36 LONGISLANDPRESS.COM • OCTOBER 2021
HOW YOU’RE SCREENED FOR BREAST
CANCER DEPENDS ON YOUR RISK SCORE
On average, a woman has a 1 in 8, or
about 12.5%, chance of developing
breast cancer over her lifetime.
“Women who are at average risk for
breast cancer should get a baseline
mammogram at age 40 and then continue
to get mammograms annually,”
says Dr. Alice Kim, breast imaging
director for Catholic Health. “Women
whose breasts are heterogeneously
or extremely dense should also be
evaluated by ultrasound.”
After age 75, “we still recommend
annual mammograms, but women
should engage in shared decision
making with their doctors, with
functional status and life expectancy
taken into account,” Dr. D’Abreo said.
Women in their 20s should begin
receiving clinical breast exams and
discuss their family history with
their gynecologist or primary care
physician to determine their likelihood
of carrying the BRCA1 and/or
BRCA2 mutations, which are associated
with a considerably increased risk
of breast cancer, and whether genetic
testing is recommended, according
to Dr. Melissa Fana, chief of breast
surgery at South Shore University
Hospital in Bay Shore and director
of breast services at Mather Hospital
in Port Jefferson.
Many factors are associated with
increased breast cancer risk, and
several models are used to calculate
an individual woman’s lifetime risk.
Guidelines call for women whose
lifetime risk exceeds 20 percent to
be screened more closely.
The high-risk category “certainly
includes women with the BRCA1 or
BRCA2 mutation and certain other
genetic mutations,” Dr. D’Abreo said.
Risk is also elevated for patients who
have had a prior history of abnormal
cell growth such as atypical hyperplasia
or lobular carcinoma in situ (LCIS);
a personal history of breast cancer; a
first-degree relative – parent, sibling
or child – with premenopausal breast
cancer; two or more first-degree
family members with breast cancer,
regardless of their age at diagnosis;
family history of ovarian cancer or
male breast cancer; or a history of
radiation therapy to the chest area.
Other factors go into calculating a
woman’s individual risk, including
reproductive history and age at onset
of menstruation and menopause.
“For women with a lifetime risk of 20
percent or higher, MRI may be used
as a supplemental screening tool,” Dr.
Fana said. Annual MRIs are typically
given at six-month intervals with the
patient’s annual mammogram (and
sonogram, if applicable).
Women with elevated risk may be advised
to begin annual mammograms
and other screening tests before age
40.
If you do not know your breast cancer
risk, have a conversation with
your gynecologist or primary care
physician.
“When women come to us for a mammogram,
we calculate their risk score
and include this information on the
mammography report,” Dr. Kim said.
“This assists gynecologists and primary
care physicians in advocating
for their high-risk patients in getting
insurance companies to authorize
MRIs.”
Breast cancer risk models such as
Tyrer-Cuzick have risk assessment
calculators on the web that allow
women to input factors such as age,
height and weight, age of menstruation
onset, pregnancy history, and
family history, among others, to
calculate their risk.
But it’s best to discuss breast cancer
risk with a healthcare provider.
“Some models may overestimate some
factors, and women may be alarmed
by the findings,” Dr. Abreo said. “Context
matters. It’s important to talk to
your doctor about your risk of getting
breast cancer and what screening is
appropriate for you.”
continued from page 35
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