How you are screened for breast cancer depends on your risk score

By Bernadette Starzae

Screening for breast cancer saves lives.

“Studies have shown that early detection of breast cancer decreases mortality by 15 to 40%,” says Dr. Nina D’Abreo, medical director of the breast health program at Perlmutter Cancer Center at NYU Langone on Long Island.

But as experts agree on the need for breast cancer screening, screening guidelines have become increasingly complex in recent years. Organizations issued different, sometimes conflicting, guidelines and the recommendations became considerably more individualized, based on a woman’s risk factors.

On average, a woman has a 1 in 8 chance, or about 12.5%, of developing breast cancer in her lifetime.

“Women who are at average risk for breast cancer should have a baseline mammogram at age 40 and then continue to have mammograms each year,” says Dr. Alice Kim, director of breast imaging for Catholic Health. “Women with heterogeneous or extremely dense breasts should also be evaluated with ultrasound.”

After 75 years, “we still recommend annual mammograms, but women should engage in shared decision-making with their doctors, taking into account functional status and life expectancy,” said Dr From Abreo.

Women in their 20s should begin having 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 significant risk. increased breast cancer, and if 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 an increased risk of breast cancer, and several models are used to calculate a woman’s lifetime risk. The 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. The risk is also high in patients with a 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; at least two first-degree family members with breast cancer, regardless of their age at diagnosis; family history of ovarian cancer or breast cancer in men; 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% or more, MRI can be used as an additional screening tool,” said Dr Fana. Annual MRIs are usually done at six-month intervals with the patient’s annual mammogram (and ultrasound, if applicable).

Women at high risk may be advised to start annual mammograms and other screening tests before the age of 40.

If you don’t know your risk for breast cancer, talk to your gynecologist or primary care doctor.

“When women come to us for a mammogram, we calculate their risk score and include that information in the mammogram report,” Dr. Kim said. “It helps gynecologists and primary care physicians advocate for their high-risk patients and get insurance companies to allow MRI scans.”

Breast cancer risk models such as Tyrer-Cuzick have web-based risk assessment calculators that allow women to enter factors such as age, height and weight, age of onset of menstruation, pregnancy history and family history, among other things, to calculate their risk.

But it is best to discuss the risk of breast cancer with a healthcare professional.

“Some models may overestimate certain factors, and women may be alarmed by the results,” Dr. Abreo said. “Context matters. It is important to talk to your doctor about your risk of developing breast cancer and which screening is right for you.

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