The Facts About Breast Cancer
Knowledge is power, so arm yourself with up-to-date answers to your most perplexing questions about breast cancer.
by Cara Birnbaum
Q. 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 cancer.gov/bcrisktool.
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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 Susan Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California at Los Angeles.
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.
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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.
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.
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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.
Q. Does it matter where I get a mammogram or a sonogram?
A. Yes. The accuracy of your results depends on three things: the quality of the equipment, the technician taking the pictures, and the radiologist interpreting the scan, says JoAnn V. Pinkerton, a professor of obstetrics and gynecology at the University of Virginia, in Charlottesville. So book your test at a dedicated breast center, where the staff's sole job is to find breast malignancies in their earliest, most curable stages. If you're contemplating getting a scan from a mobile mammography van, many do offer top-quality testing. The key: Ask if they're affiliated with a good breast center or a reputable hospital, says Pinkerton.
Q. Should I take a blood test for the breast cancer gene?
A. Unless you have a family history of breast cancer, no. This test is usually reserved for the close relatives of family members diagnosed with premenopausal breast cancer (which is often faster developing than nonhereditary postmenopausal breast cancer) or with breast cancer combined with ovarian cancer. Knowing that you carry the breast cancer gene, called BRCA1 and BRCA2, can help you and your doctor plan a course of action, which might include more frequent imaging scans, preventive drugs, or, in rare circumstances, surgical removal of the breasts and/or ovaries.
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Q. Can benign cysts become cancerous?
A. A true cyst does not become cancerous, says Lydia Komarnicky, chair of the department of radiation oncology at Drexel University College of Medicine, in Philadelphia. Many women develop breast cysts. The majority are fluid-filled sacs dubbed "simple cysts." Once your doctor confirms this with an ultrasound, you can usually leave it alone unless it becomes painful; then it can be drained in a routine procedure.
Q. When should I get a second opinion about my biopsy results?
A. If you're not comfortable with your doctor or the answers he or she offers, consider going to someone else. "If your physician can't explain your results in a way that you can understand, it's reasonable to get a second opinion," says Boolbol. But if you find yourself seeking a fourth, fifth, sixth, or seventh opinion, it's time for a reality check: "If seven people have told you one thing and one person says another, that doesn't make that one person correct," she adds.
Q. What is the difference between recurrence rate and survival rate?
A. The recurrence rate refers to the likelihood that cancer will ever come back after it has been successfully treated. The survival rate refers to the chances a woman will live after being diagnosed with breast cancer. When doctors refer to the survival rate for a given stage of cancer, they are often referring to the percentage of patients who live at least 5 to 10 years after the illness is diagnosed.
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