For 36 years, October has been designated at Breast Cancer Awareness Month. So we asked around looking for the current state of screen and treating the disease.
“Typically, for an average-risk woman, we still use the regular, digital mammography I(when screening for breast cancer)” said Dr. Sweta Jonnalagadda, a hematology/oncology physician at Baptist Health Care in Pensacola. “But one of the things that is utilized in addition is MRI and ultrasound. And we use that in higher-risk women.”
And while most women are at standard risk, there are factors that put some at greater risk of developing breast cancer during their lifetime.
Some of those factors you can’t control, like having dense breasts, giving birth for the first time after age 30, or even just getting older. “The other thing is based upon patient’s histories,” said Dr. Zachary Wright, a hematology/oncology physician at Ascension Sacred Heart Hospital in Pensacola. “And not necessarily a history of breast cancer per se within the individual but perhaps based upon family history. Maybe even their own history of needing a biopsy before that did not reveal a diagnosis of actual breast cancer, but maybe revealed some atypical things. Or if you started menstruation early in your life. Those other risk factors sometimes put you in consideration for other (screening) modalities other than mammography, including MRI.
Dr. Wright also says genetics is playing a bigger role in both screening and treating breast cancer. “Let’s say a patient had a family member that tested positive for (the BRCA-1 or BRCA-2 gene), and they subsequently tested positive for BRCA, then it’s possible that the patients will not only get mammography but will also get MRIs due to their increased risk for breast cancer.”
However, there are risk factors that you can control. Common sense, healthy ideas like staying active and exercising, maintaining a healthy weight, avoiding alcohol and smoking will all help. Even breastfeeding a newborn can decrease a mother’s risk for breast cancer.
If a mammogram comes back showing something that doesn’t look right, Dr. Jonnalagadda says the screening becomes more intense and more targeted. “Once you do detect an abnormality in the mammogram, we do what’s called digital breast tomosynthesis, also known as 3D mammography, which can address some of the limitations that you have in a standard mammogram by improving location of the lesion and really characterizing the lesion better.”
Jonnalagadda says that women who are diagnosed with breast cancer are usually given that genetic test to see if they have one of the mutations associated with breast cancer. She feels that for some high-risk women, genetic testing could be helpful before a diagnosis. “There is a very increasing need for genetic counseling and testing," said Jonnalagadda. "And it’s not just for women who are diagnosed with cancer, but also in identifying any potential risk for cancers so that we can have an optimal surveillance and early detection.” She also points out that about 10% of breast cancers are hereditary.
Once a woman gets a diagnosis of breast cancer, a lot of moving parts are put into action to come up with an individualized treatment plan. “The first thing we do is ‘stage’ the woman," said Jonnalagadda. "So Stage 1 and 2 are what we call ‘early-stage.' Stage 3 is ‘locally advanced.' And Stage 4 is when it’s gone outside of the breast and lymph nodes to distant organs. And also we check for ‘receptors’ on the surface of the cancer."
"So we subdivide women into ‘hormone positive’ or what we call ‘triple negative’ and ‘triple positive’ based on the status of their markers. And based on (the staging and receptors), if it’s an early stage it will involve some kind of a surgery. And it may (also) involve radiation treatment, and certainly, a component of medical treatment which can be in the form of a pill or IV treatment.”
“So, it really is very individualized. And that’s where the genetic testing also plays a critical role. Because if a woman gets tested and they do have a mutation that suggests that there’s a high risk of that cancer coming back in an opposite breast, we would sometimes recommend more extensive surgery. It really is individualized.”
When it comes to surviving breast cancer, detecting it at an early stage is critical. According to the American Cancer Society, Stage 1 breast cancer has a 99% 5-year survival rate. That can drop to under 30% for cancers that have spread to distant organs. The bottom line is early detection saves lives. “Time to treatment makes a difference," said Jonnalagadda. "It matters, and it really changes the (chance of) survival. So, especially in breast cancer and lung and some of the other organ tumors, the earlier something gets detected, from that time to the earlier someone can get a biopsy, to the earlier they can see a provider and start treatment. We know from studies that it actually changes how long one can live.”
And of course, if you need more information or specific advice for your situation, always see your doctor and have a candid conversation. Also, while the number of women going for their mammograms dropped during the pandemic, the local numbers now seem to be recovering.
