Breast cancer

screening guidelines vary with each person. You might wonder why your doctor chooses certain ones over others.




In the WebMD webinar “
Breast Cancer Screenings: What’s New and What’s Best?”
Julia E. McGuinness, MD, discussed the most recent breast cancer screenings. She explained the guidelines and why they should be tailored to each person.


McGuinness is an assistant professor of medicine at the Columbia University Herbert Irving Comprehensive Cancer Center. She specializes in caring for people who have breast cancer and those at high risk of developing it.


“One of the most important things is to learn about your own breast cancer risk factors and your breast density,” she says. “Those things help us determine the best way to screen you for breast cancer. It’ll also empower you to have that discussion with your doctor about what your risk for breast cancer is.”


Poll Questions


It can be tricky deciding which 

breast cancer screening option

is best for you. There are different reasons you may need to follow a certain protocol. McGuinness explained how to choose the best screening for you.


A poll of webinar viewers found 46% help manage their breast cancer risk by talking with their doctor about screening options.



Question: I do this to help choose the best breast cancer screening for me:


  • Talk with my doctor about which guidelines fit me best: 46%

  • Know my risk factors for breast cancer: 29%

  • Know my breast density: 18%

  • Consider my own screening preferences: 7%


Why Is Breast Cancer Screening Necessary?


“Breast cancer is still the most common cancer in women. We estimate that about 1 in 8 women will be diagnosed with breast cancer in their lifetimes,” says McGuinness. “This is why screening is so important. The goal of breast cancer screening applies to any cancer screening: find cancer early.”


Breast cancer screening can:


  • Find cancer before you have symptoms 

  • Boost your chances of a cure 

  • Lower the cost of treatment

  • Allow for treatments that have fewer side effects


Breast Cancer Screenings Aren’t One-Size-Fits-All


There are a few types of breast cancer screening options:


  • Screening mammograms

  • 3D mammograms or digital breast tomosynthesis

  • Breast ultrasound

  • Breast MRI


Continued


Most women should have a
mammogram
every 1-2 years. But if you’re at high risk for breast cancer (which includes having 

dense breast tissue

), consider having extra breast imaging done. This includes a breast ultrasound or breast MRI.


“Talk with your doctor about the best screening options for you based on your risk and the rest of your medical history,” says McGuinness. “But don’t forget to consider your own preferences. You have a voice in how you want to be screened. There’s not just one recommended way to screen for breast cancer.”


Viewer Questions



How can you manage claustrophobia during mammograms?



Can mammograms cause costochondritis?



If you have dense breasts and yearly sonograms, why do you need mammograms?


We deal with
claustrophobia
a lot during breast MRIs. One thing that we use in those situations, because they’re longer exams, are medications to help with claustrophobia.


For mammograms, it’s trickier because they’re shorter exams and they’re more commonly done. We don’t necessarily want to give everyone anxiety medication for each exam. 


Talk with the mammogram technicians or your doctor about what the process is going to look like. That way, you know exactly what you’re going into when you get there. There are different ways that the techs can minimize your pain or discomfort.


Costochondritis
is inflammation in your ribs or the tissues next to your ribs. It can cause chest pain, especially if you’re moving or taking a deep breath. Your breasts are directly over your ribcage. If you’re being squeezed into a mammographic machine, you could be touched by the machine near your ribs.


It’s not common, but every person’s body is different. Some people who are thin and don’t have a lot of excess padding, or fat, to protect them might have a little bit of pain.


If this happens, tell your doctor and the tech next time so they can adjust things.


If you have dense breasts and have sonograms yearly, you still need mammograms. Ultrasounds or sonograms of the breast aren’t very good at detecting breast cancer on their own. Mammograms are more effective at detecting cancer. We never recommend ultrasounds alone.


Continued



Which screenings are best for those at high risk of breast cancer but allergic to MRI contrast dyes?



How do breast screenings apply to people who are transgender?



How do breast implants and breast reduction surgery affect effectiveness and recommendations of breast cancer screenings?


We’d never have a person with such an allergy go through an MRI for screening. If there’s no alternative, we give them medication to help the allergy (if it’s not severe) so they can still go through it. But for screening purposes, we wouldn’t put anyone at risk in that situation. In this case, your alternatives are mammograms and ultrasounds. We’d do a combination, since you can’t get the MRI.


In the future, CAT scans for breast screening might be an option.


There are no specific guidelines in breast cancer screening for
transgender people. For trans men who still have intact breast tissue, they should still continue screening.


On the flip side, it’s a little harder for us to figure out what to do for trans women. They’re receiving a lot of female hormones, like estrogen, which theoretically could boost their risk of breast cancer. But we don’t have good guidelines on what to do yet, since they don’t have the same degree of breast tissue as cisgender women. 


Talk with your doctors. Generally, we suggest that if you were assigned female at birth and have transitioned, you should continue mammograms unless you’ve had bilateral mastectomies where there’s no breast tissue left.


We also recommend women who had breast augmentation surgery (either implants or breast reduction surgery) get annual mammograms.


Having such surgery can leave scar tissue, and that can make it harder for radiologists to fully read your mammograms. We certainly don’t tell people not to get these surgeries for that reason. But you might end up having more false positive results.


There are no guidelines saying that everyone who had these surgeries should get breast MRIs. But those can take a better look at your remaining breast tissue or the breast tissue that’s been pushed up by an implant.


Continued


Make sure you talk with your surgeon and your primary doctors, continue breast cancer screening, and be aware that you might get a lot more false positives.



At what age can someone with normal mammograms and no family history of breast cancer safely stop having mammograms?



Is there a connection between osteoporosis and breast cancer in postmenopausal women?



Do women who’ve never given birth have a higher risk of breast cancer?


With mammograms, it’s all a risk-benefit analysis. The guidelines say age 75. But if people are healthy and living longer, they can continue mammograms after that.


If you’re sick with other medical conditions – like something that’s going to shorten your life span and you’re going through a lot of other treatments — we often stop screening mammograms. Because the likelihood that breast cancer will become a danger to your health is less likely than another medical condition doing so. It’s a tricky balance. Talk to your doctor about what’s right for your specific situation.


Osteoporosis
in postmenopausal people happens because, after menopause, your estrogen levels drop when your ovaries stop producing it. Estrogen supports bone health. But there’s no direct link between osteoporosis and breast cancer risk. 


If you have osteoporosis and have lower estrogen, it doesn’t mean your risk of breast cancer is lower or vice versa.


However, never having children, or having your first child after the age of 30, is a
risk factor
for breast cancer. The reason is that when you go through pregnancy, your body has a break in the typical cycle of estrogen production you have every month when you’re getting a period.


So having that 9-month break in typical estrogen production is what lowers your risk for developing breast cancer. If you have a pregnancy at an earlier age, like in your 20s or even in your teens, that earlier break means you might improve your breast cancer risk. 


We shouldn’t make decisions about children based on our breast cancer risk. But we can incorporate that into our risk calculations. It’s not a large risk factor for breast cancer. But if you have other major risk factors, this small factor can be what bumps you into the high-risk category where you would actually need to be screened differently.



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