By Brenda Peacock, MD

For the Daily News

 

It’s October once again, Breast Cancer Awareness month, so it’s time to review some information regarding breast cancer.  The average American woman’s lifetime risk of breast cancer is still about 12%.  That 1 in 8 occurrence has not changed for many years, though over the past 10 years there has been a gradual slight decrease in the incidence of breast cancer.  However deaths from breast cancer have been steadily declining during this time frame, obviously reflecting earlier detection and more effective treatment once diagnosed.  If a breast cancer tumor can be detected when it is less than 1 cm, and treated with definitive surgery, there is currently a 90% cure rate.  In such cases, tumors are often for up to 10 years before they become palpable at 2-3 cm size.  Mammography at appropriate intervals could therefore potentially identify lesions from 0.1-cm-1 cm, or at least 3-5 years before they become palpable.  Breast cancer however does not always play by the rules – younger women (less than 50) often have more aggressive tumors, and would be looking at a shorter timeframe as far as progression of that lesion.

So that brings us to the “rules”.  The best protection is still early detection.  The United States Preventive Task Force caused a stir within the past several years with their “recommendations” to NOT start screening mammograms at age 40, to only do these studies every other year after the age of 50, no longer recommending self breast exams, or annual clinical exams.  These recommendations were not accepted however by the vast majority of women’s health organizations and other cancer organizations including the American College of Obstetricians and Gynecologists, the American Cancer Society, the National Comprehensive Cancer Network, and the National Cancer Institute.  These “recommendations” were made because of the cost to prevent mortality in that younger age group, and the increased incidence of false positives-additional studies and potentially biopsies required- that would cause stress and anxiety.

However, the statistics do support a significant decrease in mortality with breast cancer in those younger patients, ones detected earlier because of earlier screening studies.  All of these organizations therefore still recommend beginning yearly mammograms at age 40, continuing until age 75-80 depending on one’s history.  They still recommend clinical breast exam yearly after the age of 40, mammography and clinical breast exam potentially less often in the younger patient based on risk factors.  Self breast exam is now better described as “self breast awareness”, with no specific pattern of self breast exam required unless indeed a patient is high risk.  There is no emphasis on the technique anymore, simply recognizing and addressing any changes seen or felt.

Digital mammography is definitely preferred in those younger patients less than age 50, with somewhat higher detection rates having been confirmed.  Other diagnostic studies are available, but these are primarily reserved for certain circumstances.  Ultrasound is not recommended as a basic screening tool, but rather as a tool to further evaluate findings on mammography, and determine the need for further treatment.  MRI also is not recommended as a screening tool for most women, because of cost, unless the patient’s lifetime risk is calculated at greater than 20%.

Certain risk factors are known as far as increasing one’s risk of breast cancer, with risk models available to determine whether a woman is a candidate for MRI as far screening purposes, or for preventive treatment with either Tamoxifen, Arimidex, or Evista.  In some cases risk can be decreased by at least 50% based on a number of studies, but these medications are not for everyone, and not without potential side effects.

So, the rules have not changed, annual mammograms after the age of 40, annual clinical breast exams by your health care provider, and ongoing self breast awareness remain your best protection. But if you are concerned regarding your personal risk, your schedule for mammography or potentially other studies, or whether you are a candidate for preventive treatment, please discuss this with your health care provider.

 

Brenda Peacock, MD is a gynecologist at Vidant Women’s Care Washington located at 1204 Brown Street.

 

FREE breast cancer screenings.

 

Vidant Family Medicine – Belhaven (Allen Street)

October 14 from 5:30 pm – 7:30 pm
245 Allen Street, Belhaven – 252-944-2218

 

Vidant Women’s Care Washington

1204 Brown Street

Saturday, October 18th – 9:00 a.m. – 12:00 p.m.

 

Vidant Family Medicine Aurora

151 Third Street, Aurora

Saturday, October 25th – 9:00 a.m. – 12:00 pm

 

Please call 1-800-472-8500 to register for these FREE screenings!