By Nina Vincoff, MD, Chief of Division, Breast Imaging
The Katz Institute for Women’s Health (KIWH), the only network of experts devoted to every aspect of women’s care, is putting women first. The below content was originally published in its entirety on the Katz Institute for Women’s Health’s website and exemplifies its commitment to raise health for all women.
Recent decades have seen remarkable progress in breast cancer identification and treatment. Thanks largely to improved screenings that can detect cancer in its early stage, the breast cancer mortality risk decreased by 40% from 1987 to 2010.
It’s simple: By catching cancer early, we often have the tools to help patients treat their illness and go on to lead normal, happy lives.
Unfortunately, we don’t always catch it early, partly because the current breast cancer screening guidelines are vague, sometimes contradictory, and based on “average risk.” But who is average when it comes to breast cancer risk? The reality is that several factors should be taken into consideration when calculating a patient’s risk of breast cancer, including:
- Family history: Certain types of breast cancers are hereditary. If you have a family history of cancer, including breast and ovarian cancer, you may have a higher risk of developing breast cancer. When possible, understanding your history can help you and your provider determine when and how frequently you should get screened for cancer.
- Race and ethnicity: Some types of breast cancer are more likely in Black women and those with an Ashkenazi Jewish background. For reasons we don’t completely understand, Black women are 40% more likely to die from breast cancer than non-Hispanic white women, more likely to carry the BRCA gene, and more likely to develop the very aggressive form of breast cancer called “triple negative.” Black women are also more likely to have breast cancer diagnosed before age 40. For those reasons, Black women need to discuss their risk with their doctor and determine what age to start screening. Age 40 might not be early enough.
- Age: Most current guidelines recommend starting breast cancer screenings at age 40. But this doesn’t account for the 9% of breast cancer cases that occur in women younger than 45—and are often more aggressive and difficult to treat than the ones found in older women. If you have Ashkenazi Jewish background or are Black, have a relative who was diagnosed with early breast or ovarian cancer, or received radiation therapy to the chest as a child, it’s smart to talk to your provider about starting screenings before age 40.
- Lifestyle and personal history: Certain lifestyle or medical incidences in your past may impact your risk of breast cancer, including smoking, excessive alcohol intake, as well as your pregnancy, breastfeeding, and menopause history. Taking these into account can help you determine your personal risk.
- Breast type: Every woman’s breasts are different, and about half of all women have “dense breasts.” The only way to know if your breast tissue is dense is to have a mammogram. It’s not something your doctor can feel. Dense breasts make mammograms harder to read and increase your risk of developing breast cancer. If your breasts are dense, you might benefit from additional screening with ultrasound or MRI.
Given how many factors are at play when it comes to breast cancer risk, it’s simply impossible to define a one-size-fits-all risk of the disease. Instead, it’s critical that you and your health care provider look at your personal risk.
Cancer is scary, but letting it go undetected because of confusing guidelines is even scarier. By taking measures to assess your personal risk factors and receive the proper screenings, you’ll be giving yourself the gift of a better chance of living a long, full life.