Take control of your health with screening and prevention information
The most important thing to consider when it comes to genetic testing is family history. Typically, if you don’t have a family history of breast cancer, and are not of Ashkenazi Jewish heritage, you do not need to get genetic screening to determine if you might be a high-risk patient.
So what should you look out for when it comes to family history? We’ve made a handy infographic to help outline the major red flags.
This week marks the launch of our 2nd e-book in the Adult Guide: Health Screening and Prevention line: Breast Cancer Screening and Prevention! This book is much smaller than the original book, and focuses exclusively on breast cancer. It’s focused on boiling down as much information as possible into a set of need-to-know guidelines that can serve as your go-to source of information on fighting this deadly disease through preventive medicine.
When we released the original Health Screening and Prevention guide, we knew that most people would be far more interested in shorter, more focused book rather than the huge wealth of information present in the original. If you’ve already grabbed a copy of the original book, you’ve already got access to this information, along with a huge wealth of preventive tools for dealing with dozens of other common but potentially deadly ailments.
This book is for those who are looking for a simple, straightforward handbook that should explain the basics of breast cancer, mammography, positive and negative tests, and how to identify if you are high-risk for breast cancer. It also provides clear timelines so you know exactly when to talk to your doctor about testing and what the results might look like.
We’ll be releasing these “mini-e-books” for each of the major diseases covered in the big guide, and we’ll continue to update you here each time a new release goes live. Until then, we hope you find this guidebook to be useful in your own fight against breast cancer!
While writing our recently released e-book on breast cancer screening, we spoke to a number of doctors about some of the most frequently asked questions they received from their patients. Many of them address popular myths about breast cancer; others were about the mammogram procedure itself, or about what happens after you get your result back. We’ve included some of these questions, and their answers, below.
Mammography is an x-ray test to look at the inside of your breasts. It uses ionizing radiation to detect abnormal breast architecture and to evaluate for any abnormal lumps, lesions, tumors, mineralization, or signs of cancer.
Mammography is able to detect very small lumps and lesions. It can detect a lesion as small as 1 mm. It is able to pick up lesions about two years before the physician can detect it clinically in the office during the routine physical examination. A lesion has to be about 10 mm before a physician can feel it.
The breast tissue is compressed against a plate. This may be uncomfortable but only lasts a few minutes. Compression is needed to accurately visualize all the breast tissue on the film. Four films of the breasts are taken from different angles by the radiology technician. The 4 images are then examined by a radiologist (MD, DO, or MBBS) trained in this field.
The radiologist examines the films to assess for suspicious findings that may be consistent with cancer. The physician examines for lesions, masses, micro-calcifications, and distortion of the breast tissue architecture.
Mammography is not 100 percent accurate. Yes, it can miss breast cancer, but it is the most widely available breast cancer screening test we have. It is also of note that the “axillary tail” is difficult to visualize on the films and may be missed. This is the part of your breasts that extends into the armpit. A mammography can also give a false-positive test. This means that the test comes back positive (something abnormal) even though you do not really have cancer.
The magnetic resonance imaging (MRI), digital mammography and positron emission tomography (PET) are in experimental stages of development. They are not yet available for routine breast screening. Ultrasound of the breast is performed after the patient has been found to have a lump or palpable mass during the physical examination.
Yes, this is known as the false-negative test. This means that your mammography shows no evidence of cancer, lumps, or tumors, and yet you may have cancer in your breasts. This is very disturbing. This gives you the false sense of security. Younger women and women who have dense breasts have problems with false-negative tests. However, USPSTF states that it found no data that these false-negative tests led to any delay in the proper diagnosis of true breast cancer.
These are the recommendations. You may follow one of the two.
1. Begin at age 45 as recommended by the American Cancer Society.
2. Begin at age 50 as recommended by the US Preventive Services Task Force.
This is assuming you are average risk for breast cancer. The ACS recommends annual screening as long as the patient is in good health. The USPSTF recommends screening every two years and stopping at age 74.
At a much earlier age depending on your risk factors. Your doctor will determine for you the age at which you should begin screening. Mammograms and MRI are used in some high risk individuals annually beginning at earlier age.
Yes, all the insurance companies I know of cover most health screening including breast cancer. If your insurance company does not cover common types of screening procedures, I suggest you change your insurance company.
This is breast carcinoma (cancer) genetic blood testing to identify if you carry this marker of malignancy.
If you test positive for BRCA-1 or BRCA-2 gene, your chances of developing breast cancer are very high by age 70. For Ashkenazi women, the chances of developing cancer range anywhere from 26 to 81 percent.
For women who have either BRCA-1 or BRCA-2 mutation, the options are the following:
1. Intensive screening with MRI
2. Prophylactic mastectomy or oophorectomy
3. Chemo-prevention
Women who have a BRCA-1 mutation have estrogen receptor negative malignancy. BRCA-2 breast cancers are usually estrogen receptor positive. These women respond to tamoxifen with reduction in incidence of breast cancer.
Yes. Men do have some breast tissue under the nipples. One percent of all breast cancers occur in men. Roughly 500 cases of breast cancer are recorded in men each year in United States.
Your friend is misinformed. Large breasts do not increase your risk of getting breast cancer. However, large breasts often make it difficult to visualize breast cancer on mammography. This is because of dense tissue.
The sentinel lymph node is the first lymph node to which breast cancer will spread in a long chain of lymph nodes. This is a very important discovery because it allows surgeons to biopsy this node and assess if cancer has spread. The presence of cancer in this node means cancer has spread outside the breast.
Two preventive approaches are recommended in order to reduce the chances of getting breast cancer.
1. Obtain good health screening from your physician. Follow the recommended guidelines for the early detection of breast cancer as outlined in this book. Breast cancer screening begins at age 40 or 50.
2. Exercise and eat healthy. Engage in decent exercise 30 to 60 minutes a day. Eat healthy means consuming fruits and vegetables on a daily basis. These foods contain anti-oxidants that are believed to retard cancer growth.
First and foremost, let’s get this out of the way: Mammograms are often wrong. In fact, some estimates show that up to 90% of “positive” results (those that have detected abnormalities) are actually “false-positives”, meaning that there was no cancer despite the reading. And up to 20% of “negative” results are estimated to be “false-negatives,” meaning there actually was cancer present but it wasn’t detected.
Any screening test has a chance for false-negatives: it’s impossible to detect anything with 100% accuracy. Getting that percentage of false-negatives as low as possible is one of the reasons procedures are constantly re-evaluated and refined. But I want to focus today on the false-positive tests, because the impact of getting a false-positive on your mammography is a little less understood.
This number – up to 90% – may seem unacceptable at first glance. Getting something wrong 90% of the time is usually considered a deal-breaker elsewhere in life, after all!
According to the National Cancer Institute, false-positives are most common in young women, women who have had previous biopsies on their breasts, those with a family history of breast cancer, and women taken estrogen supplements.
Mammograms can also sometimes detect something known as localized ductal cancer. This is the finding of breast cancer that is localized to the ducts of the breasts known as ductal carcinoma in situ. The concern is that many women with ductal cancers may never die of breast cancer that was diagnosed with the screening mammography. These women may be are subjected to unnecessary breast surgery, radiation therapy and even chemotherapy in older age, leading to health problems and costs that were not truly contributing to their long-term survival.
False-positive tests can result in unnecessary procedures, stress, medical costs, lost time, and additional risks. Believing you have life-threatening breast cancer when you do not can be a tremendously disruptive, life-altering experience in the short term with long-term consequences. So how are you supposed to rely on a mammogram with such accuracy rates?
It all comes down to how mammograms are utilized. The most important thing to understand is that an initial positive test does not necessarily mean you have cancer. In fact, odds are you do not! But follow-up tests will be needed to learn more information and get to the truth behind the positive result. Additional mammograms, ultrasounds, and surgery followed by biopsy are the typical followups, depending on what is found. It is important not to panic at this stage, and to understand that more information is needed before a complete diagnosis can be made.
Another important factor in using mammograms the right way is understanding when they should be conducted. Young women are much more likely to experience false-positive (and false-negative) results: as a result, for average-risk women the American Cancer Society recommends screening starting at age 45, while the United States Preventive Services Task Force recommends screening start at age 50. Screening in young women has not been shown to conclusively help prevent deaths from breast cancer, and may cause more harm than good in many cases. If you are at higher risk or want to begin screening earlier than these guidelines, you should discuss it with your doctor and understand some of the limitations inherent to mammograms.
As women reach their late years, the benefits of mammograms becomes difficult to determine. Women age 75 and older can still develop breast cancer, but in some cases their remaining life span may be less than the period required for breast cancer to become fatal. For women that are still healthy and likely have a number of years remaining, screening may be a good practice. For others, screening may cause more harm than help. It is recommended that you speak with your doctor and try to determine a plan that is right for you and your health as there are no set, agreed-upon guidelines.
For all their limitations, mammograms are the best tool for detecting early breast cancer and saving lives. Breast cancer is a fatal disease that takes the lives of about 40,000 women a year. If allowed to develop and spread to other parts of the body, it can be too late to save someone with breast cancer. By staying vigilant and following proper guidelines, it is possible to detect this dangerous disease early and save lives. Be sure to speak with your doctor and schedule the right tests at the right times for you!
In October 2015, new breast cancer screening guidelines were published by the American Cancer Society. At the time, we were halfway through the publishing process for our new book. We immediately threw on the breaks and started all over again in order to rewrite the chapter on breast cancer. Even though the ACS is one of several organizations that propose breast cancer screening recommendations, their recent data provides strong evidence that screening too early for breast cancer can do more harm than good.
It may seem like a minor change to have pushed back the starting date for mammograms from 40 years of age (the previous recommendation) to 45 years of age, along with decreasing the frequency of exams after age 54, but the change represents a significant shift in how doctors are approaching early breast cancer detection. [1]
Most people are not aware that 1 in 8 women will develop breast cancer over the course of their lifetimes, and are unfamiliar with the progression of the disease. Breast cancer is a serious life-threatening condition, though the difference in life expectancy between early-detection and late-detection can be enormous. Finding breast cancer early is key… but doctors and medical data have often disagreed on the best way to do it.
While many doctors still recommend breast self-exams, and perform breast exams in the clinic, there is no longer scientific consensus that these tests are effective at detecting early cancers. I’ll be discussing the reasons behind this in a future post, but for now it’s important to understand that the most important and accurate test for breast cancer remains the mammography.
There are several reasons for these changes in recommendations. The most significant is that while mammograms are reasonably accurate tests, they do sometimes result in false positives, and the test performs poorly in young women. The younger you are, the less likely you are to have breast cancer, and the more likely you are to have a false positive test. New research has shown that a large percentage of positive mammograms performed on young women are false positives, and a relatively low frequency represent actual cancers. [2]
A false positive can result in enormous amounts of stress and mental anguish, as well as medical costs, time, and invasive procedures. Unless you are a high-risk individual (in which case starting your screening early is advised – speak to your doctor about this), pushing back the screening start-date should help alleviate the frequency of these false positives while continuing to detect early and potentially fatal cancers.
A review of the new guidelines for women of average risk follows, from the American Cancer Society’s website:
It’s important to keep abreast of changing screening recommendations, especially with something as common and potentially deadly as breast cancer!