Breast Cancer: Why We Worry

The reasons are: Breast cancer is quite common; breast cancer is curable, especially if it’s caught early; and mammograms can detect breast cancers at an early stage.

Let’s start with the sobering facts about breast cancer. One out of eight women will be diagnosed with breast cancer at some point in their lives. It is the second leading cause of cancer-related death in American women.

Some good news: Most women who get diagnosed with breast cancer can be cured with a combination of surgery and some mix of radiation, chemotherapy, and hormone based therapy. By cure I mean, live their normal life spans. The percentage of patients who live long lives after being diagnosed with breast cancer grows every decade thanks to earlier detection and more effective treatments. For example, researchers at Providence Cancer Center and around the globe are currently enrolling patients with breast cancer to trials studying the efficacy of immune therapy. This combination of therapies has been successful: In 1975, only about 75% patients survived 5 years after a diagnosis of breast cancer; in 2010, over 90% survived 5 years or more.

The recommended screening test is the mammogram. This is a radiology test in which the breasts are fit snugly into a machine that images the entire breast. If the screening test is suspicious, the patient will be asked to return for a more zoomed in view. Based on these tests, a radiologist may recommend a needle biopsy. If the biopsy shows suspicious cells or cancer, the patient is sent to a surgeon to talk about removing the mass and sampling the lymph nodes in the axilla, because those nodes are the first place cancer cells would be detected if they had started to spread. This information is important because it impacts prognosis and subsequent treatments.

There is not a consensus on when a woman should start having screening mammograms, and how often she should have them. Why not? Because there are some risks of mammogram, including radiation exposure, cost, anxiety, and false positive findings resulting in unneeded procedures. The benefit of decreased risk of dying from breast cancer needs to be weighed against these risks, and these risk vary patient to patient. There are a number of validated breast cancer risk assessment tools available. Sometimes, patients have genetic risk factors such as a family history of breast cancer or BRCA mutation. Some risks can be modified, such as smoking, alcohol, and body mass index. Other risk factors have to do with exposure to estrogen over a patient’s lifetime. Patients with a greater than 20% lifetime risk are considered high risk, and may opt for more intensive screening that includes alternating contrast enhanced breast MRI with mammogram every 6 months.

For woman at “average risk,” the U.S. Preventative Task Force recommends mammograms once every two years for women aged 50-75. On the other end of the spectrum, the National Comprehensive Cancer Network recommends annual mammograms starting at age 40 until the patient’s other medical conditions limit life expectancy to 10 years or less. Most of the organizations, USPTF included, recommend that starting at age 40, all women be counseled about the risks and benefits of mammography, and be allowed to decide themselves about timing of initial mammogram and frequency of mammograms. To summarize, it seems reasonable that women aged 40-50 should choose how often/how early to be screened based on known risk factors, with the understanding that all women should start getting mammograms at least every 1-2 years starting at age 50.

Dr. Newell attended University of Arizona for medical school, followed by a general surgery residency at Mount Sinai Hospital in New York, N.Y. In 2010, she moved to Portland to begin a Hepatobiliary and Pancreatic Surgery Fellowship at Providence Portland Medical Center. In 2012, Dr. Newell was hired as a liver/pancreas surgical specialist at the Oregon Clinic, where she worked for eight years. She then became the Medical Director of the Liver Cancer Program at Providence Cancer Institute and is now part of the general surgery team at Providence Hood River Memorial Hospital. When she’s not working, Dr. Newell enjoys exploring the outdoors around Hood River with her two boys, Rocky and Bode.