Breast cancer screenings have helped significantly improve the breast cancer survival rate. But now is not the time to be complacent.
Ever since turning 40, Brenda Franks—now age 69—had always been diligent about her yearly mammograms. Because she had dense breasts, she would often feel lumps that would turn out to just be denseness or cysts. In fact, it wasn’t uncommon for her to be called back from a mammogram to have further testing or to have a cyst drained. So when she was called back after a mammogram this summer, she wasn’t worried. But this time it was different. This time, they suspected cancer.
“I couldn’t believe it,” says Franks, a Clementon resident and also a retired Cooper nurse. “They did a biopsy and confirmed it was ductal carcinoma in situ [DCIS]. I was in shock at first. I think when anyone hears the word ‘cancer’ they feel that way.”
DCIS is cancer that starts in the milk ducts and “in situ” means that it is “in its original place.” The fact that the cancer had not even left the duct put her cancer stage at “zero,” Franks says. It couldn’t have been much better news than that. But it could be a very different story had she not been diligent about an annual mammogram, she says.
Though the recommendation from the American Cancer Society and the American College of Obstetricians and Gynecologists is still “a yearly mammogram after 40,” some societies have come out with different wording—and that’s caused some confusion. The U.S. Preventive Services Task Force came out with a message of biennial screenings and many patients have adopted that recommendation. Though most physicians in the region still seem to go with the annual recommendation, the general population seems confused as to what’s best for them.
“I’ve had relatives and friends tell me they didn’t think going every year was necessary,” Franks admits. “I couldn’t disagree more. If I had waited, who knows if my cancer would have spread? I feel so fortunate it was caught early. I put out a message on Facebook asking that everyone share with me the date of their next mammogram and I know at least three or four of my relatives called to schedule theirs. I hope to see some good things come from this very bad thing.”
That early detection message through regular screenings is one that Dr. Preeti Sudheendra, medical oncologist with the MD Anderson Cancer Center at Cooper, also promotes. Cooper follows the recommendation of the American Cancer Society and the American College of Radiology, which both continue to recommend and have not deviated from yearly mammograms. Women who have dense breasts may have reason to be even more diligent, because while the density doesn’t make cancer more likely per se, it does make it harder to detect.
“Breasts are composed of fatty and glandular tissue,” explains Sudheendra, who specializes in breast cancer. “When there’s a lot of glandular tissue, we call that ‘dense,’ and it can cause suspicious areas to be more hidden. If we do find there is something potentially suspicious hiding, it may warrant additional studies. We offer SenoBright contrast-enhanced spectral mammography (CESM) at Cooper Breast Imaging, as well as breast MRI.”
Beginning in May, it became state law in New Jersey that women who have dense breasts be notified of the density following their mammogram. The law also mandates that insurance companies cover additional testing, says Dr. Sherrill Little, co-director of women’s imaging at South Jersey Radiology. Ultrasound screenings often have the ability to turn up cancer that mammograms may have missed.
“Having dense breasts isn’t something that should be frightening, but it’s definitely something to be aware of,” Little says. “It does not mean you’re going to get breast cancer and it doesn’t necessarily even mean you need additional testing if you’re at a normal risk for breast cancer. But it is something you should know so that you can make the best educated decisions for your own health.”
Another way that people can take control of their breast health is by paying attention to family history and sharing that information with their physician. Individuals who have first or second degree relatives who have had breast cancer at age 45 or younger should be referred to a high-risk cancer genetic program like the one at Cooper, Sudheendra says. They will then go through the process of determining whether they should be screened for the BRCA1 or BRCA2 gene mutation.
This all may sound very familiar, as it’s the process that actress Angelina Jolie went through. When it was determined she carried a mutation to BRCA1, which put her at a high risk for breast and ovarian cancer (the latter of which her mother died from), Jolie made the decision to have a preventative double mastectomy. Jolie famously wrote an editorial piece in The New York Times explaining that her decision to have this mastectomy lowered her risk of developing breast cancer from 87 percent to 5 percent.
Of course it also sparked a lot of conversation. Women are now exploring their own risk percentages and taking action.
“Those who have this mutation do have a markedly higher risk of getting cancer and a double mastectomy is an option, as is more aggressive screening,” Little explains. “For women with this gene mutation, screening may also include regular breast MRIs. Some women do feel more at ease having the preventative mastectomy than going in for regular screenings and possible callbacks if anything is ever found. But it’s a personal decision.”
In addition to yearly mammograms after 40, all women should do breast self-exams at home and always inform their doctor of possible lumps or changes. Sudheendra says that even the armpit should be felt for lumps. Any abnormal skin changes or abnormal nipple discharge is another reason to see the doctor. But self-exams aren’t enough.
“The majority of breast cancers don’t have signs or symptoms. That makes the screening tools we have available so important,” says Little. “Oftentimes if people wait until they have symptoms, the cancer has already progressed.”
Franks says she is confident her diligence about yearly mammograms was the reason her cancer was caught early and is quite treatable. She says her cancer would not have been felt as a lump for several years and at that point she doesn’t want to think about how it could have spread. Franks will have a lumpectomy to remove the cancer along with six weeks of radiation.
“It’s strange to say this about a diagnosis like cancer, but all in all, it’s been a wonderful experience,” Franks says. “The team at Cooper has been incredibly helpful about explaining and walking me through everything. I hope that my story can serve as a reminder to others how important those yearly mammograms are. Maybe my story could help save another person’s life—and that will have made it all worth it in my eyes.”
MD Anderson Cancer Center at Cooper
900 Centennial Blvd.
South Jersey Radiology Associates, P.A.
100 Carnie Blvd.
Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 5, Issue 7 (September, 2014).
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