Dr. Kristen Lewis discusses how you and your provider can work together against breast cancer.
Odds are high that you or someone you know has been affected by breast cancer. It’s the most common cancer diagnosis in women (excluding non-melanoma skin cancers): 1 in 8 will be diagnosed in their lifetime. But the good news is that much progress has been made over the years in detection and treatment of the disease.
With routine screening, more women are catching breast cancer in its earlier stages while the disease is still localized in the breast area. The 5-year survival rate for localized breast cancer is 99%! From discussing your family history and personal risk factors with your doctor to knowing the signs and staying on top of your routine screenings, there’s a lot you can do to improve your own outcome should the disease develop.
Risk factors and risk reduction:
There are some risk factors you can’t do much about, but others you can. We’ve broken out risks you can’t control and risks you may be able to reduce.
Risk factors you can’t control:
While the population lifetime risk is 1 in 8, the risk of developing breast cancer increases as you age. Very few women are diagnosed before age 40. The rates begin to pick up after age 40, with the highest rates of diagnosis in women over age 70.
While males can be diagnosed with breast cancer, females are at a much higher risk.
Family History of Breast Cancer or Ovarian Cancer
First, I want to caution that most women who are diagnosed with breast cancer do not have a family history of the disease. It’s important that women don’t assume they are in the clear because they do not have any relatives who have had breast cancer.
Family history of breast cancer constitutes ~10% of breast cancers. The closeness of a relative who has been diagnosed with breast cancer factors into the risk. A diagnosis in a first-degree relative (parent, child, or sibling) increases your personal risk for the disease the most. A woman’s risk of breast cancer is twice as high if she has an affected first-degree female relative and 2-4 times higher if she has more than one affected first-degree relative than that of women who have no family history. The risk is increased even more if that family member was diagnosed at a young age (under 50). A family history of ovarian cancer is also associated with an increased risk for developing breast cancer.
You should discuss your family history with your doctor, especially if it includes any of the following that would put you at a higher risk than the general population:
- Ovarian cancer
- Breast cancer diagnosed at age 45 or younger in women
- Two primary breast cancers, meaning they have occurred in the same individual or same side of the family
- Male breast cancer in a relative (of any degree)
- Triple negative breast cancer
- Pancreatic cancer AND breast or ovarian cancer in the same individual or on the same side of the family
- Ashkenazi Jewish ancestry AND breast, ovarian or pancreatic cancer in the same individual or on the same side of the family
- A previously identified BRCA mutation in the family (see next section)
Women who have inherited genetic mutations (abnormal alterations in genes that can be passed from mother or father to a child) in the BRCA genes (BReast CAncer genes) are more likely to develop breast and ovarian cancer. Mutations in the BRCA genes are rare in the general population – about 1 in 400 have one. They are the best-studied breast cancer susceptibility genes and account for 5-10% of all female breast cancers and 15-20% of all familial breast cancers. Talk to your provider if you are concerned about your family history of cancer and are interested in having genetic testing done to determine if you have a genetic mutation that would put you at a higher risk for breast cancer.
Personal History of Breast Cancer
If you have had breast cancer before, you are more likely to get breast cancer a second time.
Dense breasts are composed of more connective and glandular tissue than fatty tissue. Women with dense breasts have a slightly higher risk of breast cancer. While the density of your breasts is initially influenced by your genes, it generally decreases with age, pregnancy, and menopause.
Estrogen Exposure During Menstrual Cycle
Women who begin menstruating before age 12 and women who did not experience menopause until after age 55 are at higher risk for breast cancer due to longer exposure to estrogen.
Risk Factors You Have Some Control Over
There are also risk factors that you have some control over. Some of these are personal and family decisions related to reproduction, while others are general healthy lifestyle choices.
Parity (giving birth)
This may not be the best reason to start a family, but it should be stated that giving birth reduces your risk of breast cancer.
Every year of breastfeeding is estimated to reduce your risk of breast cancer by 4%.
Physical Exercise, Diet, and Obesity
Generally, having a healthy lifestyle reduces your risk for developing cancer. Women who exercise regularly are at a lower risk for breast cancer. Overweight or obese women have a higher risk for postmenopausal breast cancer than lean women. Studies on nutrition and diet are mixed, but there is growing evidence that women who eat a Mediterranean diet (olive oil, fruits, vegetables, nuts and legumes, etc.) are less likely to develop breast cancer.
Alcohol and Tobacco Use
Use of alcohol and tobacco can also increase your risk for breast cancer. Several studies have confirmed the risk of breast cancer increases with each drink of alcohol consumed per day on average. Studies of smoking also indicate increased risk, especially for long-term smokers.
Exogenous Hormones (Postmenopausal Hormone Replacement Therapy)
There is an increased risk of breast cancer with use of postmenopausal progestin therapy (also known as hormone therapy or hormone replacement therapy). This risk increases with longer use of HTR and when HTR is started sooner after the onset of menopause.
Breast Cancer Screening and Detection
No matter how many or how few risk factors you have, there is still a chance breast cancer could develop. If it does, detecting it early can make a huge difference in your prognosis and outcome.
We no longer recommend routine monthly self-exams, but a concept of “breast self-awareness.” The idea is that stringent monthly exams can be onerous and lead to more diagnostic procedures that may be unnecessary, increase anxiety, etc. However, we want women to feel empowered to know their body as well as be proactive if they are in a higher-risk population.
Know the Signs
Breast self-awareness works best if you know what to be aware of. Here are the signs and symptoms to look out for:
- Hard, immobile breast mass
- Thickening, dimpling, erythema of the overlying skin
- Bloody nipple discharge
Routine Screening Mammograms
Screening mammograms are an important part of maintaining your breast health because they can help detect breast cancer before symptoms develop. They can also increase the chance that breast cancer is detected before it has spread to other parts of the body. Early detection not only improves chances of survival significantly, but it can also allow for more treatment options, including less extensive surgery or treatments with fewer side effects.
We recommend average-risk women start receiving routine annual mammograms between the ages of 40 and 50. Talk to your provider about your risk factors and family history to see if you fall into a higher-than-average risk category. If so, we may recommend starting your annual screening mammograms at an earlier age.
Where to schedule your mammogram (including if you are uninsured)
VPFW currently offers screening mammograms at our Midlothian Turnpike, West Creek, and Prince George offices. We have plans for expansion in 2021 to include adding mammography at our St. Francis location and expanding mammography capacity in our Prince George office and in our new headquarters office on Koger Center Blvd (scheduled for completion in the fall of 2021). This time of year appointments fill up quickly, so call us at 804-814-2428 or request a mammogram appointment online today.
VPFW offers 3D mammography at all locations where we perform mammograms. With 3D mammography, multiple images are taken of each breast from different angles. Women with dense breasts may benefit from 3D mammograms.
Currently, most insurance plans cover routine screening mammograms without any out-of-pocket expenses. If you don’t have insurance, there are some free or low-cost options. Each October, VPFW offers free mammograms for uninsured women; however, spots are limited and have already been filled for 2020. The Virginia Department of Health has a program called Every Woman’s Life, which offers free screenings for uninsured, low-income women who meet specific criteria. We recommend calling them to see if you qualify.
All women deserve the best breast health care possible – no matter their age, ethnicity, economic status, or insurance status.
Staying on Top of Your Breast Health
With the good news in breast cancer research, we hope you stay optimistic but also remain vigilant! We’re here to answer your questions and discuss your family history and risk factors to help you figure out the best way to maintain your breast health.