Guidelines for breast cancer screening are a source of confusion due to their constant change over the years and the variation in recommendations made by multiple medical bodies. If women recognize their risk factors, they are able to undergo the necessary tests and take simple steps that help them reduce their risk, according to Dr. Holly J. Pedersen, director of breast services at the Breast Center at Cleveland Clinic.
Pedersen called on women to learn about the risk factors related to breast cancer so that they can communicate with their health care provider, inquire about the best tests for them, when they should repeat these tests, and see if they and their family members can benefit from genetic counseling or taking medications that contribute to reducing risk factors.
Breast density
"High breast density can affect imaging outcomes and is itself an independent risk factor for breast cancer. If there is excessive breast density or other risk factors, health care providers may recommend annual MRI scans or medications that reduce the risk."
If lumps are detected in the breast during the clinical examination – but it is possible that the radiography shows that the breast density is not large – only mammography can detect the actual density of the breast.
It is necessary for women with moderate risk factors to have a basic mammogram at the age of forty, and to discuss their breast density and other risk factors with their health provider, to reach the appropriate screening program for them.
The importance of the annual examination
The annual screening is important for everyone, as medical science has not yet reached the stage of identifying women with low risk factors, who may not have to take many preventive measures, and women with medium and high risk factors should have an annual radiography as long as they are in good health. About 75% of breast cancer cases are detected without any known or diagnosed risk factors.
Mammography can save many lives and detect microcalcifications, which may be one of the earliest signs of breast cancer development. In addition, women should not refrain from periodic radiological examinations for fear of exposure to radiation because the radiation levels in these examinations are almost negligible, according to Dr. Pedersen.
Alternative options
For women who have dense breast tissue or have been diagnosed with a higher risk of breast cancer, there is the option of additional screening, all of which may not be covered by health insurance.
Rapid imaging – a miniature version of an MRI – is an option for women whose imaging has been shown to have dense breasts and want to undergo early detection tests, although they know that inaccurate or incorrect results of the disease may appear.
Speaking about the efficacy of additional options for radiography, Pedersen said research has shown that 5 cases of breast cancer per thousand women who undergo conventional two-dimensional radiography are recorded.
One to three additional cases of breast cancer were recorded for every thousand women who underwent three-dimensional radiography.
An additional 15 to 27 cases of infection were recorded on rapid MRI imaging. An additional 13 to 15 cases were recorded on shadow imagery.
A 2023 study showed that full-breast ultrasound screening resulted in only 1.1 additional cases per <>,<> women examined.
Non-adjustable factors
Other non-modifiable risk factors besides breast density include women with a medical history of childhood radiation therapy for Hodgkin's lymphoma (a type of cancer that affects the lymphatic system, part of the body's germ-fighting immune system), who have previously been diagnosed with any other type of cancer, or whose family members' medical history includes the disease.
She recommended that women talk openly with health care providers to see if there are any alarming signs that require genetic testing, noting that these signals are not limited to cases of breast cancer in family members, but also include other cancers such as: ovarian, pancreatic, prostate metastatic cancer or metastatic stomach cancers, so the medical history of family members is very important in assessing potential risks.
Genetic testing can show what are the best treatments for patients newly diagnosed with cancer, and can identify individuals who may benefit from a full annual MRI scan, medications that reduce risk, or surgical interventions that may help reduce the risk of developing people with high risk factors.
Adjustable factors
There are several modifiable risk factors that women can control to reduce their risk of developing breast cancer, and obesity is a risk factor for many cancers, including breast cancer, so making sure to keep weight at healthy levels is paramount.
In general, women should follow general guidelines to be healthy, including exercising regularly and following a healthy diet such as the Mediterranean diet.
"Breast Cancer Awareness Month is an ideal opportunity to remind women to be aware of the risk factors and reduce them if possible, and this month we invite them to get tested for breast cancer in its early stages, which is the most treatable stage," concluded Dr. Pedersen.