The Medical Minute: Do you know your risks of breast cancer?

The memories are everywhere. When a woman turns 40, doctors say she should have annual mammograms to detect breast cancer. You see it on posters, advertisements and buttons.

May 8, 2024Penn State Health News

Doctors beat the drum strongly and often because the stakes are high. According to the American Cancer Society, breast cancer remains the second leading cause of cancer death in women. About 42,250 women in the United States will die from it this year and 310,720 new cases of invasive breast cancer will be diagnosed. In recent years, the incidence has increased by 0.6% per year. In women under 50 years old, the increase is about 1%.

Although the message to get mammograms is crucial, it is not completely complete. Forty is the age at which an average-risk woman should get her first mammogram. But how do you know if you are at average risk?

The chances of developing the disease at a younger age are higher for some people, experts say, and several factors may require screening before age 40. Particularly at greater risk are minority women, who are much more likely to die from breast cancer before age 40. of 50, according to the American College of Radiology.

Rather than delaying taking action to protect their health until middle age or later, younger women can take action now to assess their risk and plan a more effective early detection schedule.

And that’s good news, doctors say. When breast cancer is detected early and at a localized stage, the five-year survival rate is 99%, according to the American Cancer Society. Technology offers medical oncologists a wealth of new tools to stop breast cancer early – from improvements in 3D imaging to MRI or contrast-enhanced mammography to ultrasound. Early detection of cancer is becoming easier.

Dr. Emel Kaya Aumann, a breast radiologist at Penn State Health Breast Center, discusses risk factors, what younger women can do now to manage their risk and why prevention and self-care can be a lifelong practice.

When should a woman get her first mammogram?

For an average-risk woman, the American College of Radiology suggests that we begin the annual screening mammogram at age 40. But if the person is in a high-risk group, she may be recommended to start screening mammography between the ages of 25 and 40. and also breast MRI (magnetic resonance imaging) between the ages of 25 and 30, depending on the type of risk.

How can you determine your risk? Who should do this?

The American College of Radiology recommends that every woman receive a breast cancer risk assessment before age 25. This can be performed by a primary care provider. If the woman’s total lifetime risk is more than 20%, this means that she belongs to a risk group. And that means they may need to start breast cancer screening between ages 25 and 40, instead of starting at age 40.

According to the American College of Radiology, minority women are 127% more likely to die from breast cancer before age 50 than white women. Why the higher risk?

Black women, Ashkenazi Jewish women, and other minority groups have been found to be at higher risk compared to white women because black women and Ashkenazi Jewish women tend to have more BRCA 1 and BRCA2 gene mutations, which increase the risk of developing breast cancer. If the individual has the BRCA gene mutation, it means that the risk of developing breast cancer is more than 60% to 70%.

And this gene is more common in black and Ashkenazi Jewish women?

Yes, both BRCA1 and BRCA2. In addition, black women tend to develop a more aggressive form of breast cancer at a younger age than white women. These are triple negative or ER negative cancers: tumors that tend to grow and spread more quickly than other types. The possibility of having this gene mutation is the main reason.

Forty percent more black women die from breast cancer compared to white premenopausal women.

What factors other than genetics may cause mammography to be recommended early?

There are many risk factors – an individual’s family history of breast cancer, ovarian cancer, endometrial cancer, colon cancer and others; a personal history of previous breast cancer; or if the patient has previously had radiotherapy to the chest.

How often do women get these ratings before age 25?

If they don’t see their primary care providers regularly, most are unaware of it. People usually think that if they don’t have a family history of breast cancer, it won’t happen to them. In fact, only 5% to 10% of our patients diagnosed with breast cancer have a family history of breast cancer. So 90% to 95% don’t know that they are genetically predisposed to have it.

So every woman should get an assessment before she turns 25. Can they do anything else?

The first thing they have to do is the self-exam. Every woman should consider having a breast and armpit exam once a month. More information about breast self-examination can be found here.

When should self-exams start?

As long as they begin to develop breast tissue, we recommend that they do a self-exam. So if they notice new lumps or bumps in their breasts or armpits that don’t go away, we don’t want them to wait. We want them to come in for further evaluation as soon as possible.

None of this – the risk assessment or the self-exams – is a substitute for mammograms. Right?

The gold standard is still mammography for breast cancer screening. In certain subgroups and high-risk individuals, breast MRI and breast ultrasound may be appropriate for additional breast cancer screening. Breast cancer risk assessment is so important that personalized screening strategies can be planned by the physician and the individual patient.

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