Why Knowledge Is Power in Breast Cancer Testing

Jewish women and men have a 1-in-40 chance of carrying a BRCA gene mutation (BRCA1 or BRCA2) — as compared to approximately 1-in-500 for the general population. This statistic places Jewish families at significantly increased risk for hereditary breast, ovarian and related cancers.

Genetic testing

The 1-in-40 message isn’t new, but what is new is that medical experts are discussing “population screening,” genetic testing for all Ashkenazi Jews, because individuals without a strong history of breast or ovarian cancer may still be BRCA-positive. Everyone who carries a cancer gene mutation has a 50 percent chance of passing it on to the next generation, so it’s important to test for these genes when appropriate. Multi-gene panel testing can identify mutations in genes other than BRCA1 or BRCA2 as well, such as CHEK2 or PALB2, which predispose to a variety of other cancers. And if results of genetic testing in a family are negative, it is still possible that the cancer in the family is inherited, resulting from genetic mutations that we do not yet know how to identify.

There are steps you can take to catch cancer early, when it can be treated or even cured, or to prevent cancer through life-saving measures including increased surveillance, prophylactic surgery and chemoprevention (the use of pharmacologic or natural agents that inhibit the development of invasive cancer). Simply put, genetic testing can save lives.

Source: Peggy Cottrell, M.S., Genetics Program Coordinator, Sharsheret

In my own medical practice, patients often ask me when and how frequently they should come back for a screening mammogram. They are understandably confused given the conflicting guidelines by different organizations regarding the use of this imaging test. We must end the confusion for women and their families by providing them with the key facts about screening mammography. Women can then make informed and empowered decisions about the timing of screening in keeping with their own values and preferences.

Here are four key facts about screening mammography that are irrefutable and grounded in science.

1. Screening mammograms save lives

Screening mammography prevents deaths from breast cancer through early detection. This is supported by clear evidence from studies showing fewer breast cancer deaths in women who had screening mammograms compared to those who did not.

2. Regular screenings make a difference

The most breast cancer deaths are prevented and lives are saved when screening mammography is performed annually beginning at age 40. This is the basis for organizations such as the American College of Obstetricians and Gynecologists and the American College of Radiology continued recommendations for annual screening starting at age 40 given that more lives will be saved.

3. Early detection reduces severity of treatment

Early detection with mammography not only saves lives but also reduces the severity of treatment that women with breast cancer must undergo. Studies have demonstrated that women whose breast cancers are found with screening mammography are less likely to have more intensive treatment such as mastectomy or chemotherapy.

4. Results aren’t always right

Screening mammography is not perfect. The primary limitations of screening mammography are that it will not find all cancers (false negatives), that it will require some additional testing for non-cancers (false positives), and that there is a very small risk that a cancer found and treated would not have harmed a woman in her lifetime (overdiagnosis and overtreatment). Importantly, physicians and scientists continue to work to improve breast cancer screening methods. One example is digital breast tomosynthesis (DBT), a new 3-D technique for performing screening mammography that is now routinely available. DBT is a more accurate mammogram which directly addresses the limitations of standard mammography by decreasing both false negatives and false positive exams.

We must work together to end the confusion about screening mammography by communicating these core facts to women. They themselves can weigh the benefits and limitations of screening and make individual decisions based on their own values. Women and their families deserve the opportunity to benefit from the proven life-saving value of screening mammography through informed and fully-insured choices.