Leah Millheiser, M.D.
Instructor, WRHR Scholar
Phone: (650) 725-9447
For more information: www.breastcancer.org OR www.cancer.gov/cancertopics/types/breast
The Facts (courtesy of the National Cancer Institute):Breast cancer is the 2nd most common cause of cancer deaths in women after lung cancer.
It is the second most common cancer diagnosed in women (occurs in 1 out of 8 women)
Women in the US have the highest rate of breast cancer in the world
Carriers of the BRCA 1 or 2 mutation have a 50-80% lifetime risk of breast cancer
Signs of breast cancer:Hard breast lump or mass
Breast skin changes: dimpling, redness, thickening, irritation
Abnormal nipple discharge
Breast cancer risk factors:BRCA 1/BRCA 2 gene mutations (men and women)
Mother or sister with history of breast cancer
Estrogen exposure (early age of menstruation (<12 yrs old) or later age of menopause (> age 55)
Race: Caucasian women are at higher risk than African-american women. African-american women are more likely to die from breast cancer than Caucasian women. Hispanic, Asian, Native American women are least likely to develop and die from breast cancer.
Previous chest wall radiation
Never been pregnant or older age at first pregnancy
Excessive alcohol intake
Different types of breast cancer screening:Mammography
Mammography + MRI
Clinical Breast Examination
Mammography: Baseline mammogram younger than age 40 is no longer routinely recommended.
Yearly mammogram is advocated for all low-risk women starting at age 40. The benefit is greater in women > 50 years of age.
Mammograms may miss some breast cancers.
Mammograms have been shown to decrease the rate of breast cancer deaths.
False positive rate: 10% postmenopausal women, 20% premenopausal women; this may lead to additional testing
Reasons why women don't get routine mammograms:Fear of radiation exposure
False positive and false negative results
Fear of pain
Fear of abnormal findings
Fear of embarrassment
MRI + Mammogram:Woman with known BRCA 1 or BRCA 2 mutation
Known first-degree family member with BRCA 1 or 2 mutation
20% or greater lifetime risk based on risk assessment tools
History of chest wall radiation
Clinical Breast Examination:Women in their 20's and 30's should have one every 1-3 years by their clinician
Women 40 and older should have a yearly breast exam by their clinician
Ultrasound:Not a substitution for screening mammograms
Can help distinguish between solid masses and cysts
Used to further evaluate suspicious lesions found on mammogram or masses felt on exam in young women
Monthly Breast Self-Examination:Unlike clinical breast exam and mammogram, breast self-examination has not been shown to decrease the rate of breast cancer deaths. However, it is a good way for women to detect changes in their breast tissue and report any changes to their clinicians. Therefore, it is still recommended by health care professionals. It's not recommended as a replacement for a clinician's breast examination or mammogram
Recommendations for breast cancer screening in women with BRCA 1 or 2 mutations: Breast self-examination starting at 18
Annual mammogram and MRI starting at age 25