Richmond Surgical October 11, 2016

Early detection is currently the cornerstone of the arsenal in the war against breast cancer. This is accomplished through annual mammograms, and, at times, other imaging methods such as Ultrasound and Breast Magnetic Resonance Imaging (MRI). Combined with genetic screening, we look to identify signs of the disease early and improve the chances for a favorable patient outcome.

Screenings and tests tell us many things about a patient’s overall risk, and findings from Mammography can lead to Breast Needle Biopsy, where results can range from benign, to benign but abnormal, to cancer. These results dictate the next action, which may include surgery or closer surveillance. The results also allow us to better stratify individual risks, and determine next steps for investigation or treatment.

There are many paths that further tests and detection can take. As an example, Christina undergoes a Screening Mammogram, leading to a Needle Biopsy; results show Atypical Ductal Hyperplasia (ADH), which is a benign lesion of the breast that indicates an increased risk of breast cancer. Her risk of developing cancer is now known to be four times that of a woman her age without those findings. There are certain measures she can take to decrease that risk, including lifestyle modification, surveillance, and chemoprevention (the use of natural, synthetic, or biologic substances to reverse, or prevent the development of cancer).

Family history plays a significant role in incidence of breast cancer, and there are individuals with a personal or family history, who should be further evaluated at the time of mammography or during the office visit. We know that a family history in a first degree relative (mother, sister, or daughter) confers an increased risk for development of breast cancer.

There are many available options to pursue if unfavorable results are found after mammography or other screening activities. If we find that there is a malignant tumor, and the breast cancer was one of several types (early onset, two separate breast cancers, male breast cancer, ovarian cancer, multi-generational), we would consider whether there is an inherited mutation in the family. Although this is present in only 5 to 10% of individuals, the breast and ovarian cancer risk is as high as 87% and 44%, respectively, in the patient’s lifetime, depending on many factors.

Fortunately, there are many options for treatment and future preventive activity. Preventive Mastectomy and removal of ovaries is the choice of many, but not all, women. This reduces the risk of breast and ovarian cancer, but not to zero. This prevention, one form of risk management, was chosen by Angelina Jolie after she discovered she carries a mutated copy of the BRCA1 gene, with wide media coverage after the announcement. This is a personal decision, to be made with all facts in place and with information from a health care provider with extensive knowledge in this area. For those at a lesser risk, at the opposite end of the continuum, one would start with lifestyle changes and medication.

Because more data allows us to make informed decisions regarding the next steps in the path to prevention, early detection is the most important piece of the puzzle, and options have never been more readily available for preventive care.

For further inquiries about breast cancer and genetics, or to set up a consultation for a breast health screening, contact Susan Uhle, RN, MSN, CNP, at (804)285-9416.

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