By Dr. David Weintritt
Creating a plan for breast cancer risk assessment and screening may seem complicated, but at the heart of the matter there is a simple solution consisting of four key steps. I used to preach the importance of the first three, but now realize the fourth is ultimately the most important and – all too often – the largest barrier to detecting breast cancer.
The first three:
In order to create a plan that is simple to follow and understand, focus on three basic areas when deciding on a screening plan.
First, gather a focused history of factors that influence breast cancer risk. Some of these can be modified while others ingrained in personal or family history cannot be changed.
Lifestyle risk factors that can be modified – and will benefit other areas of wellness – are obesity and alcohol consumption.
Being physically active, eating well and limiting alcohol consumption is good for you, but for women, choosing this path can also directly impact the risk of breast, colon and uterine cancers.
The most inherent risk factors are personal history of prior breast biopsy showing certain precancerous changes or a family history of cancer types that have potential to be hereditary. These include breast, ovarian, uterine, colorectal, gastric, prostate, pancreatic and melanoma.
These “red flags” indicate the possibility that a gene mutation, such as BRCA, may have been inherited. Thus, anyone with these cancers in their family should be offered genetic testing.
Carrying a BRCA gene results in up to an 85% chance of developing breast cancer. Even though the first BRCA gene was discovered over 25 years ago, it is estimated that only 15% of women with a personal history of breast or ovarian cancer have undergone testing. They all qualify for testing based on their history and should take advantage of the tests offered.
The second element of risk assessment is a clinical breast exam and teaching techniques for self-exam.
While these exams alone do not constitute a comprehensive plan, having self-awareness and establishing what is normal for each individual is an important part of the equation. It is also one of the most important habits for young women who are under the age for routine mammogram screenings to know what is normal for their body.
One should visit a specialist when something changes.
The third part of screening involves mammography.
Like it or not, according to the American Cancer Society, routine mammography can detect breast cancer at an earlier stage. This can lower the mortality rate of breast cancer by up to 40%.
Another key finding now reported with every mammogram is breast density.
There are four patterns of density that can only be assessed by mammograms: pre- dominantly fat, fibroglandular, heterogeneously dense and extremely dense.
When the pattern is predominantly fat, mammograms can be as high as 98% accurate in detection of cancer. With an extremely dense pattern, the sensitivity of mammogram screening can be as low as 30%.
Fortunately, there’s an answer for women with dense tissue. Ultrasound screening – and MRI in cases of other elevated risk factors – can detect up to 96% of cancers missed by a mammogram.
And then there was one:
Access to care
The fourth and most important step in risk assessment and screening for breast cancer is access to care.
I started the National Breast Center Foundation in 2014 with the support of family, friends and individuals will- ing to donate time and funds. Our goal is to support access to care, improve technology for breast cancer screening and to give women the options and treatment they deserve.
Without the ability to accurately calculate risk, understand the importance of genetic counseling and testing, establish a normal exam, develop healthy routines and have routine mammograms – and ultrasound or MRI when needed – lives are lost.
The Foundation provides screening days for underinsured women in our community and provides funding for specialty consultations, biopsies and even surgery when needed. There is currently a waitlist of at least 300 women in our area who need mammograms.
The Foundation hosts two annual fundraising events a year. The Walk to Bust Cancer in October and the Swing to Bust Cancer which will take place this year on May 15. All proceeds support the Foundation’s mission to improve the lives of women. We remove the barriers that prevent patients from getting proper care with screenings, diagnoses, treatment and education about breast cancer.
To learn more about the National Breast Center Foundation, Swing to Bust Cancer, or the Walk to Bust Cancer, please visit nationalbreastcenterfoundation.org.
The writer is a longtime resident of Alexandria. He is a board-certified breast surgeon and also the founder of the National Breast Center and National Breast Center Foundation.