Ask the Expert: Breast Cancer Screening Guidelines

In 2009, the U.S. Preventative Services Task Force announced a change in breast cancer screening guidelines, recommending that women begin annual mammograms at age 50 rather than age 40. The new guideline continues to be disputed by other national medical associations and organizations, leaving the question looming in the minds of many women: When should I begin my breast cancer screening?

Dr. Kelly DeWitt, a radiation oncologist affiliated with Sharp Grossmont Hospital, answers a few questions about breast cancer, including how to diagnose and treat breast cancer, as well as how to reduce your risk in light of the latest guideline updates.

What is breast cancer?
Breast cancer consists of abnormal cells that develop and multiply uncontrollably in the breast tissue, specifically in the milk ducts or glands that sit in between the skin and chest muscles. Though these cancerous cells may develop in a patient’s breasts, they have been known to travel to other areas of the body — bones, lungs, liver or other organs — at which point the cancer spreads, or becomes metastatic.

What causes breast cancer?
While the exact causes of breast cancer are still unclear, doctors and scientists have been able to identify some of the main risk factors through the years. Some of the most significant factors include:

• Age — The older a women is the higher her risk of breast cancer.
• Family history — A women’s risk of breast cancer increases if one or more first-degree relatives (mother, sister, daughter) has been diagnosed with breast cancer in the past.
• History — A woman who was previously diagnosed with breast cancer has an increased risk of developing a new, unrelated breast cancer (separate from a recurrence of the previous breast cancer) in the other breast or in another part of the same breast.
• Hormone therapy — As estrogen causes more cells to divide, there is a greater chance for certain cells to become abnormal in women who take estrogen supplements or have other causes for high levels of estrogen.

It is currently being debated whether a healthy diet can affect one’s chances of getting breast cancer, as studies have shown that individuals who have a history of regularly drinking alcohol or eating diets that are high in fat from red meat and dairy products can be more susceptible to the disease. It is not clear, however, whether the increased susceptibility to breast cancer seen with these dietary habits is a direct effect of the diet itself, or an indirect effect correlating with other risk factors such as increased body mass index.

How common is breast cancer?
Nearly one in every eight women will develop breast cancer sometime over the course of her lifetime, making it the most common type of cancer diagnosed among women. It is also possible for men to get breast cancer, though they account for less than half of one percent of all cases. Generally, women over 50 are more likely to be diagnosed with breast cancer than younger women.

What symptoms are normally associated with breast cancer?
In its early stages, breast cancer typically doesn’t have any symptoms. However, there are a few signs that can be associated with breast cancer as it progresses:

• A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation or ulceration; scaling of the nipple is symptomatic of Paget's disease, a localized cancer
• A lump in the breast or underarm that remains after your menstrual cycle; lumps are usually visible on a mammogram long before they can be seen or felt
• A marblelike area under the skin
• A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt
• Any change in the size, contour, texture, color or temperature of the breast
• Swelling in the armpit
• Pain or tenderness in the breast
• Unusual discharge from the nipple that may be clear, bloody or another color, which is usually caused by benign conditions, but could be due to cancer in some cases

How can breast cancer be treated?
There are several ways to treat breast cancer. Surgery or radiation therapy is used for localized treatment, in order to remove or destroy the cancer cells in the breast. Systemic treatments such as chemotherapy, hormonal therapy or biological therapy are methods to control the cells. While some individuals may only require one specific treatment, others may need to employ a combination of treatments in order to battle their condition. The treatment methods to use should be determined during consultations with a team of oncology doctors including a surgeon, a medical oncologist and a radiation oncologist. 

Can breast cancer be prevented?
While there are no dietary recommendations known to directly reduce the risk of breast cancer, living a healthy lifestyle that includes exercise and a healthy diet may help indirectly by reducing the body mass index.

Also, as estrogen exposure is known to increase the risk of breast cancer, any perimenopausal woman considering hormone replacement therapy should have a discussion with their physician as to whether the benefits of hormone replacement therapy warrants the increased risk of breast cancer given their individual health profile.

Self breast exams are important way to help with early breast cancer detection. Check your breasts once a month, three to five days after your menstrual period ends and be sure to getting regular mammogram screenings, especially if your family has a history of breast cancer.

How can I use the information about the latest breast cancer screening guidelines to help protect myself from the disease?
The best thing to do is to talk to your doctor, who can help guide you and provide the best advice based on your individual needs and medical history. The latest guidelines, presented in the 2009 U.S. Preventative Services Task Force, suggest that screening mammograms:

• Be performed every other year between the ages of 50 and 74
• Should not start until the age of 50
• Should stop at the age of 75

The newly presented guidelines also suggest that monthly self-examinations should not be taught or recommended. Much of the basis for these recommendations lies in the cost-effectiveness of screening these women in terms of the number of lives saved.

However, the American Cancer Society and most medical societies have not adopted these guidelines and continue to recommend annual screening to begin at the age of 40 for most women as well as continued education regarding self-breast exams. Medicare and most insurance carriers continue to cover an initial baseline mammogram between the ages of 35 and 39 with annual mammograms covered once a woman turns 40.

Find a San Diego Oncologist
To find a Sharp-affiliated doctor, search for a San Diego oncologist specializing in breast cancer or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.