STAYING HEALTHY

The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. About 3% of breast cancers (about 7,500 women per year) and 10% of ovarian cancers (about 2,000 women per year) result from inherited mutations in the BRCA1 and BRCA2 genes.

Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But some mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers.

However, not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer. Everyone has two copies of the BRCA1 and BRCA2 genes, one copy inherited from their mother and one from their father. Even if a person inherits a BRCA1 or BRCA2 mutation from one parent, they still have the normal copy of the BRCA1 or BRCA2 gene from the other parent. Cancer occurs when a second mutation happens that affects the normal copy of the gene, so that the person no longer has a BRCA1 or BRCA2 gene that works properly. Unlike the inherited BRCA1 or BRCA2 mutation, the second mutation would not be present throughout the person’s body, but would only be present in the cancer tissue.

Breast and ovarian cancer can also be caused by inherited mutations in genes other than BRCA1 and BRCA2. This means that in some families with a history of breast and ovarian cancer, family members will not have mutations in BRCA1 or BRCA2, but can have mutations in one of these other genes. These mutations might be identified through genetic testing using multigene panels, which look for mutations in several different genes at the same time.

You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Family members who inherit BRCA1 and BRCA2 mutations usually share the same mutation. If one of your family members has a known BRCA1 or BRCA2 mutation, other family members who get genetic testing should be checked for that mutation.

If you are concerned that you could have a BRCA1, BRCA2, or other mutation related to breast and ovarian cancer, the first step is to collect your family health history of breast and ovarian cancer and share this information with your doctor.

Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for you—and if so, when to have it—this is called informed and shared decision-making.

Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.

MAMMOGRAM A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women of screening age.

What do mammograms show? Mammograms can often show abnormal areas in the breast. They can’t tell for sure if an abnormal area is cancer, but they can help health care providers decide if more testing (such as a breast biopsy) is needed. The main types of breast changes found with a mammogram are:

• Calcifications

• Masses

• Asymmetries

• Distortions

What are three-dimensional (3D) mammograms? Three-dimensional (3D) mammography is also known as breast tomosynthesis or digital breast tomosynthesis (DBT). As with a standard (2D) mammogram, each breast is compressed from two different angles (once from top to bottom and once from side to side) while x-rays are taken. But for a 3D mammogram, the machine takes many low- dose x-rays as it moves in a small arc around the breast. A computer then puts the images together into a series of thin slices. This allows doctors to see the breast tissues more clearly in three dimensions. (A standard two- dimensional [2D] mammogram can be taken at the same time, or it can be reconstructed from the 3D mammogram images.)

Many studies have found that 3D mammography appears to lower the chance of being called back for follow-up testing after screening. It also appears to find more breast cancers, and several studies have shown it can be helpful in women with dense breasts. A large study is now in progress to better compare outcomes between 3D mammograms and standard (2D) mammograms.

For more on 3D mammograms, see American Cancer Society Recommendations for the Early Detection of Breast Cancer.

Are mammograms safe? Mammograms expose the breasts to small amounts of radiation. But the benefits of mammography outweigh any possible harm from the radiation exposure. Modern machines use low radiation doses to get breast x-rays that are high in image quality. On average the total dose for a typical mammogram with 2 views of each breast is about 0.4 millisieverts, or mSv. (A mSv is a measure of radiation dose.) The radiation dose from 3D mammograms can range from slightly lower to slightly higher than that from standard 2D mammograms.

To put these doses into perspective, people in the US are normally exposed to an average of about 3 mSv of radiation each year just from their natural surroundings. (This is called background radiation.) The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over about 7 weeks.

If there’s any chance you might be pregnant, let your health care provider and x-ray technologist know. Although the risk to the fetus is very small, and mammograms are generally thought to be safe during pregnancy, screening mammograms aren’t routinely done in pregnant women who aren't at increased risk for breast cancer.

A breast MRI uses magnets and radio waves to take pictures of the breast. Breast MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.

Breast ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that can be harder to see on mammograms. It can help your healthcare provider find breast problems. It also lets your healthcare provider see how well blood is flowing to areas in your breasts.

Thermography, also called thermal imaging, uses a special camera to measure the temperature of the skin on the breast’s surface. Thermography is based on two ideas: Because cancer cells are growing and multiplying very fast, blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up.

Thermography has been available for several decades, but there is no evidence to show that it’s a good screening tool to detect breast cancer early, when the cancer is most treatable.

On Feb. 25, 2019, the U.S. Food and Drug Administration (FDA) put out a safety communication telling people that thermography is not a substitute for a mammogram.

“There is no valid scientific data to demonstrate that thermography devices, when used on their own or with another diagnostic test, are an effective screening tool for any medical condition including the early detection of breast cancer or other diseases and health conditions,” the FDA said.

“Mammography (taking X-ray pictures of the breasts) is the most effective breast cancer screening method and the only method proven to increase the chance of survival through earlier detection.”

Researchers are developing and testing new versions of thermography that someday may improve the test’s accuracy and usefulness.

This information is provided by Breastcancer.org.

Clinical Breast Exam

A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

Breast Self-Awareness

Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider. Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.