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New guidelines call for early breast cancer risk assessment

Dr. Michele Ley

Women should get a formal breast cancer risk assessment between the ages of 25 and 30, according to the new guidelines set by The American Society of Breast Surgeons (ASBrS), published in May.

According to the organization, one in eight women, or 12 percent of women in the United States will be diagnosed with breast cancer over the course of a lifetime. That risk increases for women with Eastern European, or Ashkenazi, Jewish ancestry.

Both the American College of Radiology and the Society for Breast Imaging have “supported that all women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30,” says a statement from the ASBrS.

In an editorial last week in the Journal of the American Medical Association, the U.S. Preventative Services Task Force recommended that Ashkenazi Jewish women should be screened for the BRCA1 and BRCA2 genes linked to breast cancer.

Dr. Michele Ley, who specializes in breast surgical oncology at Arizona Oncology in Tucson, explains why screening for breast cancer at a young age is vital.

“The earlier we detect breast cancer the better prognosis. Early detection works because you find a cancer when it’s small, and even if it’s an aggressive cancer but it’s small, you’re more likely to live a normal life span,” she says. “We want people to know what their risk is.”

Mutations in the BRCA gene are a risk factor for breast cancer; one in 40 people of Ashkenazi descent have this mutation, which makes the risk 10 percent higher than the general population. Other factors include family history, obesity, breast density, lifestyle choices, and medical history.

Ley also points out that risk factors are not always an indication of future breast cancer, and people who develop breast cancer may not have any risk factors.

The initial screening, done by a breast physician or another appropriate health care provider, discusses a woman’s family history, medical history, and the possibility of genetic testing. There are also online resources for those who wish to calculate their risk but these should not be used as a replacement for an appointment.

Ideally, says Ley, a woman should get assessed by her primary care doctor, but Ley understands that not all doctors are able to perform breast cancer screenings.

Depending on the level of risk determined by the screening, the guidelines have recommendations on next steps.

For women with average risk, an annual mammography starting at the age of 40 is recommended.

For women with higher risk, an annual mammography is recommended at age 25 or 35, depending on the risk factors present.

The individuality of breast cancer prompted the ASBrS to create these guidelines.

“Controversy surrounding screening mammography guidelines has resulted in conflicting recommendations from physicians and uncertainty for women,” says the ASBrS. The guidelines are based on research from numerous breast cancer trials. Breast centers throughout the nation are adopting these policies.

“The technology of mammographic imaging has progressed substantially, and we have a deeper understanding of heterogeneity in breast tumor biology,” says the ASBrS statement. “Both of these issues generate concerns regarding the balance between ‘over-diagnosis’ versus the outcome benefits of early detection.”

Ley recommends being familiar with one’s own breasts to aid in possibly detecting a new mass or dimpling. Look out for nipple discharge, inversion, or redness of the breast.

“Understand your risk factors,” says Ley. “For those who can identify risk factors, some are modifiable. You can change your diet, avoid alcohol and smoking. Exercising and losing weight — all those things help reduce the risk of developing any type of cancer, including breast cancer.”