How common is breast cancer?
Breast Cancer is too common. It will occur in about one in eight women in the United States during their lifetime. It is the most common type of cancer in women in the US and the second leading cause of cancer death after lung cancer. The risk of developing breast cancer has gradually increased (about 0.5% per year) in recent years.
At what age is breast cancer diagnosed?
The median age at diagnosis is 62. This means that half of cases are discovered after and half before this age. Breast cancer is uncommon below the age of 45. Breast cancer occurring at relatively young age can be an indication of an inheritable genetic disorder and may prompt genetic screening for the patient and her relatives.
How deadly is breast cancer?
Breast cancer overall has a 5-year survival rate of 90%. This means that 9 out of 10 women diagnosed will still be alive 5 years later. It’s very important to understand that diagnosing breast cancer in early stages saves lives. Cancers found in the earliest stages have 5-year survival rates of 99%. 5-year survival decreases to less than 30% if the cancer has spread to other areas of the body.
Breast cancer deaths are decreasing!
Since 1989, the risk of dying from breast has reduced by about 41%! This is usually attributed to both early detection and better treatments. The routine use of screening mammograms for early detection has been a mainstay of this improvement.
When and how often should I get a screening mammogram?
There is some variation in recommendations from different professional organizations. What is clear is that regular use of screening mammograms starting at age forty reduces the risk of dying from breast cancer in women at average risk because it improves the chance that it will be discovered at an earlier more treatable stage.
What are the arguments against routine use of mammography?
Routine use of mammography also increases the chance of “false positive” results. This means the x-ray might detect an abnormality that turns out to not be cancerous but requires further study such as more radiology studies or a biopsy and the resulting emotional trauma for a patient. In addition, mammograms are uncomfortable at different levels among women. Finally, all these events contribute to the overall costs of a healthcare system that we are trying to make sustainable.
What are some “official” recommendations for the use of mammograms?
There is a range. The American College of Obstetricians and Gynecologists (ACOG) recommends offering patients the option of annual to biennial (every other year) mammograms starting at age 40 and no later than age 50. The U.S. Preventative Services Task Force (USPSTF) recommends starting at age 50. The American Cancer Society and National Comprehensive Cancer Network (NCCN) recommend considering at age 40. In all cases it has been shown that getting mammograms earlier and more frequently will lead to less deaths from breast cancer overall. Using mammograms less frequently will result in a few more deaths but will prevent more situations where additional studies and biopsies will be done for cases that turn out to be non-cancerous and therefore unnecessary.
What is the recommendation at Fortier Gynecology?
We utilize shared decision-making with our patients. This means that we discuss and decide together what works best for each patient. It’s our job to provide the best information and to base the decision on each patient’s desires. For some patients the paramount desire is to be most cautious regarding finding potential problems when they are earlier and more curable. For others the more prominent concern is to avoid the risk of additional testing. In addition, we will consider each patient’s relative risk to develop breast cancer (see risk factors below). For patients who are entirely neutral my tendency is to encourage a baseline mammogram at age 40 then annual for most patients, based on my previous experiences and the facts that most breast cancers do not have symptoms, and mammograms today are more accurate than ever.
What are risk factors for breast cancer?
There are numerous factors that may slightly increase the chance of developing breast cancer. These include early age of the start of menses, late menopause, not having been pregnant, not having breastfed, obesity, alcohol consumption, smoking, dense breasts on mammography, older age, and family history of breast or ovarian cancer.
Who should get a physical breast exam to screen for abnormalities?
ACOG and the NCCN recommend physical breast exam every 1-3 years from age 25-39 and annually after age 40. Based on his experience in diagnosing early asymptomatic breast cancers, Dr. Fortier includes breast exam in his annual physical exams except in patients who decline due to sensitivity or other concerns.
What is breast self-awareness?
Breast self-awareness means being aware of how your breasts normally look and feel and noticing any changes. You are in the best position to detect abnormalities at the earliest opportunity. Changes to look out for include lumps, nipple discharge, swelling or change in size of shape, new areas of tenderness of pain, swollen lymph nodes in the armpit, and skin changes such as redness, irritation, or dimpling. These changes may be alarming, but it’s helpful to know and remember that most changes, even lumps, are benign and not due to cancer. However, it’s important to notify us right away so you can have an exam and we can decide together whether further evaluation is needed.
Note: The above is for information only and to introduce this practice’s approach to breast cancer screening. It is not meant to be decisive for any particular patient. The decision regarding screening should be based on shared decision-making between each patient and her care provider. If you have questions, please call us at 919-916-3333.
