Ask a Health Care Professional – Breast Cancer

By Diana Weber, M.D., Medical Director, Blue Cross and Blue Shield of New Mexico

October is Breast Cancer Awareness Month, which is a good time to make sure you’re up to date on recommended screenings for this disease. Breast cancer awareness is particularly relevant this year because many people put non-urgent aspects of their health care on hold during the pandemic. Screening for all types of cancers declined precipitously. Breast Cancer Awareness Month reminds us of the need to return to regular screening, especially for those who have not thought about mammography since before the pandemic.

Breast cancer is the most diagnosed cancer in the world, affecting about one in eight women and one in 833 men in the United States. Screening mammography helps detect cancer before there are any symptoms. This results in finding breast cancers at very early stages when treatments are highly effective and long-term survival is excellent.

What is a mammogram?

Mammography is breast imaging that uses low-dose X-rays. The imaging exposes you to a small dose of ionizing radiation that is unlikely to cause harm. Screening mammograms can find breast cancers before they can be felt. A mammogram can also detect other breast abnormalities that are not cancer. If a screening mammogram is abnormal, an additional mammogram — called a diagnostic mammogram — is usually recommended. Other types of imaging, such as an ultrasound or MRI, may also be advised. If the abnormality persists, a biopsy may be indicated. Most of the time, these additional tests and even the biopsy are normal, indicating that there is no evidence of cancer. This is called a false positive mammogram, and it is one of the risks of screening mammography.

Who should be screened?

For women who have no breast symptoms or concerns and who have no family history of breast cancer or other breast cancer risk factors, the American Cancer Society recommends the following:

  • Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so.
  • Women ages 45 to 54 should get mammograms every year.
  • Women 55 and older should switch to mammograms every two years or continue yearly screening.
  • Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

As women age, the guidelines become a bit less clear. The United States Preventive Services Task Force concluded that there is insufficient evidence to determine the benefits and harms of screening mammography in women aged 75 years or older.

Are there factors that increase a woman’s risk of breast cancer?

Women at higher risk of breast cancer should speak with their physician about appropriate screening. High risk includes:

  • Women who have a history of breast cancer
  • Women who have had a biopsy that shows a high-risk breast lesion (DCIS, LCIS, ADH, ALH)
  • Women with genetic markers or syndromes associated with high risk (e.g., BRCA1 or BRCA2 gene mutations, Li-Fraumeni syndrome, Cowden syndrome, hereditary diffuse gastric cancer or other familial breast cancer syndromes)
  • Women who have had large doses of chest radiation before age 30

Two other groups of women should speak with their physicians about screening as they are at higher risk of breast cancer:

  • African American women tend to be diagnosed at a later stage of cancer and are more likely to be diagnosed at a younger age and with more aggressive features than white women.
  • Women of Ashkenazi Jewish descent are also at higher risk of breast cancer.

Women with any breast symptoms — a lump, nipple discharge, breast pain, or a change in the look or shape of the breast — may need different types of tests. These may not be symptoms of breast cancer, but they may require a diagnostic mammogram or ultrasound rather than a screening mammogram.

How do I schedule a mammogram?

You can call your health insurance company to find out which mammogram facilities are covered. Screening mammograms do not require a referral from your physician.

Are there ways to prevent breast cancer?

While there are no sure-fire ways to prevent cancer, you can take steps to minimize your risk of breast cancer. These steps also help reduce your risk of other cancers and medical conditions, such as heart disease and diabetes.

  1. Be physically active. Aim for 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week.
  2. Eat whole and healthy foods. Tips for healthy eating:
    1. Fill most of your plate with colorful vegetables and fruits, beans and whole grains.
    2. Choose fish, poultry or beans as your main sources of protein instead of red meat or processed meats.
    3. If you eat red or processed meats, eat smaller portions.
  3. Maintain a healthy weight.
  4. Limit alcohol consumption. Women should limit their intake to no more than one drink per day.

If you are 40 years of age or older and haven’t had a mammogram in the last year, please make an appointment and get screened.

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If you have a health question that you would like to be considered in Ask a Health Care Professional, please email [email protected]. BCBSNM will select questions that may appear. Questions will not be personally answered. The opinions expressed in this column are solely those of the author and not necessarily those of BCBSNM. This column is not intended to be a substitute for professional medical care.


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