Knowledge is power, so arm yourself with up-to-date answers to your most perplexing questions about breast cancer
Miha MakeiQ. How do I know if I'm at high risk for developing breast cancer?
A. Anyone with an immediate family member who was diagnosed with breast cancer before the age of menopause or with multiple relatives suffering from the disease is at high risk; you should start getting mammograms at age 30 or younger, depending on your case. If you're not at high risk, begin at 40. Calculate your own chances by using the Breast Cancer Prevention tool, a short questionnaire at www.cancer.gov/bcrisktool.
Q. Do birth-control pills increase my risk?
A. Any links between the Pill and breast cancer appear to be weak. While estrogen exposure can potentially increase your risk, today's birth-control pills contain far less of the hormone than earlier versions. However, women who take oral contraceptives in their mid- to late 40s to help mitigate perimenopausal symptoms have not been studied, so if you fall into that group, you should weigh the risks and the benefits of the Pill with your doctor, says surgeon Susan Love. (See Breast Cancer: Facts and Fiction)
Q. Should I do breast self-exams?
A. They certainly can't hurt, but experts disagree over the long-term merits of self-exams. Until five years ago, the American Cancer Society recommended doing one monthly. However, research has found that these exams don't actually decrease the cancer death rate, so they have been deemed optional. Nonetheless, it's good to familiarize yourself with your breasts so that you know which lumps are normal and which are new and different.
Q. How much do diet and exercise affect my chance of getting breast cancer?
A. A nutrient-rich diet and an aerobic-exercise regimen won't keep breast cancer totally at bay, but studies have shown that both can help reduce the risk of breast cancer and its chance of recurrence in higher-risk women by a small degree, says Love. Conversely, some data have shown an association between alcohol consumption of one drink or more a day and an increased breast cancer risk in all women, not just those already at high risk.
Q. What's the difference between a screening mammogram and a diagnostic mammogram?
A. A screening mammogram scans both breasts for trouble spots, while a diagnostic test zeroes in on questionable areas detected during a screening exam. A radiologist isn't always present during a preliminary screening mammogram, which is why you often don't get results for two weeks, says Susan K. Boolbol, chief of breast surgery at Beth Israel Medical Center , in New York City . If this screening reveals a mass - or if your gynecologist or some other doctor feels a lump during a routine examination - you'll probably be sent directly for a diagnostic mammogram. In that case, a radiologist is often on-site to read your results immediately. (See 10 Medical Tests Every Woman Should Have)
Q. How often do screening mammograms turn up suspicious lumps?
A. Roughly 10 percent of women are called back for additional imaging after a screening mammogram. Of those, only 8 to 10 percent ultimately wind up with a biopsy of some sort, and approximately 80 percent of the suspicious lumps biopsied are benign (harmless). Also, keep in mind that screening mammograms can have a high false-positive rate. So don't panic if your doctor requests additional testing on one.
Q. Can the X-rays from mammograms cause cancer?
A. The chance that mammogram X-rays will increase your risk of cancer is minute and vastly outweighed by the chance that your mammogram might uncover a malignant (cancerous) mass, says Jennifer Harvey, a professor of radiology and the director of breast imaging at the University of Virginia, in Charlottesville. "Mammography uses one of the lowest doses of radiation of any X-ray," says Harvey . "Even pregnant women can have them if absolutely necessary." (A shield is placed over the patient's belly.)
Q. What are digital mammograms, and when are they used?
A. Like pictures taken with a digital camera, digital-mammography images can be altered to look lighter or darker, making it easier to see a potentially dangerous mass. Digital screenings are better than traditional X-ray mammograms for screening women who have dense breast tissue, are under 50, or haven't gone through menopause. The premenopausal years are when breasts typically develop more benign lumps and cysts, says Harvey . Increasing numbers of breast-imaging centers offer digital mammograms, and most insurance plans cover them. While the appointment may be shorter, the results may still take a few days to a week to come back.
Q. When should I have an MRI or a sonogram?
A. Your doctor may order a magnetic resonance imaging (MRI) test or a sonogram (ultrasound) following a routine exam or a mammogram, especially if you are at high risk. A sonogram helps determine whether a mass is solid, which would warrant a biopsy, or if it's a harmless liquid-filled cyst. MRIs suss out malignancies using contrast dye injected into a vein. Because this process is so good at picking up possible tumors (along with completely benign masses), many experts urge patients at high risk for developing breast cancer to begin yearly MRI tests along with mammogram screenings around age 30.
Written by Cara Birnbaum
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