High Risk? Know Your Screening Options

Photo by @ju.cako

Angelina Jolie. Christina Applegate. These two Hollywood superstars have something in common that many other women also share:

Having been labeled HIGH-RISK for breast cancer, they opted to have their breasts removed to reduce their risk. In Applegate’s case, she was diagnosed in one breast and then decided to remove the other as a preventative measure.

If faced with the same dilemma, what would you do?

Your gut reaction might be, “take ‘em both off.” That’s a completely understandable thought if you know that many women in your family have had breast cancer and your doctor’s analysis based on family and medical history places your risk level squarely above 20%. Knowing there’s a high likelihood you will develop breast cancer can be scary and overwhelming. Preventative surgery — otherwise known as prophylactic mastectomy — can seem like a reassuring solution.

Yet the decision to go ahead with such a major procedure is far from easy. Removing both breasts is both physically and emotionally strenuous—not to mention irreversible, and life-altering.

As a breast imaging specialist, I often have discussions with women about their breast cancer risk and what they can do about it. With so much information out there, the options can be confusing and difficult to sort through. While prophylactic mastectomy is one choice, it may not be the right one for everyone. If you are not ready to take this step, there are still many powerful screening options that will allow you to be proactive about finding any potential changes that may signal it’s time to take action:

1. Annual screening mammography and ultrasound.

Mammography in combination with ultrasound are the most accurate tools we have to screen for breast cancer. If your center offers 3D mammography, also known as tomosynthesis, you should definitely choose this option. This newer type of mammogram is better at finding subtle cancers and also decreases the number of women who need to return for additional pictures. Ultrasound imaging is especially important for women with dense breast tissue that mammography alone can miss and younger women. It is important to advocate for both tests in a high risk surveillance program.

2. Breast MRI.

By far the best additional test for high risk women under surveillance is a Breast MRI. This test is extremely sensitive—it finds nearly all cancers when they are small.. Other screening tests such as breast specific gamma imaging are less commonly used.

3. Develop a relationship with a breast specialist.

Some large centers offer high-risk clinics, but in most parts of the country this will mean making an appointment with a breast surgeon. This doctor will go over your history and help you develop a surveillance program that works for you.

Some women prefer to have their mammogram and breast MRI performed on the same day. Others choose to stagger these tests every six months so they are being screened at least twice a year. Your breast surgeon will also examine your breasts on a regular basis to assess for subtle changes.

4. Hormone Therapy

There are also several medications that can help reduce your risk of breast cancer, often referred to as hormone therapy. While these medicines have been shown to decrease your chances of getting breast cancer, they also can cause side effects such as hot flashes and blood clots. Set up a meeting with an oncologist to discuss the pros and cons to help you decide what treatment is right for you.

5. Know your own breasts.

While involving medical professionals in your care is important, you are the ultimate expert on your body. If you notice something feels or looks different—a lump, an area of thickening, nipple discharge—let your doctor know immediately. Also, call your doctor if you notice any changes.

It’s also important to know that women who are considered high risk can have widely different chances of developing breast cancer and still only account for 5-10% of all breast cancer cases in Canada. However, women who carry a mutation in their BRCA 1 or BRCA 2 genes have a 40%-85% chance of developing breast cancer in their lifetime, are more likely to develop breast cancer at a younger age (before menopause), and often have multiple family members with the disease.

Although the BRCA genes are the most significant in influencing breast cancer risk, there are other genes that have been discovered that may increase your risk as well. If you are concerned about your genetic risk, talk to your doctor to learn more about your eligibility for genetic testingYou can do this. It’s always better to be educated and informed than bury your head in the sand. Congratulations on taking control of the situation and being proactive about your breast health.

Heather Frimmer is a radiologist who specializes in breast imaging. She’s also an avid reader and writer. Her debut novel, Bedside Manners, will be published by SparkPress in October 2018. To find out more, visit www.heatherfrimmer.com.

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