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The Importance of Mammogram Screening

By Rebecca Kwait, MD

In today’s modern, fast-paced world, women are typically incredibly busy. Between motherhood, careers, taking care of family members, and volunteering in the community (even when there is not a pandemic occurring) self-care and regular screenings often slip down the totem pole of priorities. Some women actively avoid mammograms due to fear of a cancer diagnosis, pain, or concerns over radiation and cost. However, with a woman’s risk of developing breast cancer being 1 in 8 in her lifetime, screening is more important than ever. At Exeter Hospital’s Center for Breast Health, we recommend that women start annual screening mammograms at age 40. This is in keeping with guidelines per the American College of Radiology (ACR) and the American Society of Breast Surgeons (ASBrS). Other guidelines exist, supporting delayed and less frequent screening patterns, however annual mammography in the 40-50 age group results in a reduction in breast cancer mortality of up to 29%. Importantly, more than 40% of the years of life lost to breast cancer are among women diagnosed in their 40s. These tumors tend to be more aggressive and more difficult to treat, hence why early detection leads to better outcomes. We also recommend continuing screening as long as there is relatively good health, an estimated 10 year remaining life expectancy and a willingness to treat a breast cancer if one was found.

Women at higher risk should begin screening earlier so it is important to talk about your breast health. There are a number of risk factors for breast cancer, including age, family history, genetics, atypia, history of radiation, and hormonal and lifestyle factors. Many of these are outside of our control but certainly smoking, alcohol consumption, obesity, physical activity, and the use of hormone replacement therapy can be mitigated. Lifestyle improvements may help to lower risk but in the meantime, additional options exist for screening high risk women.  

At Exeter Hospital’s High Risk Breast Health Program, patients may undergo high risk screening breast MRI, especially when they have dense breasts. Breast MRI, when combined with mammography, can increase the screening sensitivity of cancer detection, compared to mammography alone (94% vs 38% in a pooled analysis). Therefore the ASBrS supports supplemental screening MRI in high risk patients, initiated at a risk-adjusted age. High risk patients also have the opportunity to meet with a Massachusetts General Hospital medical oncologist to discuss chemopreventive strategies and can be referred for genetic evaluation if warranted.  

Few cancers are truly hereditary, i.e. related to a specific pathogenic gene mutation that is passed from parent to child. The most well-recognized genes pertaining to breast cancer risk are BRCA 1 and 2. In only 5-9% of breast cancer patients do we find a clinically significant mutation, however this information can be critically important for patients and family members so that steps can be taken to reduce cancer risk, or help with early detection or even prevention. Patients with a BRCA mutation should initiate screening breast MRI at the age of 25 with routine mammography by the age of 30 and have the opportunity to discuss the risks, benefits and timing of prophylactic surgery with a breast surgeon. Discussing breast cancer family history with your doctor can help to determine whether a gene mutation such as BRCA could be present and referral to a high risk program warranted.          
 
The Center for Breast Health at Exeter Hospital is focused on helping women decrease breast cancer risk and obtain appropriate screening based on risk factors. Despite being a frustratingly common disease, by and large, most breast cancers can be treated comprehensively with high survival rates. The earlier the disease is detected, the smaller the chance of spread and the lower the likelihood that more aggressive therapies such as chemotherapy or mastectomy would be needed. Talk to your doctor about your breast health and initiate screening today.

Patients who appear to have a high risk for breast cancer may be referred to Exeter Hospital’s High Risk Breast Health Program.  For more information, contact the Center for Breast Health at 603-580-6867.

Rebecca Kwait, MD, FACS is the medical director at Exeter Hospital’s Center for Breast Health.  She is a fellowship-trained breast surgeon with Core General Surgery, which is affiliated with Exeter Hospital. She works with Massachusetts General Hospital Cancer Center oncologists at the Exeter Hospital Center for Cancer Care, and Core Physicians’ plastic surgeon Dr. Kimberly Marble to treat breast cancer.