October is Breast Cancer Awareness Month and today is National Mammogram Day! My amazing mother is a survivor of breast cancer, so this is very meaningful to me. I have learned a lot about breast cancer in medical school, and thought it would be worthwhile posting about to help others understand the most updated guidelines for breast cancer screening.
Breast cancer is the second most common cancer among women in the US, and Black women die from breast cancer at higher rates. This data is currently reported by the CDC as “women”, but people of all gender identities and expressions can get breast cancer. So this discussion will be framed towards those who are assigned female at birth, as they have the most breast tissue and thus highest risk, regardless of gender identity/expression.
**Disclaimer: this is not personalized medical advice and every individual should discuss risks and benefits with their healthcare provider.**
Breast cancer screening begins between age 40-50, depending on the recommending organization and patients’ preferences and risk factors. The American College of Obstetricians and Gynecologists (ACOG), US Preventive Services Task Force (USPSTF), and American Cancer Society (ACS) have similar, but slightly different, recommendations for screening. I am highlighting the ACOG guidelines in this post, because it was recommended to me by Dr. Jessica Shepherd, a great Obstetrician and Gynecologist who provided expert input on this post. However, the other recommendations are not necessarily wrong, and also have expert reasoning behind them.
Why are the recommendations different? Reasons include risks of false positives, increased anxiety, overdiagnosis, and unnecessary procedures that may outweigh the benefits in younger ages. Those with a first-degree family history may benefit more from starting mammograms in their 40s.
Mammography saves the most lives when done every other year for those ages 50-74, especially ages 60-69, at average risk. So it is most important to have regular screening in this age range!
The American College of Obstetricians and Gynecologists (ACOG) recommends offering screening at age 40 to those at average risk, with shared-decision making. If patients have not yet been screened, then screening should begin no later than age 50.
For ages 50-75, ACOG recommends yearly or biennial mammograms. After age 75, a patient’s individual overall health and life expectancy should be considered in deciding whether or not to continue screening, so the recommendation again relies on shared-decision making with a healthcare provider.
Regular clinical breast exams by a healthcare provider are not recommended by either ACS or USPSTF for those at average risk. Providers may offer clinical breast examinations to asymptomatic, average risk patients with a discussion that there are uncertain benefits and possible risks. For those at high-risk, regular clinical exams are recommended.
Breast self-examination, which means regular and repetitive inspection of your own breasts, is also NO LONGER recommended. This is a big reason I wanted to make this post, because I have seen so many people and companies this month encouraging those with breasts to do regular self-exams. This used to be recommended, so many people still think they should do this. But this just increases anxiety, takes time for busy people, and increases risks of false positives and unnecessary testing and procedures- and there is no evidence that it actually has a benefit!
Instead, breast self-awareness is important, according to ACOG, as it has the potential to detect palpable (meaning, something you can feel) breast cancer. Self-detection of breast cancer is a main way that breast cancer is first identified. Breast self-awareness means being aware of the normal appearance and feel of your own breasts, so that you are attuned to notice changes or concerns. If you notice things like pain, a mass, new nipple discharge, or redness, you should tell your healthcare provider.
Things you can do to help lower your risk of breast cancer include getting regular exercise, breastfeeding if applicable, not smoking, and limiting alcohol intake. It is important to be aware of your risk factors and to discuss them with your healthcare provider so you can make informed decisions for your health!
Risk factors for breast cancer include: family history of breast cancer, ovarian cancer, or other hereditary breast and ovarian syndrome associated cancers; known problematic gene mutation (such as BRCA1/2); and increased exposure to estrogen, such as early age at first period, late menopause, never giving birth (“nulliparity”), increasing age, and increased adipose tissue. Exposures that are harmful to our body’s natural repair process are also associated with an increased risk of cancer, such as smoking, high-dose chest radiation, and alcohol consumption.
Of course, estrogen is a naturally-occurring hormone in everyone’s body and does not in itself cause cancer. It is needed for growth, menstruation, and other physiologic processes, so you should not be afraid of it! However, estrogen stimulates breast growth, and any time cells in the body grow and divide, there is a chance for mutations that can lead to cancer. The more this happens, the more chances there are for mutations that escape our body’s natural repair mechanisms, so the higher the risk of cancer.
It used to be thought that soy consumption was linked to increased risk of breast cancer, or that those who have had breast cancer should avoid soy, but this is no longer the case. It is true that soy contains some compounds similar to estrogen, but these compounds generally do not interact with our body in the same way as human estrogen.
I hope you learned something about breast cancer and can share what you learned with your friends and family to help them make informed decisions about their health! Thank you to Dr. Jessica Shepherd, MD, MBA, FACOG for your expert input!