Let’s talk averages

Published 5:50 pm Friday, October 6, 2017

October is Breast Cancer Awareness month, and breast cancer remains the second leading cancer cause of death in women in this country. There has been a significant decrease in mortality over the past 25 years, with 5-year survival rates now about 90 percent, because of early detection and increased screening. The lifetime risk of breast cancer in the average risk patient is still about 12 percent, and more than 75 percent of all breast cancer cases occur in this average risk group — not those considered high risk. Therefore, let’s make sure we know who is average risk versus high risk.

A woman is considered average risk if there is no family history of breast or ovarian cancer, especially family members at a young age, or family history of male breast cancer; no other familial cancer syndromes; no history of abnormal breast biopsy in the past; no history of chest radiation between the ages of 10 and 40; and no history of dense breast on previous mammograms.

Risk assessment is vital to determine the best individual screening regimen, as those with certain risk factors do potentially need different screening methods such as 3-D mammography, or MRI of the breast, and potentially different screening intervals or even risk reducing surgery. Therefore, every woman should make sure at her annual visit to discuss and update any family history and any other risk factors that could impact appropriate breast cancer screening.

So, back to the average American female again who accounts for the vast majority of breast cancer diagnoses. The goal of any screening regimen is to detect early disease in an otherwise healthy patient, to prevent adverse outcomes if possible, improve survival rates, and decrease the need for more aggressive treatment or intervention required with later diagnosis. Benefits should outweigh any potential risks including that of excessive cost, false positive results, over diagnosis and over treatment, and any adverse reactions.

Basic screening recommendations for average-risk women seem to change every few years, so the American College of Obstetricians and Gynecologists recommends that every patient share the decision making with her provider as far as the type of screening study and intervals for repeating that study. Obviously, starting screening exams at a younger age and more frequent intervals have the benefit of much earlier diagnosis and decreased mortality. However, this does increase false positive findings, callbacks for additional studies and potentially negative biopsies. These obviously can cause somewhat adverse reactions as far as significant anxiety and stress for patients, but many studies have shown that most women are very tolerant of this, and there is no longterm anxiety associated or any change in compliance with further screening recommendations. The risk of radiation exposure causing any harm — those very rare cases of breast cancer caused by radiation exposure, is far outweighed by the benefits for regular screening for more than 30 years for most women.

We previously recommended self breast examination at certain intervals, but this actually has not shown to be of any longterm benefit. There is no risk associated, but “self breast awareness” is now recommended at all times instead. This would include both palpation and inspection on occasion, as a number of breast cancers are still detected by the patient herself. Clinical breast exams by medical providers basically are still advised yearly after age 40.

Rather than review the current screening recommendations for the average risk patient from various individual organizations, the following basically combines current recommendations from the American College of Obstetricians and Gynecologists, the National Comprehensive Cancer Network and the American Cancer Society.

  1. Upon discussion with your health care provider, determine whether you are indeed at average or increased risk.
  2. If average risk, at least discuss initiating screening mammography between ages 40-45, no later than age 45, repeating every 1-2 years. Status should be reevaluated annually.
  3. Yearly mammography beginning age 50-55.
  4. Continuing annual mammography until age 75-80, with any discontinuation at that time based on a sure decision with your provider, if life expectancy is greater than 15 years (the case for many women in this country at this time).

Have that talk with your health care provider every year and decide on the best screening method and frequency for you, once your risk has been determined.

Brenda Peacock, MD, is a gynecologist at Vidant Women’s Care-Washington, located at 1204 Brown St.