By Megan Conway
October is National Breast Cancer Awareness Month, a time to promote education about the disease that impacts 1 in 8 American women diagnosed in their lifetime.
Recently, famous figures such as Olivia Munn and Danielle Fishel have gone public about their journeys with breast cancer, boosting visibility of available screenings and treatments and emphasizing the importance of committing to regular check-ups.
To learn more about current breast cancer detection and treatment, we spoke with Dr. Jennifer D. Son, breast surgical oncologist at MedStar Montgomery and MedStar Georgetown University Hospital, as well as Dr. Rachel Brem, director of breast imaging and intervention at The George Washington University Hospital and chief medical advisor and founder at The Brem Foundation, a Silver Spring, Maryland-based nonprofit focused on maximizing women’s chances of finding early, curable breast cancer.
Self-Examinations, Screening and Risk Factors
The conversation around breast health and breast cancer awareness should ideally begin in high school, noted Brem, but at the age of 25 is when women should begin monthly self-examinations. This entails checking breasts for new lumps, dimpling, sores and skin color changes. Many YouTube videos are available as how-to guides.
During monthly self-examinations, if a woman feels any new or hard breast masses, breast pain that persists past fluctuations in hormones, or any discharge from the nipple, it’s time to contact your provider, noted Son.
As far as outpatient breast cancer screenings, “Patients of average risk — average meaning no family history of breast cancer and no symptoms — should start getting screened [for breast cancer] at the age of forty,” done via screening mammograms that look at breasts in two views, explained Son.
If you have a family history of breast cancer, “you should start 5 to 10 years earlier than the first degree relative who had [it],” noted Brem. “And if you come from a family with high risk, then you should consider talking to your doctor or getting an MRI every year if [needed], because early breast cancer is a really curable disease.”
Alongside family history, a previous breast biopsy showing atypia and previous radiation to the chest are risk factors. About 40% of American women have dense breast tissue, the number one risk factor, and one only findable by mammography, said Brem.
When input into a risk assessment model by providers, all risk factors contribute to a score which informs a patient and their doctor whether the patient is of average risk or higher.
One of the most commonly used models is the Tyrer-Cuzick model (that which Munn’s provider utilized to determine her risk), which can also be found easily online for patients to calculate their risk themselves, relayed Son.
Treatment
When potential problem areas are found, a provider will order a diagnostic mammogram, which offers doctors additional views of the breast, and potentially an ultrasound as well to look deeper into the area of concern, said Son. If the findings are still of concern, providers would then recommend a biopsy, which is sent to pathology to confirm a diagnosis.
“There are different types of breast cancer,” Son continued. “It ranges from Stage 0 to invasive cancer, but we also test it for certain markers,” inclusive of estrogen, progesterone and the HER2 protein, the results of which determine the path of treatment.
While misinformation may be rampantly spread online, Son highly cautioned against relying on solely holistic treatment, which she has firsthand seen fail to treat breast cancer and delay standard care treatment to the point of being too late.
Providers are happy to work alongside alternative medicine, she noted, but standard breast cancer treatment will usually entail surgery and then additional recommendations to ensure the cancer stays away, sometimes radiation, sometimes a pill.
“I know the biggest thing that people are concerned about is chemotherapy, [but] some of the breast cancers don’t require chemotherapy at all, and so [patients] shouldn’t be afraid to seek treatment because they’re afraid of chemo,” explained Son.
Self-Advocacy and Seeking Care
The Brem Foundation is dedicated to early detection. “We kind of have a cure for breast cancer – which is early detection!” explained Brem. “North of 95% of women diagnosed with early breast cancer survive five years or longer, which is the definition of essentially a cure.”
Education must go beyond pink ribbons on display in October — “It’s important that every woman know that the best way to save the most lives, and everybody agrees, is to start a mammogram at age 40 every year — not every other year … and if you are at higher risk, then you should talk to your doctor or consider starting to screen earlier,” Brem emphasized.
The other thing to keep in mind? “Nobody knows you like you know you, and you have to advocate for yourself,” Brem said.
While mammograms are typically covered under insurance as they are considered preventative care (and therefore women should be encouraged to get them as soon as recommended), sometimes women who are at an increased risk are denied something such as an MRI they might need, said Brem. Therefore, it’s vital to be loud—to be a “badass,” as Brem lovingly encouraged.
“Call your insurance company, advocate for yourself, learn enough to know how you can get the best cancer screening and don’t accept no for an answer,” she concluded.
To Learn More
For more information on The Brem Foundation’s work in breast cancer education, advocacy and care for underserved communities, including new risk assessment app Checkmate and the Wheels for Women program that allows women to get to their life-saving mammograms at no cost, visit bremfoundation.org.
The website also has plentiful details on breast cancer screening, breast health and more.
