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Breast Cancer Awareness

Breast health is paramount.  In today’s world we have multiple means to screen for and prevent breast cancer, but several of these are underutilized or inappropriately administered.  The goals of this article are to provide actionable recommendations and dispel commonplace breast cancer myths. 

Breast cancer screening is consequential to breast health.  We screen to detect breast cancer at an early stage when it is most treatable and most curable.  Overall, death rates have dropped by one third with screening.  There are currently multiple screening guidelines by various organizations.  These have disparate age requirements for initiating and ending screening.  They additionally possess varying frequencies, ranging from yearly to biennial screening.  Ultimately, the American College of Radiology and Society of Breast Imaging recommend that average risk women receive an initial mammogram at age 40 with yearly mammograms to follow.  Mammograms should be maintained throughout one’s healthy lifespan as the risk for breast cancer increases with age.  For a high-risk woman, a health care provider should create bespoke recommendations to accommodate individual risk factors and family history.

The breast cancer screening armory includes physical exam and imaging.  A clinical exam by a health care provider is recommended yearly for average risk women.  Monthly self-breast exam is encouraged for all women and is comprised of two parts.  It is to be performed lying down or in the shower in such a manner to examine the entirety of both breasts and underarms.  Women can employ concentric circles, radial spokes, or vertical lines to cover the breasts and underarms.  Changes from the previous exam are to be noted, such as mass, discharge, or pain.  The monthly self-breast exam also involves examining oneself in the mirror to vet outward changes, such as color change, dimpling, or masses.  The monthly self-breast exam may be met with trepidation and anxiety initially, but with each month, one will become more familiar and accustomed to it and will have the ability to discern a change that can then be presented to a health care provider for evaluation.

Mammography is the mainstay of breast cancer screening.  It utilizes low-dose x-rays to create an image of the breast.  The radiation exposure is scant at about 0.4 millisieverts.  People in the United States are exposed to an average of about 6.2 millisieverts of radiation each year from their natural surroundings.  It is therefore a negligible and safe amount.  Mammography with tomosynthesis or a 3-D mammogram is becoming the standard for screening.  Here x-rays are utilized to create a 3-D image of the breast by taking x-rays from multiple angles.  Mammography with tomosynthesis is advantageous as it affords less compression during the exam and fewer callbacks for additional imaging and superfluous biopsies as a more accurate picture in attained from the start.  This is especially helpful in dense breasts, allowing for more facile discernment of breast cancers. 

Ultrasound and magnetic resonance imaging (MRI) are utilized in high risk screening and in further evaluation of a known issue.  Ultrasound helps to elucidate if a mass is solid or liquid, and MRI allows for a more thorough comprehensive view.  They are each limited therefore preventing them from being a sole method for screening, such as the ultrasound does not provide a comprehensive architectural view and neither detect calcifications, a potential presentation of breast cancer, with as much accuracy as mammography. Thermography is a technology often falsely advertised as a form of breast cancer screening.  Thermography creates an image of the breast based on temperature differences at the skin.  It is therefore desirable as no radiation is utilized.  The breast cancer detection hypothesis is that normal breast tissue has a predictable heat pattern and breast cancer would disrupt this pattern.  Breast cancers have increased growth and new blood vessel formation, which would cause more heat evidence at the skin. 

Author


Tiffany Chichester, MD

Breast Surgeon

Dr. Chichester is a fellowship-trained breast surgeon and is board-certified by the American Board of Surgery, and she is a member of the American Society of Breast Surgeons. She recently joined Arizona Breast Health Specialists (a division of Arizona Blood and Cancer Specialists) and sees patients in Green Valley and Tucson.


Currently though, thermography cannot replace mammography as screening for breast cancer.  It can only detect breast cancers when they are larger and more advanced.  It is not effective as screening as it cannot detect cancers when they are smallest and most treatable.  Thermography can be used in adjunct to mammography.  The FDA issued a warning, that is not a replacement for screening mammography and should not be used singly to diagnose breast cancer.  Thermography decidedly has potential for successful and early breast cancer detection.  It has the potential to detect cancer growth at the cellular level before it has even become a mass but currently is in a rudimentary stage and requires further study and refinement.

There are a myriad of factors that increase one’s breast cancer risk.  An unhealthy weight and diet, excess alcohol use, tobacco usage, and inordinate estrogen exposure are modifiable risk factors.  Each of these can be altered to forestall their risk accumulation.  Maintaining a healthy weight and well-balanced diet, limiting alcohol use, omitting tobacco use, and limiting estrogen exposure, namely omitting hormone replacement therapy can negate these risk factors.  Non-modifiable risk factors include family history of breast and/or ovarian cancer, family history of BRCA 1 or 2 mutation, possession of BRCA 1 or 2 mutation or other associated mutations, Jewish ancestry, history of mantle radiation, and inordinate exposure to estrogen through early first period, late menopause, or late first pregnancy.  Increasingly prevalent are risk factor myths that deodorant, underwire bras, and cell phone handling can increase risk for breast cancer.  These are unfounded and do not increase one’s risk for breast cancer.

It is my hope that you all will feel empowered by these recommendations.  Go forth and screen for and prevent breast cancer.  You have the power to take charge of your breast health!

Author


Tiffany Chichester, MD

Breast Surgeon

Dr. Chichester is a fellowship-trained breast surgeon and is board-certified by the American Board of Surgery, and she is a member of the American Society of Breast Surgeons. She recently joined Arizona Breast Health Specialists (a division of Arizona Blood and Cancer Specialists) and sees patients in Green Valley and Tucson.