Kathleen Harden, MD is a breast oncology physician, board-certified in medical oncology and internal medicine at Inova Schar Cancer Institute. She has a special interest and conducts research in the management of breast cancer. Her research is focused on early phase clinical trials in breast cancer, breast cancer genomics and individualized treatment for patients based on advanced testing results.
As a breast oncology physician, my primary responsibility is treating patients who have been diagnosed with cancer.
But cancer screening and early detection are always top of mind for me, as well. One important reason is that screening for breast cancer with a mammogram is both diagnostic and preventative.
A mammogram — like a colonoscopy — is rare in that it can save a patient from a cancer diagnosis by finding an abnormality early. And when a mammogram does find a cancer, it’s often found earlier, which means the patient typically doesn’t need as much treatment, and the cure rate is likely to be higher.
In other words, mammograms save lives.
Not surprisingly, I am asked a lot of questions about breast cancer screening and detection. too. For this post, I have answered the five questions I hear most often from patients. I hope you find it helpful for yourself or a loved one.
1. How do I know my level of risk for breast cancer, and what do I do when I know it?
The place to start is a risk assessment, and I suggest the National Cancer Institute’s breast cancer risk assessment tool. It is a click away on the internet, and it’s free.
The tool is like a quiz, with a series of questions you can answer on your own. You don’t need information or test results from a doctor to complete it. When you’re finished, the tool will tell you if you have an average level of risk, a higher-than-average level, or a lower-than-average level.
If you are at average risk or less, I recommend you plan to have annual 3D mammograms once a year, starting at age 40. You should continue to have an annual mammogram until you’re no longer in good enough health to undergo a procedure to remove breast cancer.
If the tool shows that you face higher-than-average risk, it will estimate your lifetime risk. Your next step would be seeing your primary care physician or OBGYN, who will create an individualized screening plan for you.
(Another option for patients in this latter category is visiting the high-risk breast cancer clinic at the Inova Saville Cancer Screening & Prevention Center.)
2. If I feel an abnormality in my breast, what should I do?
There’s no way to know if a lump or other abnormality you find by touch is in fact benign. So anything that feels different from what you’re used to should be evaluated with a mammogram and an ultrasound.
It’s more common for younger women, whose breast tissue is more active, to have abnormalities detected by touch that are benign. It could be a cyst or a fibroadenoma.
But it’s also crucial to note that many times when I see young patients in the office, their cancer has been diagnosed later than it otherwise would have been, because no one wanted to believe that a young person had breast cancer. And cancer in younger people often is more aggressive, as well.
That means it’s all the more important for young women who feel something different in their breasts to see their doctor promptly for an exam and screening.
If you have a family history of breast cancer, paying attention to breast lumps, lumps under the arms, skin changes on your breast or nipple discharge is vital, as well. They are all signs that should be evaluated by a doctor immediately.
3. What family history is important in understanding my breast cancer risk?
The most important history to consider is that of first-degree relatives — mother, sisters and daughters.
Additionally, any family history of male breast cancer is concerning; it should be reported to your physician immediately and you should plan to undergo a high-risk assessment.
If your first-degree relatives or a man in your family has had breast cancer, you face an elevated risk for the disease. The exact level of additional risk will depend on other factors. But you should not ignore that sort of history.
4. Is breast tissue density important?
This is an area in which we could do a better job of raising awareness. Breast density is typically measured during a mammogram, and it’s usually noted on the report. It is important, and not enough patients realize it.
Women who have no known history of breast cancer but have higher breast density face a higher risk of breast cancer. And high breast density creates two problems in detection and screening.
One, breast density makes abnormalities harder to spot.
And two, higher breast density means there are more areas of the breast that can become breast cancer — there are more ducts and lobules.
So it’s imperative that patients ask about breast density when they get a mammogram. And if you have high breast density, ask about additional screening.
Women with higher breast density should feel comfortable advocating for themselves, because they face higher risk. And they should talk to their doctor about a plan for screening based on the density of their breasts.
5. How can I reduce my risk for breast cancer?
There are three primary ways to reduce risk for breast cancer, and which one you might pursue depends on what is learned during your risk assessment.
If you are at high risk for breast cancer, risk-reducing mastectomies are an option. It’s a preventative treatment that is generally considered only for women who have a genetic risk for breast cancer. For instance, we may have identified the BRCA1 or BRCA2 gene.
For other patients with a moderate to high risk, we might consider risk-reducing medication. A common medication prescribed is tamoxifen, a pill patients take once a day. It can reduce a patient’s risk by about half.
The decision to have a mastectomy or take a medication like tamoxifen is one patients make after individualized discussions with their doctors and specialists.
Patients with average or below-average breast cancer risk can reduce that risk through lifestyle changes. Those changes include:
Diet: Less red meat in the diet is associated with lower breast (and colon) cancer risk. Having a mostly plant-based diet is, too.
Tobacco and alcohol: Quitting smoking (or never starting) reduces your breast cancer risk, as does reducing your consumption of alcohol.
Losing weight and exercising: If they’re not a smoker or heavy drinker, the best thing the average person can do to reduce their cancer risk is to reduce their body weight to a healthy body mass index (BMI) and to exercise 3 to 5 times a week.
Obesity is likely to soon become the leading cause of cancer in the United States — it’s a significant factor. So being mindful of your ideal body weight and doing what you can to get there or get closer to it can make a big difference.
Do you have a question that I didn’t answer here, or a follow-up to one of the questions above? Do you want more details? Don’t hesitate to contact the Inova Saville Cancer Screening & Prevention Center at 571-568-7557 or schedule a consultation online.