IT SEEMS like every
Case in point is the diagnosis of breast cancer. The news is rife with reports of newer and better diagnostic tools such as breast MRIs that can detect breast cancer earlier and more successfully. But every new discovery is not for everyone, no matter how good it sounds.
Women are left asking themselves if they'd benefit from the new technology, or if they should get screened at all. Many women are at average to only slightly increased risk for breast cancer, yet they expend
Before you throw up your hands and forgo potentially life-saving screening, here are some questions you can ask yourself to see if, when and how you should be screened.
How old am I?
I start with this one because it's relatively straightforward. By 40 years of age, all women should be having mammograms yearly or every other year, and after 50, yearly mammograms are recommended for all women. If you're between the ages of 40-49, it's best to talk to your doctor or healthcare provider to see what's best for you.
Do I have relatives who have been found to be carriers of the BRCA (BReast CAncer) gene, or do I know that I'm a carrier?
If you know you have relatives who are BRCA gene-carriers, you also may be a carrier. There have been two BRCA genes identified, and families who carry these genes will often have multiple family members with breast, ovarian, colon, prostate and pancreatic cancers. And, they're more likely to have developed these cancers at an early age.
If you know that you are a carrier of the BRCA gene, or you have relatives who are, this puts you in a very high-risk category. (For recommendations for women at very high-risk and high-risk, read on, as I'll discuss that later in the column.)
Have I ever had a breast biopsy that came back abnormal?
Women who have had abnormal breast biopsies with the diagnosis of atypical ductal hyperplasia or lobular carcinoma in-situ are either at very high-risk (if they have a family history of breast cancer) or high-risk (if they do not).
Have I had radiation exposure to the area around my breast (for example, to treat Hodgkin's Disease),
If the answer is yes, this puts you in the very high-risk category.
What should I do if my mother and sister were both diagnosed with breast cancer in their 30s? If you have two or more first-degree relatives (mother, sister or daughter), a relative diagnosed at a young age, or multiple second-degree relatives with breast cancer, you're at high-risk.
What if I've personally had breast cancer?
Women who have had breast cancer should be followed by a doctor who specializes in the treatment of breast cancer. A personal history of breast cancer places a woman at high-risk of developing the disease again later.
Are my breasts dense?
If you've been told that you have very dense breasts, this may put you in a high-risk category.
when the risk is high
Women at very high-risk should consider being seen in a comprehensive breast care or high-risk clinic, with breast exams every 6 months and possible MRI screening. There are also medications available today that can reduce breast-cancer risk in women at very high-risk that should be considered.
If you have relatives who are BRCA carriers but you haven't been tested, referral to a genetic counselor for possible testing is a good idea. Some women at very high-risk opt to have mastectomies or removal of their ovaries to decrease the risk.
Obviously, these are very serious choices to make, and consultation with a doctor well-versed in the pros and cons of each is imperative.
Women at high-risk should have an annual mammogram and breast exam. Treatment with medications that can reduce the risk may be considered depending on individual risk.
There are other factors--such as late or no history of childbirth and early onset of menstruation--that can increase a woman's risk, so individual consultation with your doctor is the best way to know for sure what you should do.
Dr. Arlene Lewis welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401 or by e-mail at