KnowYourBreastCancerRisk.com

Breast health is important to everyone! Do you know that 75% of breast cancer occurs in women with no risk factors? This means they have no family history, or have not had a biopsy with atypical cells. Their only identifiable risk factor is having breasts! But all is not lost. Knowing these facts you can take proactive steps to reduce your risks.

The first thing is to perform monthly breast exams on a regular basis. This enables you to get more comfortable over time with what your breasts feel like and will help to identify any new areas of concern. Ask your physician to teach you to perform a thorough breast exam.

If there is no family history of breast cancer start yearly mammograms at the age of 40. Do not miss it; take the time once yearly to take care of yourself. Also, the HALO test may help to identify if a patient needs closer follow-up or additional imaging tests.

The HALO allows a physician to identify if a person is producing atypical cells long before a mammogram is abnormal. Like family history, the HALO test may allow us to filter out those women who may need closer follow-up.

Lastly there are definitive lifestyle habits we can all embrace for overall health and also breast health: eating a healthy low fat diet, consisting of at least 4 vegetables and one fruit daily.

Find an aerobic exercise program and do it regularly- it reduces stress, is good for your heart and keeps your bones strong. Together with your health care team you can take steps for a stronger healthier future!

It is disturbing that much too often we hear of a relatively young woman diagnosed with breast cancer. Further distressing is that many of these young women are diagnosed at an advanced stage of the disease. Breast cancer is the leading cause of death for American women ages 35 – 50.

Unfortunately, most women (about 70%) who are diagnosed with breast cancer have no identifiable risk factors other than age. 8 out of 9 women diagnosed with breast cancer have no family history of the disease and have no reason to think they may be at higher risk.

Current risk assessment methods are limited for women under age 40.

Mammogram screening is typically not recommended until age 40 unless a woman has a family history of the disease. Mammograms are also not ofen recommended in this age group because breast tissue is too dense, decreasing the sensitivity and making it less accurate. Additional exposure to radiation to the breasts can be of concern as it increases the risk for breast cancer.

This is where the HALO Breast Pap Test has one of its most important applications. Women ages 25 to 40 years old, without a family history of breast cancer are a target population for the HALO screening which could potentially be life saving. HALO may be utilized to identify women that may be at increased risk for breast cancer and could benefit from earlier mammograms or other forms of screening.

I found it enlightening when one of my patients was excited to learn about the HALO Breast Pap Test because of its similarity to a breast cancer screening test performed in Europe decades ago.  While she lived outside of the U.S., she was offered a similar test called Ductal Lavage, but declined it because of its invasive and painful method of administration. Sometimes, physicians confuse ductal lavage with HALO. It’s important to understand the difference, in case your doctor does not. Ductal lavage is an invasive procedure indicated only for women who are already at high risk for developing breast cancer. 

In contrast, the HALO Breast Pap Test is a noninvasive, significantly less uncomfortable risk assessment tool used to determine which women without symptoms are at highest risk for developing breast cancer. HALO combines warm water, compression and suction to bring nipple aspirate fluid (NAF) to the surface. NAF is found in the milk ducts where 95% of all breast cancers originate. The entire cycle is five minutes and is easily incorporated into your well-woman visit. If you produce fluid, the sample is then sent to the lab and analyzed for cellular abnormalities.

The concept of obtaining and analyzing cells from the breast is not unique, and HALO is much more practical and amenable for the widespread risk assessment of breast cancer.

Practicing in Newport Beach, California, I have many patients with breast implants. Thus I am often asked if they can still have the HALO Breast Pap Test. In most cases the answer is an emphatic YES, but it depends on how your surgery was performed. Implants do not interfere with ability to perform the HALO test. In fact most women who have had breast lifts can also have the HALO. But in the past, it was not unusual for the milk ducts to be severed during the surgery, making it impossible for HALO to collect fluid from the ducts.  These days, the plastic surgeons don’t usually cut the breast ducts when performing breast lifts or augmentation. If a woman has successfully nursed after an implant or breast lift, then clearly her milk ducts are still intact. Therefore the HALO test can obtain cells from those breast ducts as well.

Another question that I am frequently asked, is how uncomfortable is the HALO exam? The answer is that it varies from patient to patient. Some patients barely notice anything, while others are quite uncomfortable. Most patients, however, are in the middle with only slight discomfort. I have done thousands of halos over the last few years and only 2 patients felt they could not finish the 5 minute HALO exam due to discomfort. Most patients say it is less uncomfortable than a mammogram. A good guide, is the amount of discomfort a woman may have had when nursing her children. Using myself as an example, when my babies first latched on I always cringed a little. Then within 30 seconds, the discomfort let up and I was fine for the duration of nursing. For me, the HALO is a similar experience. The first 30 seconds are uncomfortable, and then it eases up and I have no trouble finishing the 5 minutes. If you tend to have sensitive breasts, it might be a good idea to wait until after your menses to do the HALO. That is when your breasts are the least tender and thus the HALO will be most comfortable. So don’t let these fears stand in your way of having the Halo Breast Pap Test done.

My patients are all very used to getting a cervical Pap smear every year. It has been ingrained in us for decades that yearly Paps can lower the risk of cervical cancer. In fact, it’s been well proven that the incidence of cervical cancer has dropped dramatically since the advent of the Pap smear. Since the introduction of the Pap test, US deaths from cervical cancer have been reduced by over 80%. Patients think nothing of coming in regularly to get screened for cervical cancer, even when their risk is extremely low.

Yet, some patients will still hesitate to be screened regularly for breast cancer, even though a woman’s risk for breast cancer is much higher than her risk for cervical cancer. In the US, about 11,000 women will develop cervical cancer each year compared to over 180,000 women who will develop breast cancer.

The HALO Breast Pap test can detect abnormal cells in the breast ducts years before a mass would be visible on mammogram, or before a lump would be felt. Just as we collect cells from the cervix for the pathologist to look at under a microscope, with the HALO we can also collect cells from the breast ducts to examine under the microscope. If abnormal cells are detected the patient can be referred for early monitoring and intervention as needed.

Once patients get used to being screened regularly with the HALO, we can hopefully lower the rate of breast cancer over time. At the very least we could lower the morbidity and mortality from breast cancer, just as we’ve lowered it for cervical cancer using pap smears.

Congresswoman Debbie Wasserman Schultz from Florida’s 20^th district (FL-20) became aware last year that young women, women under the age 40, can and do get breast cancer - about 10,000 cases each year.

The Congresswoman herself was diagnosed with breast cancer and shortly thereafter discovered that she carries a mutation in her BRCA 2 gene. This placed her at a very high risk for both ovarian cancer as well as recurrent breast cancer.

The first step…. with that information in hand she has already taken preventative measures to reduce the risk of ovarian cancer plus steps to insure that her breast cancer will not return.

The next step… Congresswoman Wasserman Schultz has become an advocate for women throughout the United States. She introduced the “Breast Cancer Education and Awareness Requires Learning Young Act of 2009″. This bill is more commonly referred to as the “EARLY Act”.

When adopted it will surely save lives!!

It is clear that young women need some help.  Actually, we all could use some education about young women and their risk of getting breast cancer, how it differs from breast cancer in older women and the unique situations and challenges the women are sure to face.

First, education is key, and this is what the bill is about. Young women must learn the facts, understand their risk, know their own bodies – breasts, speak up when there may be an issue, ask for and get appropriate help.

For most every cancer, risk assessment, prevention and early detection can save lives and for young breast cancer this is certainly true. As it stands today, not many women under 40 years old have been taught or have learned the lesson. In health care we need to put greater emphasis on prevention and early detection!!!

Just think of a 30 year old woman with cancer. What would it mean as far as relationships go? Married or not, just think of the stress it would probably bring into a relationship. How about work? In the best of health it is hard to get and keep a job these days. These are not the best of times for financial instability.

There are entire textbooks filled with the challenges women face after a breast cancer diagnosis - double that for young women.

I applaud Rep.Wasserman Schultz. We must target the needs, both the physical and emotional, of our young adults. Education, understanding risk, prevention and early detection sum up the Early Act. The Congresswoman has it right. We all can do more. So, let‘s do that.

Check out the link to Rep. Debra Wasserman Schultz’s Early Act:

http://wassermanschultz.house.gov/earlyact/index.shtml

What can you do? Write your Senators and House members and tell them to support the EARLY Act. You can find their contact info at www.thomas.house.gov. While the bill (H.R. 1740) already has more than 270 coscponsors, popular support is crucial to getting it passed.

My patients in their 20s and 30s will often ask me if they should get a mammogram. I explain that if there is no family history of breast cancer, the current recommendation is to start mammograms at age 40. Because patients often still want to be screened for breast cancer, I discuss that mammograms are actually not a great tool in young women. Young women still have dense breasts that are hard for the mammogram to penetrate. Abnormalities on mammograms show up as white spots, but so does dense breast tissue, so for young women, it’s like looking for a snowball in a blizzard. Therefore the information from the mammogram is limited. They would be getting radiation (albeit small doses) to their breast for very little helpful information. If they live to be 80 years old, they’ll be getting at least 40 years of radiation to their breast as it is; they don’t need any extra if it isn’t helpful. As a woman ages, her breasts get less dense, and mammograms become much more useful.

Of course, a woman with a family history of breast cancer, especially if that relative had it a young age, would need to start mammograms before age 40. A mammogram might also be needed in anyone with a palpable lump that is suspicious, or a lump that doesn’t go away on its own in a month or so.

But for most women in their 20s and 30s, the HALO Breast Pap is the ideal screening test for breast cancer risk. It is non-invasive, no radiation, and more likely to yield helpful information. The HALO may show atypical cells many years before anything would be visible on a mammogram. Once a woman is in her 40’s, the HALO can be combined with regular mammograms.

Am I at risk for breast cancer? I’ve been asked this question a million times. As an OB/GYN I see 100 patients a week in my office. Most worry about their breast cancer risk and they should. More than 180,000 women are going to get breast cancer this year in the United States.  Are you at risk for breast cancer? That’s not the right question. The question should be am I at low, medium or high risk for breast cancer and when you go to your doctor this is a question that you should be asking.

Every woman is at risk for breast cancer. The job of the physician, my job, is to figure it out. I need to figure it out so I can give the patient advice, proper advice. This is a dynamic process. Sometimes, this means changing what you’ve been doing and sometimes it means you don’t have to.

Many factors are taken into account - gender, age, genetic risk factors, family history of breast cancer, personal history of breast cancer, race and ethnicity, dense breast tissue, certain pre-existing breast conditions, menstrual periods, lifestyle factors such as having children, contraceptive use, post menopausal hormone therapy, not breast-feeding, alcohol, obesity, lack of physical activity, high-fat diets and night work.

It goes without saying that gender is the most important risk factor as women are about 100 times more likely to get breast cancer than are men. Age is the second most important factor. The older someone is the more likely they are to get it. So much of the advice that I give is based on age. Let me give you a couple of examples. A woman shows up in my office for an annual checkup. I will call her Samantha. On second thought, I’ll call her Christina. She is 26 years old. Her main concern is birth control. As always, I take Christina’s history. I find nothing unusual. Her risk for breast cancer is low and I don’t change any of the recommendations that I give her. Christina comes to my office again. She is now 46 years old. Her main concern is her changing cycles. I take her history. Again, I find nothing unusual. But now due to her age I send her again for a yearly mammogram because her age risk factor says she is at increased risk compared to when she was 26 years old. It’s simple, more 46-year-olds get breast cancer than the 26 years old. Age plays one of the biggest roles.
The next on the list of risk factors is family history. About 5 to 10% of breast cancers are hereditary. This means that it is handed down from generation to generation. It may even be passed down through the male side of the family. Christina has a friend. Her name is Jane. When Christina was 26 years old Jane who was also 26 came for a visit. Unlike Christina, Jane had a family history of breast cancer. Jane’s mom had breast cancer at 39 years old and Jane’s grandmother had breast cancer at 60 years old. Why do I care about the family history if Jane is only 26? Why? Because Jane may not be low risk! I need to know. She needs to know.

This is the first installment of many. I will look at and discuss all of the different risk factors for breast cancer. What they mean and why they are important. How I approach them and how you should.