By Joseph Rosen, MD

In the United States, almost 200,000 women each year will be diagnosed with invasive breast cancer. Approximately another 60,000 are diagnosed with non-invasive duct carcinoma in situ. For the 1 in 9 women who will be diagnosed with breast cancer in her lifetime, the single biggest risk factor is simply getting older. Five percent of breast cancers are diagnosed under the age of 40, 25 percent under the age of 50, and 75 percent will occur after age 50.

Joseph Rosen, MD
Joseph Rosen, MD

Almost 70 percent of the women diagnosed with breast cancer have no identifiable risk factors. For the 30 percent of women identified as being at increased risk of developing breast cancer, typically due to family history or personal history of abnormal breast biopsies, consultation with a breast care specialist is recommended to discuss prevention and high risk screening strategies. Genetic testing may also be indicated. For the remaining 70 percent of women at average risk, there are no proven breast cancer prevention treatments. (The average woman is 6-10 times more likely to die from a heart attack than breast cancer. Exercise, weight reduction, smoking cessation, avoidance of fatty food, etc. can significantly reduce the risk of a heart attack.) If we are unable to prevent a breast cancer, the next best strategy is to find it as small and early as possible. History has shown us that early detection results in more women being cured, with less morbid treatments, and less cost.

Routine screening for breast disease includes physical exams and serial mammography. Self-breast exams have never been demonstrated to improve survival, due to the observation that the average breast cancer is growing 7-8 years before it is big enough to feel. After this amount of time whether a woman is cured of her breast cancer is dependent on biological factors, not early detection. Women are still encouraged to be familiar with their own breast exam. Each woman’s breast exam is unique and mammography does not identify all cancers. Most women normally have areas of thickening in their breast and many normally have lumps. Each woman knowing what is normal for herself and sharing this information with her health care provider can be very helpful in avoiding false alarms.

For the last 40 years mammographic screening has been the mainstay of early breast cancer detection. Virtually all breast care specialists would agree mammogram screening is safe and has saved countless women’s lives. Routine mammogram screening has prolonged survival and allowed the development of less invasive, yet more successful, breast cancer treatment. National medical societies that are responsible for the treatment of women with breast cancer recommend mammographic screening to start at age 40 and continue every year. When to stop mammographic screening is not based on any specific age. The American Cancer Society recommends continuing mammographic screening for women as long as they remain in good health. There have been suggestions from academic think tanks, like the U.S. Preventive Task Force, that mammogram screening can start later, be done less frequently, and end sooner. These recommendations are based on statistics of questionable validity and are interpreted by folk that do not actually care for women with breast disease. This is a very complex topic that each woman should discuss with her own physician. At this time it is standard practice, as legislated by Congress, for insurance companies to pay for annual screening mammography starting at age 40.

As frightening as a breast cancer diagnosis can be, we should take comfort that the prognosis is better than it has ever been. Well over 80 percent of women diagnosed with breast cancer by mammogram will be cured of their disease. For those discovered without mammography, although the cure rate is not as good, it is still better than at any time in our history of treating breast cancer.

Dr. Joseph Rosen is Medical Director of the Brattleboro Memorial Hospital Breast Care Program and is a staff surgeon at BMH. He has been an active member of the American Society of Breast Surgeons since 1998. For questions about mammograms, finding a doctor or financial assistance, please contact BMH Breast Care Program Administrator and Nurse Navigator Kelly McCue at 802-251-8437 or Dr. Rosen at 802-257-3751.