October is breast cancer awareness month, a time when many women and men come together – on fundraising walks or by simply wearing a pink ribbon on a lapel – to rally and fight for a cure for breast cancer.
Whatever you choose to do publicly, this month is also a good time to take a private moment for yourself and answer the question, “What can I do to reduce my risk?” If you’re not quite sure how to answer that question, I’ve listed below some of the key things you should do for yourself.
Screening Mammograms and Other Imaging Technologies
Harvard Vanguard follows the American Cancer Society’s recommendations that all women 40 years and older should have an annual screening mammogram. In 2009, there had been some controversy about whether women should start screening at 40 or at 50. Some of that controversy stemmed from the fact that younger, pre-menopausal women have denser breast tissue, which sometimes “confounds” a definitive screening – making it harder to catch a smaller tumor or leading to suspicious or false positive results that in turn may lead to more invasive, anxiety-producing follow-up tests. Awareness of density of breast tissue is increasing as a conversation point between a patient and her clinician. Other states (as close as Connecticut) require by law that a clinician inform a woman how dense her breasts are as part of a screening procedure to make her more aware of this factor.
Today, we use digital mammography at Harvard Vanguard for normal risk women, and that technology is very effective, allowing for magnification views of different areas of the breast. Mammograms are one of the best tools to detect breast cancer early in women who have no other symptoms. Additionally, ultrasound is used if there is an area on the mammogram that needs further clarification or if a patient has a specific complaint of a lump, pain or nipple discharge. Ultrasound is also used to look at a breast concern in women under the age of 30 and women who are pregnant, as there is no radiation exposure.
MRIs are sometimes used for high-risk women (in addition to a screening mammogram) as well as for “inconclusive” digital mammogram/ultrasound readings. To date, the data does not support MRI scanning to women with dense breasts who are not at high risk. MRIs are typically used for women who carry a known breast gene mutation (BRCA1 or 2), a woman with a total lifetime risk of >20%, and anyone who has had chest radiation treatment from a prior cancer (like Hodgkins lymphoma). While very comprehensive, MRIs are not always covered by insurance, making them very expensive as an alternative.
The newest technology is tomosynthesis, sometimes called a “3-D mammogram.” Our imaging center expects to have one of these units by early spring of 2014.
Tomosynthesis takes multiple X-ray pictures of each breast from many angles. The breast is compressed as with conventional mammograms. The X-ray tube moves in an arc around the breast and multiple images are taken. Then the information is sent to a computer, where it is assembled to produce clear, highly focused 3-dimensional images of the breast.
Tomosynthesis is particularly helpful for women with very dense breasts; however, the technology has not yet been approved for screening, and insurance therefore does not cover the cost. It also does have slightly more radiation, but if a woman has dense breast tissue, it might be a good idea to discuss this option with her clinician and determine whether it is right for her.
Breast Exams
Like screening mammography for women under the age of 50, the effectiveness of self-breast exams has also been scrutinized in recent years. Once again, women with denser breasts may miss something or think they have found something, leading to more, possibly unnecessary, tests and anxiety. The American Cancer Society now talks more about “breast awareness,” meaning changes to what is normal for you – watch for shape changes, nipple discharge, discoloration, etc. that are not normal for you and speak with your clinician about any that you might see.
Clinical breast exams are very important, and these should begin for women in their 20s (every 3 years) and once per year for all women >40 years of age. If you do have a higher risk for breast cancer, it is best to have a clinical breast exam every 6 months.
Lifestyle Choices to Reduce Risk
Although there are risks that you cannot control, such as age, genetics or a family history, there are lifestyle choices you can make that can reduce your risk. Not surprisingly, they’re many of the same healthy lifestyle factors that do you good for so many other health issues, too, but here’s why they affect your risk for breast cancer:
- Maintain a healthy weight. Being overweight or obese especially after menopause increases your risk of breast cancer. After menopause, when the ovaries stop making estrogen, most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can increase your chance of getting breast cancer by raising estrogen levels.
- Be physically active. More and more evidence is showing that being physically active decreases your risk for breast cancer, but what’s a good amount? Although the specific levels can vary, follow the general guidelines of 150 minutes per week of moderate-intensity exercise.
- Hormone replacement therapy. Talk with your clinician very carefully about your options and understand what benefits – and what risks – hormone replacement therapies pose for you.
- Limit your alcohol use. Alcohol consumption has indeed been linked to an increased risk of breast cancer. Although one drink per day for women appears to have a very slight increase in risk, the risk goes up with 2 drinks and sharply up with 3 or more.
- Quit Smoking. Older studies did not actually find a link between smoking and breast cancer, but more recent studies are, particularly for women of certain ethnic backgrounds. Second-hand smoke as a risk factor is still unclear, but causal associations have been found, suggesting limiting exposure whenever possible.
The Breast Care Program at Harvard Vanguard
At Harvard Vanguard, we will be moving our breast imaging program and breast services program into a joint space to be open in the spring of 2014. This will join the newly-renovated oncology department on the same floor, facilitating the collaboration between all 3 departments and allowing us to provide our patients with more coordinated care and an overall better experience.
Our breast program provides diagnosis and treatment of breast cancer as well as a wide range of non-cancerous breast conditions. Our services include:
- Breast imaging (digital mammography, ultrasound and MRI)
- Minimally-invasive biopsies via mammography, ultrasound and MRI
- Consultation, treatment, and management provided by board-certified breast surgeons, medical oncologists, genetic counselors and specialty trained nurse practitioners for a number of concerns, including
- Breast cancer
- Breast cancer genetics, particularly for those with a family history of breast cancer
- Breast infections, specifically mastitis and breast-feeding concerns
- Breast pain
- Nipple discharge
- Breast lumps and thickenings
- Abnormal mammogram results