Risk and Strategy: Mapping Your Breast Health Plan

Let’s get personal. Medicine has become more and more individualized and this is to our benefit. We can tout statistics about breast cancer risk for the general population of women of average risk – or even point out if you are of elevated risk – but did you know that your screening process can be honed in based on multiple factors?

While your basic risk comes from simply being a woman and getting older, you may belong to the subset of women with breast cancer in their family,  women with dense breast tissue or women with elevated risk based on reproductive factors (these can influence how long your body is exposed to estrogen). The more we can narrow down what risk category you belong to, the better we can serve you.

For the purposes of breast health the key word is action. What can we do about breast cancer? The first step is to proactively work towards one’s best possible health – this means exercise, a mindful diet, education and more. The second key is screening because early detection saves lives. Luckily, screening is our area of expertise.

As radiologists,our focus may seem to be on your black and white mammogram on our computer screens, but in reality, we prefer the bigger picture. You’ll notice when you fill out your breast health questionnaire we ask about things like family history of breast cancer, your reproductive history and your history of breast biopsies and/or surgeries. All of these can influence your personal risk for breast cancer.

When we synthesize the known factors, we can determine a screening course of action for you. As you know, annual screening mammograms for women 40+ are for those in the average risk category. Breast density also influences how well we can see things in your breast tissue, and the densest breast tissue has a slight increase in breast cancer unrelated to other risks. Taking all of these into consideration, your breast report will include a recommendation for screening based on your particular risks. This recommendation might include:  

• Annual screening mammography – this means you are good with your yearly screening mammogram, careful yearly breast exam by your doctor and monthly self-exams
• Annual mammography alternating with breast MRI at 6 month intervals – this is the screening recommendation for those in our highest risk category (those with a lifetime risk of greater than 20%) and may be suggested in patients with dense breast tissue and intermediate risk levels
• Consider adding screening breast ultrasound – for patients with intermediate risk, in between our lowest and highest risk categories, screening breast ultrasound may supplement your annual screening mammogram especially in women with dense or mostly dense breast tissue
• These recommendations are based on latest evidence on breast cancer screening and can be the basis of discussion with your personal doctor to determine your best screening strategy.

You are more than just a category and more than just a number. Your genetics, environment and day to day life all can influence the risk of developing breast cancer. Together, we can take the knowledge we have to move forward on helping to ensure a long, healthy life.