No matter your age, a breast cancer diagnosis can be scary. But it’s not uncommon. In the United States, doctors detect breast cancer in women more often than any other cancer except skin cancer. In fact, one in eight women will experience breast cancer during their lifetime.
In a recent webinar, breast cancer surgeon
Jennifer Manders, MD, medical oncologist
Julie Specht, MD, and genetic counselor
Chloe Meier, CGC, discussed factors that may increase your breast cancer risk, screening and treatment options and genetic testing.
Here’s what they want you to know about breast cancer.
Breast cancer is common — early detection can help
According to U.S. numbers, in 2022, doctors diagnosed nearly 290,000 new cases of invasive breast cancer. They also detected roughly 50,000 cases of carcinoma in situ, the earliest-stage breast cancers that haven’t spread.
Recent studies show breast cancer rates are rising, particularly in younger Black women. Doctors frequently detect more aggressive disease in this patient group. These women are also more likely to receive a breast cancer diagnosis on their first screening exam between ages 40 and 45.
Fortunately, these studies also show higher five-year survival rates. More than 99 percent of women are alive after five years if doctors diagnose their cancer early. Even breast cancers detected at later stages have a nearly 90-percent five-year survival rate. But there’s still room for improvement. In 2022, there were approximately 44,000 deaths from breast cancer.
Breast cancer screening options are available
Current recommendations suggest women should start annual breast cancer screening between 40 and 45. You may need to start earlier if you have:
A family history of breast cancer
A personal history of breast cancer
A genetic mutation linked to breast cancer
Dense breasts
Mammograms are the most common breast cancer screening method. These exams capture X-ray images after squeezing your breasts in two directions. Mammograms catch between four and five early-stage cancers out of 1,000 exams, potentially reducing breast cancer deaths. But Dr. Manders recommends talking to your doctor before scheduling your first mammogram.
“Deciding when to start mammograms should be a shared decision-making process for women in their 40s because there’s a trade-off between the benefits and harms of diagnostic mammography,” she says.
The benefits of mammography can include:
Early breast cancer detection
Finding lobular carcinoma in situ (non-cancerous abnormal cells in milk glands that raise breast cancer risk)
Finding smaller tumors
Less (or no) chemotherapy
Less extensive surgery
Mammography also presents some disadvantages. These risks include:
Dr. Manders says women have options. Other screening techniques can catch early-stage cancers, including:
Digital tomosynthesis—This test takes three pictures of your breast tissue at different depths. It uses computer-aided imaging to scan the tissue and distinguish between abnormalities and healthy, overlapping tissue. This exam can detect an additional one to three early-stage cancers.
Breast MRI—High-risk patients benefit from this radiation-free, 45-minute exam. As the most sensitive breast cancer screening test, it can detect an additional eight early-stage cancers. But it also produces a high number of false positives.
“We have to be as aggressive as possible to find as many cancers as we can,” Dr. Manders says. “And with these newer techniques, we’ve reduced the number of patients who must return for additional imaging.”
Breast density and other factors can increase your risk
Having high-density breast tissue places you at high risk for breast cancer. Dense breasts have less fatty tissue and more of the connective tissue that gives your breasts their size and shape. That causes diagnostic problems because both connective tissue and cancerous masses appear white on mammograms. Consequently, your doctor may suggest a breast MRI screening if you have dense breasts.
Additionally, you are high risk if your lifetime risk for breast cancer is greater than 20 percent. Factors that elevate your lifetime risk include:
Alcohol use
Ashkenazi Jewish ancestry
Family history (several first-degree relatives with breast cancer or ovarian cancer)
First full-term pregnancy after age 30
Having high-risk lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ)
Never giving birth
Obesity
Progesterone or estrogen hormone therapy for more than five years after menopause
Radiation exposure
Smoking or long-term second-hand smoke exposure
Starting menopause at a later age
Starting your period at an early age
Vitamin D deficiency
To reduce your breast cancer risk, Dr. Manders suggests:
Eating a well-balanced, low-animal fat diet
Getting at least 150 minutes of weight-bearing and cardiovascular exercise weekly
Talking with your doctor about maintaining a healthy weight
Genetic testing and caring for high-risk patients
Breast cancer risk can be inherited (passed down from family members). But only about 10 percent of women with breast cancer have a genetic difference, or mutation, linked to an increased risk for cancer. If breast cancer runs in your family, you may be at risk for having one of these mutations. Your doctor may recommend genetic testing to determine if you inherited certain genetic mutations, such as in the BRCA1 or BRCA2 genes.
Genetic testing uses a blood or saliva sample to examine your cells for harmful genetic differences, or mutations. The two types of genetic testing include:
Based on these tests, your results can be:
Negative—Based on our current knowledge of cancer genetics, you don’t have a genetic mutation that increases your risk of cancer. Your doctor will continue to manage your condition based on your personal and family history.
Variant of uncertain significance—You have a genetic difference, but there isn’t enough evidence to know whether it’s harmful. Your genetic counselor and doctor will talk with you about these results in depth.
Positive: You have a mutation that increases your cancer risk.
If your genetic test results are positive, your genetic counselor will talk with you about cancer management and surveillance, and what your results mean for you and your family. They may also refer you to a high-risk cancer screening clinic for specialized care. Providers will talk with you about prevention measures like medication or surgery. They may also discuss more frequent screening, such as alternating mammograms and breast MRIs every six months.
“Essentially, when we find that someone has a genetic mutation, we offer personalized recommendations to make sure they’re getting the best possible care and that we are preventing cancer or catching cancer in its earliest stages,” says Meier, a Christ Hospital genetic counselor.
Cancer type determines treatment options
If you are determined to be at higher risk of developing breast cancer, chemoprevention may be an option to decrease this risk, Dr. Specht says.
“Chemoprevention isn’t chemotherapy,” she says. “Instead, it’s more of an anti-estrogen therapy that works best at decreasing the likelihood of hormone receptor positive breast cancer, the form of the disease that accounts for roughly 70 percent of breast cancer cases.”
The three most common chemoprevention medications are:
Tamoxifen—Either a full dose (20 milligrams a day) or a mini-dose (5 to 10 milligrams every other day) can reduce the chance of developing breast cancer by nearly 50 percent. Women experience fewer side effects, such as nausea, fatigue and numbness, with the mini-dose.
Raloxifene—This medication reduces the risk of invasive breast cancer in post-menopausal women.
Exemestane—This medication lowers the risk of recurrent breast cancer and invasive breast cancer in post-menopausal women.
Doctors have other treatment options based on your type of cancer:
Immunotherapy—These infusions use your immune system to identify, attack and destroy cancer cells. These treatments work best with triple negative breast cancer, the most aggressive form of the disease.
Poly-ADP ribose polymerase (PARP) inhibitors—These medications help reduce the risk of recurrent BRCA-positive breast cancer.
Breast reconstruction is an option — but it’s not necessary
Some women choose a mastectomy—the surgical removal of one or both breasts—to treat their breast cancer. This procedure also lowers your chances of developing breast cancer by 90 to 95 percent. But it’s a life-altering, body-changing surgery.
Breast reconstruction can restore the look of your breasts after a mastectomy, but you should talk with your doctor before deciding to have the procedure, Dr. Specht says.
“The question of whether to have breast reconstruction is a personal one, and it should be based on extensive conversations with your doctor about the types of reconstruction available,” she says. “Women should know reconstruction can sometimes interfere with our ability to complete your entire treatment.”
For example, you may need radiation therapy after a mastectomy to clear your cancer completely. If you have breast reconstruction before you finish treatment, radiation may tighten your scars and cause pain. Additionally, radiation may cause your breast implant to shift upward in your chest wall.
Some women choose to postpone or forgo breast reconstruction.
“Choosing not to have breast reconstruction needs to be celebrated and part of the conversation. For some women, their breasts have become baggage they have to carry,” Dr. Specht says. “Their breasts have been heavy their whole lives, and some women choose not to have anything anymore.”
Stay ahead of breast cancer
Early detection can play an important role in ensuring you have the best breast cancer outcomes. You have several screening options depending on your personal and family history. The screening results and genetic testing help guide your treatment options, ensuring your experience the best outcomes possible.
To schedule a breast cancer screening at The Christ Hospital Health Network, call 513-585-2668 or
click here to schedule online.