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Most of us have been affected, either directly or indirectly, by breast cancer. Given the statistics, it’s no wonder. According to the Centers for Disease Control and Prevention, breast cancer is the second most common cancer diagnosed in women in the United States (behind skin cancer) and is the second leading cause of women’s cancer deaths (behind lung cancer). Approximately one in eight American women will develop invasive breast cancer at some point in her life.

However, there is good news amidst all of this alarming data: Screening and prevention practices are making a difference. Healthcare teams and patients are learning more about how to work together to improve breast cancer outcomes. 

First, screening practices continuously benefit from technological advances and scientific research. As a result, a greater number of breast cancer cases are detected and treated early, which helps to raise survival rates.

Secondly, more is known about prevention – steps women can take to lessen their chances of developing breast cancer. While there is no guaranteed way to avoid cancer, these approaches can help lower the risk substantially.

Brown & Toland is leading the charge on both fronts, fervently committed to and well-versed in the latest breast cancer screening and prevention trends. We spoke with Brown & Toland Physicians’ Chief Medical Officer Pamela Laesch, M.D., FACEP to get her insights on this ever-topical subject.

Q:                 What can women do to be vigilant about breast health?

Dr. Laesch:  This is such an important way to begin this discussion because breast health, like any form of wellness, begins with self-awareness. The more familiar women are with what is “normal” for their own bodies – and by that, we mean how the breasts look and feel and change throughout normal hormonal cycles – the more they will be able to detect when something out of the ordinary may be happening. So that’s a type of baseline that we factor in. From there, it’s also good for women to know their family history, which can inform the way they’re screened. Lastly, it’s critical to visit the doctor regularly and follow the recommended schedule of screening tests. Self-awareness is key to prevention.   

Q:                 What are the most common ways to screen for breast cancer?

Dr. Laesch:  Screening starts at home with self-exams, which is an easy technique that any of our doctors can demonstrate to patients how to do. Screening tests performed by healthcare providers include clinical breast exams, mammograms, ultrasounds, and magnetic resonance images (MRIs). Let’s walk through each one.

  • A clinical (or physical) breast exam simply refers to the process of a doctor or nurse using the hands to feel for lumps or other changes in the breast tissue. It is usually done during a normal check-up and requires no equipment.
  • A mammogram is a low-dose x-ray of the breast and can detect irregularities that might signal breast cancer, even in an early stage. A mammogram can only be done using a mammography machine.
  • Ultrasounds and MRIs offer even more detailed images of breast tissue. They, too, require special equipment. Ultrasounds and MRIs are sometimes ordered when abnormalities are found in physical exams and/or mammograms. Doctors also sometimes turn to these more detailed screening methods for patients who are at a higher risk of breast cancer.  

Q:                 What are the latest recommendations about how often to screen for breast cancer?

Dr. Laesch:  Self-exams should happen regularly at home, ideally once a month several days after the end of the menstrual cycle. (Post-menopausal women can establish a routine of performing self-exams on the same day each month.) As for breast cancer screenings that happen in clinical settings, the frequency with which a woman should be screened depends on age and risk. Patients should always discuss this topic with their doctors to determine personalized screening strategies. 

Q:                 What are the most common risk factors for breast cancer?

Dr. Laesch:  The answer to this question must start with a non-answer: There is rarely one thing that can be identified as the single cause of a person’s cancer. Anybody’s risk almost always stems from a combination of factors. Also, women sometimes get breast cancer even though they have none of the common risk factors. Still, research has revealed some of the most typical culprits. They include (but are not limited to):

  • Age. Most breast cancers are detected in women over the age of 50.
  • Genetic mutations. These include inherited changes to certain genes known to be tied to certain cancers, such as BRCA1 and BRCA2. (See below for more about BRCA genes.)
  • Family history. Having a mother, sister or daughter who has had breast cancer elevates a woman’s risk.
  • Extended menstrual history. Women who start their periods prior to age 12 and/or reach menopause after the age of 55 are in a higher risk category.
  • Obesity and lack of physical activity. Extra weight (especially after menopause) and a sedentary lifestyle can raise the risk of breast cancer.
  • Hormone therapy. The hormones estrogen and progestin, especially when taken together, have been shown to raise risks.
  • Dense breast tissue. Dense breasts can be more difficult to image thoroughly, which can make irregularities in the tissue more difficult to find during screening exams.
  • Previous radiation treatments. People who have undergone radiation therapy to the chest, especially prior to the age of 30, are at a higher risk for breast cancer.
  • Alcohol consumption. Breast cancer risk rises as alcohol consumption increases.

Q:                 What can women do to prevent breast cancer?

Dr. Laesch:  In medicine, we like to talk about “protective factors” – things that increase our health and resilience against disease. While there are some protective factors we have no control over (such as genetics), there are plenty others that we can do something about. Those are the ones that feature prominently in any discussion about prevention. A few actions a woman can take to lower her chances of receiving a breast cancer diagnosis include: 

  • Abstain from or limit alcohol consumption.
  • Avoid cigarettes.
  • Keep weight in check.
  • Maintain a regular exercise routine.
  • Breastfeed.
  • Limit or avoid combination hormone therapy.

It’s a good idea for patients to ask their doctor if they have questions about any of these suggestions. 

Q:                 What is the BRCA gene and what is its relationship to breast cancer?

Dr. Laesch:  A lot of work has been done in recent years to shed light on some of the links between genes and cancer. In the context of breast cancer, we now know more about the BRCA1 and BRCA2 genes – pronounced “BRACK-a” and so named because of their relationship to BReast CAncer. In their normal state, both BRCA1 and BRCA2 help protect the body from cancer. But when they are inherited with any mutations or they change, BRCA genes can raise the risk of breast cancer as well as cancers of the ovaries, prostate and colon. According to the National Cancer Institute, up to one-fourth of hereditary breast cancers and up to 10% of all breast cancers can be traced to BRCA 1 and BRCA2 mutations. Genetic testing can be done to check a person’s BRCA status, but is usually advised only for high-risk patients. Patients should discuss whether they fall into the high-risk category with their physician. 

Q:                 Does breast cancer also affect men?

Dr. Laesch:  Yes. Although less than 1% of all cases occur in men, it is possible for men to be diagnosed with breast cancer. But there’s another angle to this answer that’s important to include: Any disease, regardless of the gender it typically targets, is a human disease. Men experience breast cancer alongside women – as spouses, caregivers, community members, doctors, nurses and researchers.  

Q:                 When should a woman have a conversation with her doctor about breast cancer?

Dr. Laesch:  Women should discuss breast health with their physicians early and often. Those conversations will naturally expand to include breast cancer when the time comes to begin screening or whenever any concerns arise. For example, patients are advised to contact their healthcare providers immediately if they notice any unusual lumps or discharge. Otherwise, patients should make a habit of taking control of their own breast health. I’ll stress my original point: Self-awareness is key to prevention.