Guide to Breast Health

Detection

As part of your annual exam a breast exam should be performed by a professional. Breast self-exam is now considered optional. If you are comfortable doing it and it does not create anxiety, you should examine once a month AFTER your menses or anytime if menopausal. Studies show limited benefit in self-exam in women who get examined by a professional and who do routine screening, so do what you feel is right for you.

Screening Mammograms (x-ray) should begin at age 40, then every 1-2 years until age 50 then annually. This applies to average risk women and can be modified in high risk women such as genetic carriers, or with and extremely high risk family history.  Most screening mammograms do not need to be ordered by a provider and are generally covered by insurers if done at appropriate ages and intervals.

Diagnostic Mammograms (x-ray) are used when investigating an abnormality, pain, or for follow up to prior abnormality, or for those who have had cancer.  They need to be ordered by a health care provider and costs usually include copays and deductibles.

Breast Ultrasounds are tests to help diagnose lesions seen on mammograms. They are also used in cases of “dense breasts” as some studies have shown a slightly increased cancer detection rates when used with mammograms.  Ultrasounds alone are NOT currently good enough for cancer detection. They need to be ordered by a provider and have copays and deductibles.

Breast MRI (non x-ray) is used to assist in diagnosis when other methods fail, or as a screening tool in BRCA gene carriers and other women at extreme risk for breast cancer, or for evaluation of breast implant status. They must be ordered by a provider and costs include deductibles and copays. Most insurers require precertification due to their high costs.

Molecular Breast Imaging (x-ray) is a type of scan used for both screening high risk patients and diagnosis in difficult to read cases. It involves the use of a radioactive injection and xray to see small abnormalities and has similar abilities as breast MRI.

3-D Mammography (x-ray) is a technique where additional films are done with the standard mammogram. As this is a new technique no data is available as to whether the extra films increase detection or improve survival. This technique is often not covered by insurers as indications are still developing. It does involve more radiation than a standard mammogram.

Thermography is a non x-ray technique. It is not always read by a physician and uses heat to detect breast abnormalities. Most information available shows that while it can detect some breast cancers the detection rate is much less than more proven techniques such as mammogram.  We do not recommend thermography for screening due to low detection rates.

Breast “pap” test is a method where cells are removed from the breast through breast massage. At this point, this is no scientific evidence to show its usefulness in improving survival in breast cancer or its role in early detection, and as such we do not recommend it at this time.

There are tests that can identify women at higher risk so screening can be tailored to their risk level. BRCAanalysis®, High Risk Modeling (Gail), Brevagen® SNP testing are all used to assist in tailoring what testing should be done based on risk, they do not detect breast cancer.

*No detection method is foolproof and breast cancers can develop between testing. Using testing, especially mammograms, has markedly reduced the death rate from breast cancer to the point that approximately 85% of women survive their illness.

Prevention:

The average risk of a woman developing breast cancer by age 90 is about 11%. In menopause it is approximately 30 women per 10,000 women each year who develop the disease. Overall good health is one of the best preventers of breast cancer so eat a low fat diet, maintain a proper body weight, and do not smoke.  Smoking and obesity have significant influence on breast cancer rates.  Hormones in women over fifty contribute to small but significant increase in breast cancers rates (32-38 women per 10,000 women).  Birth control pills used during the reproductive years are neutral to breast cancer rates.  While women who take hormones in menopause live to be the same age as those who don’t take hormones, the breast cancer rate is increased after five years of daily use.

BRCAanalysis®: If you have a strong family history of breast or ovarian cancer, especially in first degree relatives having the diseases before menopause, and/or you are of Eastern European decent please inquire about this blood test. About 5% of inherited breast cancers fall under this category and if the gene is detec ted the risk of breast cancer is up to 80% in a lifetime. Special testing and preventative surgery may be indicated to reduce risks.