Making sense of screening guidelines
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Mammograms—diagnostic
imaging tests that
help doctors spot potentially
cancerous lumps within
the breast—are one of the most
important screenings women
receive during their lifetimes.
When to begin screening,
however, is not always clearcut,
especially for women who
recently turned 40.
Each woman’s personal
breast cancer risks affect
when they should begin
screening, how often screenings
are needed and if mammograms
should be supplemented
with other imaging
methods like breast magnetic
resonance imaging (MRI) or
ultrasound. Vivian Bea, MD,
chief of breast surgical oncology
and Dr. Shreena Shah,
Breast Imager at NewYork-
Presbyterian Brooklyn Methodist
Hospital’s Breast Center,
recommend that women
follow the American College
of Radiology, Society of
Breast Imaging and NCCN
screening guidelines. These
guidelines advise that women
with an average risk of breast
cancer:
• Begin annual mammograms
at 40
• Ultrasound may be recommended
for women with
dense breast tissue
• Screen annually
• Continue screenings as
long as they are healthy and
desire to be screened
• Be aware of and tell their
doctors about breast changes
All women, especially
black women and those of
Ashkenazi Jewish descent,
should be evaluated for breast
cancer risk no later than age
30, so that those at higher
risk can be identifi ed and can
benefi t from supplemental
screening
“The majority of women
with breast cancer don’t have
a family history of the disease,”
says Josine Veca, MD,
gynecologist at NewYork-
Presbyterian Brooklyn Methodist.
“That’s why it’s important
for all women to visit
their doctors, become aware
of their risk and develop a
plan for screening.”
All women are at some
risk for breast cancer—one
in eight women develops the
disease. Doctors diagnose the
majority of breast cancers in
women over age 55 although
black women are more likely
to be diagnosed at a younger
age. However, age is only one
consideration. A variety of
things can infl uence breast
cancer risk. When a woman
meets with her doctor
to develop her breast cancer
screening plan, her
doctor will likely perform
an exam and take
a detailed personal
and family medical
history. The
fi ndings from
this visit help
women understand
if they fall
into average or
higher risk categories.
Women with an average
risk, according to Dr. Bea,
have no confi rmed or suspected
genetic mutation associated
with breast cancer
and no previous personal history
of breast cancer or radiation
therapy to the chest.
They also have no signifi cant
family history of the disease.
Those with a family history
have a higher than average
risk, particularly if women
have one or more fi rst-degree
relatives who’ve had breast
cancer.
“When women have a
family history, we recommend
starting annual mammograms
and breast exams
10 years before the
age at which their
fi rst-degree relative
was diagnosed
or at age
40, whichever
is earlier,” says
Hani Ashamalla,
M.D., chief of New-
York- Presbyterian
Brooklyn Methodist
Hospital’s Department
of Radiation
Oncology. In some
cases, a strong family history
of breast cancer can suggest
mutations in certain genes
that are passed through families.
These genes raise a woman’s
risk for multiple cancers,
including breast cancer. The
most common gene mutations
associated with breast cancer
occur in the BRCA1 or BRCA2
genes. Women with a BRCA
gene mutation have a 70 percent
likelihood of developing
breast cancer by their 80th
birthdays.
“If women have family
members with a BRCA gene
mutation, we recommend genetic
testing to see if they
also carry the mutation,” Dr.
Veca says. “I advise women
with a BRCA mutation to get
a clinical breast exam every
six months and a yearly mammogram,
breast ultrasound
and breast MRI.” Outside of
personal and family history,
doctors may also consider
these factors when assessing
a woman’s breast cancer risk:
• Ethnicity
• Ages at which she began
menstruating, gave birth to
her fi rst child and, if applicable,
completed menopause
• Positive or negative
breast biopsies in the past
• Dense breast tissue
• Other breast irregularities,
such as the presence of
benign tumors or multiple
cysts within the breast
To schedule your mammogram
or breast exam, please
call the Women’s Diagnostic
Center at NewYork-Presbyterian
Brooklyn Methodist Hospital
at 718-780-5029.
Health