In the November 17 issue of Annals of Internal Medicine, (see www.annals.org), the U.S. Preventive Services Task Force (USPSTF) radically changes its recommendations on screening for breast cancer. For ever, the recommendation was for women 40-49 years old to have a Screening mammography every 1-2 years and for women 50 years and older to have a mammography once a year.

Most OB/GYNs will send their patients once between 35 and 40 years old. Now, the USPSTF recommends against routine screening mammography in women 40 to 49 years unless there is a good reason to get one. Routine mammography may create more harm than good. It may lead to anxiety and unneeded biopsies. So, don’t do them.

In addition, the USPSTF recommends every other year screening mammograms for women aged 50 to 74 years and no routine mammography for women over 75.

Next is the best of all. The USPSTF recommends against teaching breast self-examination.

So, if I understand this…don’t get a mammo until age 50 if nothing is going on. Get one only if there is a reason. Don’t do breast self-exams. So, even if there is something going on you will not find it.

Do you think that insurance will stop paying for mammography now?

Do you think this new concept will save lives? Or will it just save healthcare dollars?

Will your anxiety be more or less if you know you are doing nothing?

Are you telling me that you know no one with breast cancer under 50?

Mammographies miss 10% of breast cancers, maybe more. But not even trying gets me angry.

The finding of atypia is considered in the context of your health history and other family history but may increase your breast cancer risk 4-6 fold. The most important thing to do with this information is to find a breast specialist who can partner with you to minimize the risk of this developing into anything more serious.

Also, know that there are several positive interventions that we may make to reduce your risk even in the face of atypia. Science has allowed us to see things well before we can see them on an x-ray. Using this information and making positive changes may afford us the opportunity to halt the progression of these changes!

Realize that only 7-10% of breast cancer is hereditary and so there are other important factors in our day to day life that may predispose us to develop breast cancer.

Several studies have pointed to a role of high fat diets in different cancers across the board and also in breast cancers. Also, studies show that being overweight or at an unhealthy weight increases both the risk and the survival of breast cancer.

Physical activity may also play a role in both the prevention and improved survival for breast cancer. All that in context, we need to eat more fresh fruits and vegetables, less red meat, less processed foods and reduce our total fat intake to less than 15% of our dietary calories.

These are truly lifestyle modifications but will make us healthier on multiple levels both with other chronic diseases such as diabetes and cardiac disease as well as breast cancer. Many physicians are not adequately trained or do not have the time to make such dietary interventions, but may partner with registered dieticians in their community to optimize the health of their patients and their community!

Working together, we can educate patients as to their ability to control their medical future!

FACT: The survival for breast cancer now is almost 85%. The survival for early stage breast cancer approaches 90%. Breast cancer mortality (the chance of dying) has been decreasing by almost 2% per year since the early 1990s. As of January 2006 there are over 2.5 million women living with a history of breast cancer.

MYTH: Breast cancer means the loss of your breast.

FACT: Over 50% of early stage breast cancer patients are eligible to have Lumpectomy as the surgical treatment for breast cancer.

MYTH: Everyone treated for breast cancer will need chemotherapy.

FACT:  The need for chemotherapy is determined by your age, your stage and other individual factors seen in your tumor. A breast cancer diagnosis does not automatically mean chemotherapy is needed.

MYTH: Breast cancer cannot happen to me because I have no family history.

FACT:  75% of the cancers we diagnose are in women with no family history.

MYTH: My mammogram is normal, I cannot have breast cancer.

FACT:  Mammograms will miss 10-15% of breast cancers and a higher percentage in women with dense breasts. Anyone with a palpable mass and normal mammogram should still be referred to a breast specialist for further evaluation.

The first thing that has allowed us to do this is genetic testing- this has allowed us to test patents with significant family history and find out if they are genetically programmed to develop breast cancer.

Secondly, we have identified risk models that allow us to look at a woman’s individual risk factors and determine how her risk for breast cancer compares with that of women with no risk factors.

Lastly, the HALO Breast Pap Test has allowed us to identify precancerous changes before they move forward to the cancerous stages. This is particularly good in women with no family history to see if they may be at risk for cancer development. This gives us an opportunity to make interventions and prevent the subsequent steps to cancer.

Of course none of this would be possible if we did not have acceptable interventions for those who may be identified as high risk.

Tamoxifen, an antiestrogen therapy used to treat breast cancer for many years, has  been shown to reduce the risk of developing breast cancer in women with family history and/or precancerous changes.

Preventative mastectomy has been shown to reduce the risk of breast cancer development by 90%. May women with the genetic mutation ( BRCA1) or BRCA2), atypical changes (precancerous) or some with just family history choose this operation.

Modern day reconstruction can result in breasts that look very natural and in some cases appear more youthful than the patient’s natural breast. Let’s face it - time and breast feeding may play a role in breast changes and many of us have thought about procedures that may make them look more youthful!

These are very serious and individual choices but should be discussed with your breast care specialist so that the best treatment plan for your level of risk can be developed!

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The other thing I have grown to learn from my breast cancer experience is that what does not kill us makes us stronger. Cancer can help us to re-prioritize our lives and place those things that truly matter to us back on top. Isn’t it sad that sometimes it takes something like cancer to do this in our lives?

Lastly, we can take control of our post cancer lives and make positive changes in terms of lifestyle, diet and nutrition that can make us stronger, healthier and happier in the long run. Cancer can be a gift in many ways; the key is to walk away from it a different and perhaps better person.