of 30
- Breastfeed your babies. (Particularly if you have your first child over the age of 30 as it can help to decrease your risk!)
- Avoid alcohol particularly before you have your first child. The data is clear that it increases your risk, the more you drink the higher the risk, and we just need to get the word out! (This holds true for ER+ and ER- tumors!)Nutrition News.
- Maintain a healthy BMI. < 25!! Obesity is linked to an increased risk of breast cancer and an increased risk of recurrence of breast cancer in someone who already had breast cancer. (Fat is the building block of estrogen!)
- Exercise 30 minutes a day
- Eat a healthy diet viverhealth.com
- Sleep matters. (Lack of sleep and poor interrupted sleep is linked to an increased risk of breast cancer.)
- Risks of Poor Sleep
- Huffington Post
- Baseline between 35-40 and if you have a family history, ask your doctor if you need to do anything earlier
- Begin screening mammography at 40 and annually thereafter
- Know your breasts. There may not be enough data for the ACS to say the breast self exam and clinical breast exams reduce the risk of dying of breast cancer, but since 20 % of breast cancers are not found easily with screening studies, and some cancers grow rapidly breast exams matter. So become familiar with your breasts and if you feel something don’t panic, see your doctor.
- Ask if a 3 D Tomosynthesis mammography is right for you?
- If your breasts are dense, request an automated whole breast ultrasound ( ABUS)
- If your doctor calculates your risk of breast cancer and it is > 20% in your lifetime you should qualify for breast MRI for screening. http://www.hughesriskapps.com/
The take home message is to be aware of your personal risks and modify those that you can. Live consciously, eat clean, exercise regularly, limit yourself to 4 oz. glass of wine 5 X per week (or it’s equivalent) after you have had your first child and get enough good quality sleep. In addition, screening matters and don’t be afraid of a cancer your mammogram my find, instead, if your mammogram finds a cancer at an early stage, be thankful that that mammogram may have saved your life!
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