Breast cancer risks + mammogram screening guidelines
The breast experts at Tufts Medicine recommend that women with an average risk of developing breast cancer begin annual mammograms at age 40 and continue as long as they are in good health. Breast cancer is common, affecting 1 in 8 women. Most women who get breast cancer don't have specific risk factors placing them at high risk for the disease. Therefore, it is so important for all women to be screened for breast cancer.
How often should you receive a mammogram?
While the U.S. Preventive Services Task Force recently updated their recommendations to say that women with an average risk of breast cancer should receive mammograms every other year from ages 40 to 75, a change from their previous recommendation to start screening at age 50. However, the breast experts at Lowell General Hospital know that the most lives will be saved with screening every year starting at age 40 for women at average risk of developing breast cancer.
Dr. Steinkeler, Medical Director of Breast Imaging at Lowell General Hospital—a designated Comprehensive Breast Imaging Center accredited by American College of Radiology (ACR), explains what's behind Tufts Medicine's more comprehensive approach to screening and why a "one-size-fits-all" approach to breast health won't work for many women.
Q. Can you tell me why you recommend beginning annual mammograms at age 40 for women at average risk of breast cancer?
A. When we make a recommendation around screening we bring together a multidisciplinary approach of breast experts to look at the data and make decisions based on what will give our patients the best outcomes.
The fact is that the risk of developing breast cancer substantially increases as women enter their 40s. The breast cancer occurrence rate for women in their 40s is up to 3 times higher than it is for women in their 30s. We're seeing 1 in 6 women with breast cancer are in their 40s! Since the introduction of screening mammography in the 1980s, the mortality rate from breast cancer has decreased by about 40%. These data are very clear that mammography saves lives and we know that the most lives are saved when women screen in their 40s and do it every year. Early detection is key.
Specialized care for patients with a high risk for breast cancer
Q. We often hear recommendations for women with an average risk of breast cancer, but what about high risk patients? How is breast cancer risk assessed and what care is available?
A. Every woman who has a mammogram at Lowell General Hospital undergoes a risk assessment. Based on that risk assessment we may consider the patient at average, intermediate or high risk for breast cancer, and we recommend a breast cancer screening plan based on that assessment.
A small number of women are at high risk for developing breast cancer during their lifetime based on their personal risk factors. High risk means a woman has at least a 20% estimated risk of developing breast cancer over her lifetime.
If you're assessed as being at an increased risk for breast cancer, we'll make a referral to our high-risk clinic at Lowell General Hospital. Our high-risk clinic offers risk-based breast cancer screening recommendations including screening before age 40 for certain patients, genetic counseling and testing when appropriate, and strategies to reduce breast cancer risk including medications and lifestyle modification. Our goal is to fully educate and support women to help them make the best choices for their health.
Managing risk factors for breast cancer
Q. In addition to annual mammograms, and understanding risk factors, how can people reduce their risk of breast cancer?
A. There are breast cancer risk factors you can't control, including family health history, dense breast tissue and inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. But there are many that you can control, including lifestyle factors. In addition to regular annual mammograms, everyone can reduce their risk of breast cancer by:
- Maintaining a healthy weight
- Exercising regularly
- Not drinking alcohol, or drinking in moderation
- Quitting smoking
- Breastfeeding your children, if possible
- Talking to your doctor if have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes
In addition to these risk reduction strategies, we also want women to practice breast self-awareness. It's important to know how your breasts normally look and feel, which helps you notice when there are changes. If you notice any changes such as a lump, focal pain, nipple discharge or skin changes of the breast, it is important that you tell your doctor so that you can be evaluated without delay. If you have breast symptoms, you will need specialized diagnostic imaging of the breast which is different from a screening mammogram. We also recommend a clinical breast exam performed by your doctor or nurse practitioner at your annual physical.
Optimizing your breast health
Q. What's the most important piece of advice you have for women as they try to optimize their breast health?
A. First, make your appointment to get a mammogram! You can do it online through the myTuftsMed appor the website. Knowledge really is power and we're here to help you understand your options every step of the way.
