The spotlight is on preventive mastectomy (removal of breasts), which was recently highlighted by Angelina Jolie. After testing for the genetic breast cancer gene and her mother’s history of breast cancer from which she died at age 56, Angelina has brought much needed attention to the QUESTION – Should all women be tested for hereditary breast cancer?
First, a word or two about breast cancer. Every year 207,000 invasive breast cancer cases are diagnosed in the United States. 40,000 women are reported to die from breast cancer every year. Risks include age, genetics and use of estrogens with synthetic progestin. 85% of cases are found in women age 50 and above.
With all the attention on breast cancer cases, it is well documented that most are spontaneous cases – which means that they arise on their own. Women have a 12% risk of developing breast cancer throughout their lifetime, if they do not have the genes for breast cancer. This can be as high as 60% if they have the breast cancer gene. Women who have a family history, but no evidence of the genetic cancer gene, have an elevated risk over twice that of the normal population.
Since over 90% of the cases are spontaneous (occur on their own and are not related to breast cancer genes) and 6% of cases are related to genetic breast cancer genes like BRCA1 and BRCA2, this calls into question whether everyone should be tested. There has been a breast cancer model that is designed to predict risk of breast cancer but has many limitations. And then there is the reality that many women, regardless of family history, do not get tested in time, if at all, for breast cancer.
So, today, I will do an overview of these issues and in a following discussion look at breast cancer screening itself. As a start, it is well known that there are different ways to screen for breast cancer and most societies recommend starting at age 40 unless there are histories that would require earlier screening. Follow up tests when the initial screening mammogram is abnormal can involve ultrasound or more detailed imaging studies like MRI. There has been much debate on the frequency of testing with mammograms, with arguments as to whether it is needed every year or every 2 years. Clinical experience by doctors like myself has seen people become diagnosed within a year of having a normal mammogram. So in our next discussion, we’ll look in a more detailed way at the way mammograms as the current mainstay compared to other imaging modalities that have their own unique set of advantages and disadvantages.
So with all the attention on Angelina’s decision to have her breasts removed because of the breast cancer gene, the takeaway message is that breast cancer screening is still recommended for people without known family history or breast cancer genes. And more importantly, because this is a cancer that strikes middle aged women, complications of breast cancer are highly preventable and manageable with implemented screening. Ultimately, the decision for reducing breast cancer complications comes down to the relationship of the woman and her physician. A good start would be a frank discussion about concerns of breast cancer screening and reasons that a woman would not want to do it at a certain time in her life. Oftentimes having a mammogram every 1 – 2 years after age 40 becomes the issue and often presents with newly diagnosed cases outside of that window when a woman decides not to have regular follow up screening mammograms.
So as a great deal of attention is being directed toward the breast cancer gene, which for a select group of people is very, very devastating and may increase not only breast cancer but ovarian cancer risk, many women never get to undergo proper screening and may needlessly be diagnosed with invasive breast cancer and die from this disease. In the next few discussions, we’ll not only discuss the advantages and disadvantages of different types of breast imaging, but also look at the prevention and screening for ovarian cancer as well.
Dedicated to Excellence in Women’s Health,
George F. Moricz, MD
Diplomat of American Board of Obstetrics and Gynecology
P.S. Also, I almost forgot to mention that we have added new services to benefit women in the Arklatex even more. Please remind us when you come in to see us.