Breast cancer risk factors, detection and why you should #AskHer
Mammograms can help find breast cancer early when treatment is most successful. In this Community Conversation on October 7, 2021, Lisa Bash, MD, a radiologist and medical director of the Breast Center at Chilton Medical Center,breast cancer, the latest advancements in detection and Atlantic Health System’s #AskHer campaign, which encourages everyone to ask the people they love to get screened.
Why is it important for women to get mammograms?
Breast cancer is the second most common cancer diagnosed in women and the second leading cause of cancer death in women. One in eight women will be diagnosed with breast cancer in her lifetime. Dr. Bash said the five-year survival rate for breast cancer is greater than 98% when it is diagnosed at its earliest stages.
That's why getting a mammogram is so important, she added.
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What kinds of mammograms are available to women?
Screening technology has advanced significantly and today, women have access to both digital and 3-D mammograms (tomosynthesis), Dr. Bash said. She explained that 3-D mammograms are more accurate than conventional mammograms and enable doctors to find cancers more easily with improved sensitivity and specificity. A 3-D mammogram takes the same amount of time and uses the same amount of radiation as a regular digital mammogram. In addition, women with dense breasts, who are at increased risk for breast cancer, can benefit from supplemental screening with either ultrasound or breast MRI.
What are dense breasts and why do they increase your risk of cancer?
Dense breasts contain more fibrous and glandular tissue than fatty tissue. Dr. Bash said that women who have dense breasts are at higher risk of breast cancer for two reasons.
- Fibrous and glandular tissue appears white. Breast cancers are also white, which makes it harder to detect.
- Cancers start in fibrous and glandular tissue. The more tissue there is, the more places cancer can start.
Dr. Bash added that, “by law, every patient is made aware of her breast density, and that insurance companies must cover supplemental screening in women with dense breasts.”
Should women receive a mammogram every year?
The American College of Radiology recommends starting annual screenings at age 40. However, starting at age 30, it is important for women to have a conversation with their doctor about factors that may increase their risk of breast cancer, Dr. Bash said. A doctor can help determine whether earlier or additional screening would be beneficial.
For example, women who have had radiation to the face, neck or chest or those with genetic mutations or family members with genetic mutations are at higher risk and should start screening with a breast MRI sooner.
What are the highest risk factors for breast cancer?
Dr. Bash said the highest risk factor is just being a woman. The next biggest risk factor is age. Certain genetic predispositions such as the BRCA gene or other genetic mutations put women at very high risk. However, only five to 10% of all breast cancers diagnoses are in this high-risk category.
Most women are average risk. “And that's why it's really important to get a mammogram. Even if you don't think that your risk is high, just being a woman and getting older really increases your risk,” Dr. Bash advised.
What resources are available at the Breast Center at Chilton Medical Center?
The Breast Center at Chilton Medical Center includes a network of clinicians, resources, and services to provide women with the highest quality of care. The Center takes a multidisciplinary approach and delivers individualized care through a collaborative effort among multiple physicians and multiple departments. Nurse navigators guide patients through the process of screenings, follow-up appointments, biopsies, clinical trials and more.
Dr. Bash explained: “We have a tumor board made up of radiologists, breast surgeons, oncologists, radiation oncologists, plastic surgeons, genetic counselors, and dietitians where we meet and discuss every cancer diagnosis. We discuss what's the best possible care for this patient.”
Should a person insist on a biopsy when the result of a breast ultrasound is probably benign?
Dr. Bash said it is not necessary to order a biopsy if a patient receives a result in the BI-RADS three category, which means that there is a 98% chance that it is benign.
“We usually have you come back in six months. And if anything changes at that time, we could do a biopsy, but 98% of the time it's nothing.”
How important is it to build a relationship with a physician?
It is very important to build a trusted relationship with a primary care doctor. Dr. Bash added that any time you have a concern about breast health you should bring it to the attention of your doctor. Find a doctor >
What is the #AskHer campaign?
The #AskHer campaign began at Atlantic Health System six years ago to encourage people to start a conversation about mammograms.
Dr. Bash said: “The whole premise is that, as women, we often neglect ourselves to take care of others. So, many times we turn to the women in our lives and we ask them these sorts of questions: What's for dinner? Did you have a chance to do this for me? (Instead) we should ask the women in our lives, our friends, our spouse, our family: Did you have your mammogram this year? And just start that conversation.”
Dr. Bash said that often, women simply need a reminder to make an appointment. In fact, over the course of the campaign, more than 6,500 women have scheduled a mammogram. Atlantic Health System makes it easy to do so, with 24/7 online scheduling at 10 different sites of care. Make an appointment >
What can I expect when I schedule a mammogram?
A mammogram is simple and straightforward. The screening takes no longer than 15 minutes. No prescription is necessary for a screening. Upon arrival, patients register and fill out personal and family health history. The registration process helps doctors calculate a woman’s cancer risk. If you need to come back for additional imaging, the staff will help you find a physician to write the prescription.
What happens if I am at elevated risk for breast cancer?
When you schedule a mammogram, Atlantic Health System calculates your risk of developing breast cancer as part of your screening. The average risk for breast cancer is 12%, according to Dr. Bash.
If your lifetime risk is greater than 20%, that's considered high risk. For women who are high risk, Atlantic Health System has a program that connects patients with additional resources and services. Women can access additional screenings, including MRI, meet with a genetic counselor, and receive information about their risk factors. Learn more about the Breast Cancer Surveillance and Prevention program >
Dr. Bash added: “For some women who are very high risk, we may connect you with an oncologist and they can write a prescription for medication to decrease the risk of hormone-sensitive breast cancer in the future. The program is pretty all encompassing, and we really want to try and help women understand their risk and do what they can to help decrease it.”
Are there any concerns about the COVID-19 vaccine in relation to breast health?
In rare cases, the COVID-19 vaccine may cause swollen lymph nodes. Dr. Bash said this is a normal reaction as the body creates an immune response. She suggested that women who have just received the COVID-19 vaccine tell the technologist that will administer the screening, so they are aware. Dr. Bash said you can also delay your mammogram for four to six weeks.
She emphasized: “The vaccine itself does not cause cancer. It does not cause any problems in the breast. It's really important if you have a problem, if you feel a lump, if you have any concern, you should come in for your breast imaging. Do not delay it because of the COVID vaccine. Do not delay it because of COVID.”
Should I delay my mammogram until the COVID-19 pandemic is over?
Dr. Bash said it is completely safe to come in for a screening and it is very important to not delay your mammogram. The earlier breast cancer is detected, the better the outcome. All Atlantic Health System facilities follow strict cleaning protocols. Many parts of the registration process can be completed online to decrease the amount of time that women spend in the breast center. All patients and staff members will be masked and will practice social distancing.
Do mammograms require a prescription?
Screening mammograms usually do not require a prescription. Schedule a mammogram today >