Baltimore Breast Imaging Expert Rachel Brem Talks Cancer Detection at Chizuk Amuno

Rachel Brem
Rachel Brem (Heather M. Ross)

When she was 12, doctors said her mother had just six months to live. They were wrong.

This year, Rachel Brem — whose mother ultimately lived for more than four decades after her terminal breast cancer diagnosis — published her first book, “No Longer Radical,” with co-author Christy Teal.

Brem, who is Jewish and a longtime Baltimore resident, spoke on Oct. 26 at Chizuk Amuno Congregation about her book and the unique challenges and choices people face when it comes to understanding breast cancer detection, prevention and treatment options.

Brem’s expertise comes from being a professor of radiology and director of breast imaging and intervention at The George Washington University, where she is the vice chair of the radiology department. Teal, who was not present at the Oct. 26 talk, is an associate professor of surgery, director of the Breast Care Center and chief of breast surgery at GW.

Both women made the decision to undergo mastectomies.

Brem shared that, when she was 12 years old, her 33-year-old mother was diagnosed with breast cancer and doctors had told her she had just six months to live. Instead, Brem’s mother went on to live for 43 more years. But it was this experience that led to Brem beginning her lifelong quest to cure breast cancer.

“My mother had subsequently developed ovarian cancer. My aunt developed breast and ovarian cancer, and my mother had many recurrences,” Brem said. “Everything was living on borrowed time with her.”

“No Longer Radical” is the latest chapter in Brem’s mission. The book covers a wide range of breast cancer prevention and treatment topics, including mastectomies, evaluating treatment options at every age, recovery and more.

“It’s not a pro-mastectomy book,” Brem said. “It’s a pro-choice book. It’s pro-empowering women with the information they need to make the best decisions for them, understanding the best decision is different for every woman.”

During the event, Brem spoke about the importance of regular mammograms and how far early detection has come.

“I went to medical school at Columbia [University] at a time in the 1980s when we were first seeing the impact of mammography reducing the death rate of breast cancer,” Brem said.

According to the American Cancer Society, breast cancer death rates have been decreasing steadily since 1989, for an overall decline of 43% through 2020.

But despite the progress, Brem said there is still a long way to go. The next step is getting access to ultrasound screening for people with dense breast tissue.

As of 2013, the Breast Density Notification Law took effect in Maryland, requiring health care facilities to notify women categorized as having dense breast tissue about what that might mean for their health.

According to the Centers for Disease Control and Prevention, women with dense breasts have a higher risk of getting breast cancer. According to Brem, dense breast tissue can also hide cancer on a mammogram. This is because the dense tissue looks white on a mammogram — and so do tumors.

“If you have dense tissue, you do need additional testing. It’s absolute,” Brem said. “If you don’t get it, then you ask for it. If you don’t get it there, you insist on it and you go someplace else.”

In addition to dense breast tissue, Brem also discussed the heightened risk of breast cancer that Ashkenazi Jewish women face. Ashkenazi Jewish women have an increased risk of having a mutation in the BRCA1 and BRCA2 genes, according to the CDC. These mutations increase a person’s risk for breast cancer.

According to Brem, one in 40 Ashkenazi Jews carries a BRCA1 or BRCA2 mutation, compared to one in 400 people in the general population.

Knowing is half the battle. The Brem Foundation to Defeat Breast Cancer, founded by Brem, champions early detection.

In the future, Brem and Teal hope to write a second book on the topic of survivorship.

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