Thank you so very much for this very thorough explanation about understanding breast cancer risk. I was diagnosed at 42, and at the time tested for genetic markers, which were negative. My 3 daughters are in their 30’s and I will be sharing your article with them today. This is the most comprehensive review I have read and I hope it will empower them to be proactive and ask the questions they need to ask.
Lucy: I have been following your column regularly and applaud your efforts.
I think there is something else that should be noted about MRI and breast cancer: there is mounting evidence that MRI also leads to increased work up, biopsies, etc, without evidence of improved survival where it is used for screening. Ultrasound and the newer technologies are probably better options for most patients, except for certain specific conditions. The only group that recommends MRI for screening is the ACR; neither the ASBS or American Cancer Society support its routine use.
I was told (in writing) following one mammogram that I did not have dense breast tissue and then told that I did have dense breast tissue following a follow up mammogram. Is it an either/or or more of a continuum?
There are three broad categories of radiologic density descriptors: 1) scattered areas of fibroglandular density 2) heterogeneously dense breasts and 3) extremely dense breasts.
Breast density doesn't usually change over time. It's possible that the radiologist simply didn't comment the first time.
I think it's a great modality but still not considered first line/standard of care as a standalone screening test. Maybe it will in the future for certain patients but we are not there yet. :)
Love this! I was diagnosed at 40, and have realised that many doctors don't talk about the modifiable risk factors because they don't want people to feel 'blamed' for their cancer. But you're right: knowledge is power. And the stats about exercise and alcohol for risk reduction have really motivated me to make lifestyle changes to reduce my risk of recurrence. I wish I'd known about them earlier. (With the usual caveats here that we're only talking about 'risk reduction', not 'prevention', since you could follow all of the advice and still get cancer - but that's certainly not going to stop me doing all I can to reduce my risk 💪). Thanks again for all the information you share
This is great information. Based on my history and screenings I’ve been told to schedule a breast MRI, but I understand it should be timed to 6-12 days after your cycle starts. My cycles are not regular, being perimenopausal, so hard to plan for this. What are the risks to doing a breast MRI off cycle and are there any recommendations when cycles are not predictable?
Getting my first mammogram in a couple months. The NP I see said not to freak out if I’m later told I have dense breast tissue and to opt for the ultrasound. Thanks for this additional context!
Dear Dr. McBride,
What should one do if you were adopted as a baby and do not know your familial history?
Thank you,
CC
Age-appropriate screenings plus risk factor modification and talk w you doc! Recall that only 5-10% of breast cancers are hereditary :)
Dr Lucy,
Thank you so very much for this very thorough explanation about understanding breast cancer risk. I was diagnosed at 42, and at the time tested for genetic markers, which were negative. My 3 daughters are in their 30’s and I will be sharing your article with them today. This is the most comprehensive review I have read and I hope it will empower them to be proactive and ask the questions they need to ask.
You are appreciated.
Patty
You are so welcome! Thanks for writing in. :)
Lucy: I have been following your column regularly and applaud your efforts.
I think there is something else that should be noted about MRI and breast cancer: there is mounting evidence that MRI also leads to increased work up, biopsies, etc, without evidence of improved survival where it is used for screening. Ultrasound and the newer technologies are probably better options for most patients, except for certain specific conditions. The only group that recommends MRI for screening is the ACR; neither the ASBS or American Cancer Society support its routine use.
Otherwise, great job!
Pete Petrucci
Thank you for this, Dr. P!
There was no mention of breastfeeding decreasing the chances of breast Cancer
Yes - it does help! Will add this as an edit. Thanks!
I was told (in writing) following one mammogram that I did not have dense breast tissue and then told that I did have dense breast tissue following a follow up mammogram. Is it an either/or or more of a continuum?
There are three broad categories of radiologic density descriptors: 1) scattered areas of fibroglandular density 2) heterogeneously dense breasts and 3) extremely dense breasts.
Breast density doesn't usually change over time. It's possible that the radiologist simply didn't comment the first time.
Thank you.
I was just diagnosed with BC & this article was most reassuring and helpful.
Sending you well wishes!
What do you think of breast thermography as a diagnostic tool? I know what the FDA says about it, but do you have (strong) opinions about it?
I think it's a great modality but still not considered first line/standard of care as a standalone screening test. Maybe it will in the future for certain patients but we are not there yet. :)
Love this! I was diagnosed at 40, and have realised that many doctors don't talk about the modifiable risk factors because they don't want people to feel 'blamed' for their cancer. But you're right: knowledge is power. And the stats about exercise and alcohol for risk reduction have really motivated me to make lifestyle changes to reduce my risk of recurrence. I wish I'd known about them earlier. (With the usual caveats here that we're only talking about 'risk reduction', not 'prevention', since you could follow all of the advice and still get cancer - but that's certainly not going to stop me doing all I can to reduce my risk 💪). Thanks again for all the information you share
Yes indeed! Thanks for you comments - and support!
Thanks Lucy for this great newsletter (as always). Good info/analysis (as always).
So helpful. Thank you!
This is great information. Based on my history and screenings I’ve been told to schedule a breast MRI, but I understand it should be timed to 6-12 days after your cycle starts. My cycles are not regular, being perimenopausal, so hard to plan for this. What are the risks to doing a breast MRI off cycle and are there any recommendations when cycles are not predictable?
The image quality is not as good - bc of hormonal changes - so I suggest talking w your doc about timing!
Getting my first mammogram in a couple months. The NP I see said not to freak out if I’m later told I have dense breast tissue and to opt for the ultrasound. Thanks for this additional context!