I am Dr. Gail Quackenbush, a fellowship trained breast radiologist currently practicing at the Montclair Breast Center in Montclair New Jersey .
As October approaches, we begin to see pink ribbons and are once again reminded that it will soon be breast cancer awareness month. I am fairly certain that anyone reading this knows someone who has battled or is battling this disease. Breast cancer is one of the most common cancers in women, accounting for nearly 30% of all cancer diagnoses. One in 8 women will be diagnosed with breast cancer. Although these statistics may seem scary, breast cancer is also one of the most treatable cancers. When diagnosed early, 5 year survival is close to 100%. Early diagnosis is key, as are measures to actually help prevent breast cancer.
Mammography has been the mainstay in screening for breast cancer. Recommendations for screening have varied, with most breast societies endorsing baseline mammogram at age 40 with yearly mammograms moving forward. If there is a first degree relative with breast cancer at a young age, screening should begin 10 years prior to that relative’s diagnosis. The mammogram should be digital and should preferably be interpreted by a radiologist specially trained to read mammograms. Don’t be afraid to ask who is reading your mammogram. It can make a huge difference. 3-D mammogram, or tomosynthesis, is a relatively new technique which allows for improved detection particularly in women with certain types of tissue density. Again, a specially trained mammographer can determine if 3-D is right for you.
Ultrasound is an extremely helpful diagnostic tool as well. There has been a lot of talk about breast density over the past few years. Breast density refers to how much white tissue is seen on a mammogram and is often age dependent and genetically determined. For women with dense or white breasts on the mammogram, a mass is difficult to detect as masses are seen as white spots. The sensitivity of the mammogram in such women is low. Ultrasound looks through the tissue using sound waves and is density independent. Therefore women with dense tissue should routinely have both mammogram and ultrasound evaluation. The mammogram in dense patients is still useful as it can detect certain masses and calcifications, which may be an early sign of cancer.
Additional tests may be utilized to screen for breast cancer. MRI is a tool reserved for women with either increased lifetime risk for breast cancer or who have had an indeterminate finding on routine screening. MRI demonstrates areas of abnormal blood flow which can be the earliest changes associated with cancer. A nuclear medicine study, Breast Specific Gamma Imaging (BSGI), may also be used to detect blood flow changes and may be used in women with contraindications to MRI. Lifetime risk can be estimated utilizing this short quiz http://www.montclairbreastcenter.com/quiz.
Breast self examination is often overlooked and is one of the easiest diagnostic tools we have. Women should begin self exam monthly at age 20, performing the exam shortly after menstruation when breasts are typically least tender. Self breast exam can easily be performed either in the shower or while applying body lotion. Whereas many lumps are benign cysts or tissue lobules, a lump that is new and persistent or growing should always be further investigated.
On an empowering note, there are certain measures we can take to actually help prevent or reduce the risk of developing breast cancer. Maintaining a healthy weight and body mass index (BMI) less than 25 lowers the risk of developing breast cancer. http://www.montclairbreastcenter.com/body-mass-index A healthy diet with an emphasis on plant foods, limiting alcohol intake to 1 or fewer drinks per day, regular physical activity and not smoking reduce risk. Avoiding or minimizing exogenous hormonal exposure also reduces risk. In certain high risk patients, medications such as tamoxifen and raloxifene can be used to reduce risk. Prophylactic mastectomy is usually reserved for those women with the highest risk, such as those with the BRCA gene mutation.
As October approaches, take a moment to review your breast health. Are you doing all you can to reduce your risk? Have you had your age appropriate screening exam? Don’t be afraid. A healthy breast is a happy breast. You can take control!
Dr. Gail Quackenbush