With the bustling first days of fall behind and the holidays still far on the horizon, the month of October brings a welcome moment of pause—and a prime opportunity to schedule a yearly visit to your ob-gyn. Regular checkups are key in the battle against the disease, which will affect about 1 in 8 women over the course of their lifetime. With novel research emerging by way of 3-D mammography, ultrasounds, and even a new breathalyzer clinical trial, as well as a shift in American Cancer Society guidelines, which recommend delaying the age women should get their first mammograms, there have never been more ways to personalize cancer prevention. Here, in honor of Breast Cancer Awareness Month, a primer on how to take charge of your health.
Know Your Family History
Personalized risk assessment starts by setting up an appointment with your ob-gyn to walk through your family history. Do your homework before you arrive: Dr. Linda Larsen, director of women’s imaging and radiology research at USC’s Keck School of Medicine, advises women to piece together a clear health history of both parents, three generations back, to figure out when to begin imaging tests. “If your mother had cancer pre-menopause, you should start getting screened 10 years before her age when cancer was discovered,” Larsen says. In addition, Dr. Deanna J. Attai, a UCLA Health breast surgeon and past president of the American Society of Breast Surgeons, urges women to include other cancers in the list. “A family with multiple relatives with colon, pancreatic, prostate, ovarian, and other cancers may also carry a genetic mutation,” she says. Ethnic background also comes into play. Larsen says African-American women with breast cancer are at higher risk for a triple-negative subtype linked to West African ancestry that doesn’t respond to traditional treatment, though Attai notes that the overall incidence of cancer is “actually lower when compared to Caucasians.” The bottom line? In the fight against breast cancer, knowledge is power.
Ask Your Doctor About Your Breast Tissue Density
Mammography is great for detecting cancer in older women, but younger women can have denser breasts (more glandular tissue than fat), which make it harder to spot cancer. Now 3-D mammography (also called tomosynthesis) can collect multiple images of the breasts from different angles—cancer survivor Sheryl Crow is an advocate—and often reduce the need for more tests. Ultrasounds, a radiation-free option, can determine if cysts are solid or water-filled. Thermography (digital infrared thermal imaging) is also radiation-free, but lacks the sensitivity and specificity of mammography, according to Attai. “There’s no perfect breast imaging study; we sometimes need a combination of techniques.” Talk to your doctor about the best options.
Take a Blood Test
A simple blood or saliva test can reveal a host of mutations—from BRCA 1 and 2 to other genetic variants—that may or may not be harmful. Armed with this information, women are able to proactively make decisions about their health. Those who carry genes linked to cancer should talk with breast doctors to set up personalized screening plans tailored to their specific genetic variants. Attai cautions that careful explanations are needed for the results of these complicated tests. Researchers are discovering and testing these DNA variants beyond BRCA 1 and 2, but only time and further testing will tell whether they are harmful or normal. “There’s a lot of interpretive analysis that needs to happen,” she says. But the more information you have, the more educated you can become.
Get Up to Date About Mammograms
Larsen admits there’s been lots of confusion about mammography over the past two years. “We recommend following the new ACS guidelines [suggesting that a woman without a family history of breast cancer should start a screening discussion with her doctor at 40, have yearly mammograms from 45 to 54, and mammograms every two years after 55], but every woman is different,” Larsen says. The current rules are an attempt to lessen the unnecessary anxiety (and even surgery) that comes with false positives—most often the result of benign lumpy tissue—found when imaging younger breasts. Looking further onto the horizon, exciting new clinical trials are pairing mammography with a simple breath test, which may be able to reveal biomarkers for breast cancer through the scent of the breath (similar technologies have been used with success for bronchial asthma). Still, no matter the modality, each woman should make an informed decision about when to start screening. “No one knows your body better than you,” says Attai.
Take Preventative Measures
“We all have the potential ability to reduce our risk by changing our behaviors,” says Attai, who advocates a perpetual self-aware approach to changes in breast size and shape as an important addition to the self-exam. Both she and Larsen agree that 20 to 40 minutes of exercise three days a week can reduce the risk of cancer. Limiting alcohol to a glass of wine a day (but not seven in one night, adds Larsen) also helps. “Links between obesity, which causes chronic inflammation, and cancer exist,” says Attai. “So it’s never too late to start taking better care of ourselves.”