October is Breast Cancer Awareness month. Breast cancer is a leading cancer in women in the United States, comprising 1/3 of cancers in women. About 1 in 8 women (12%) in the US will develop breast cancer at some point in her lifetime. Breast cancer can also occur in men, but is rare.
The chance of curing breast cancer is much better when detected early. Surgically removing a malignant lump before it spreads is the best way to cure it. If it has already spread, then it is more difficult to cure which often involves chemotherapy and radiation. The challenge is that a tumor can start spreading to other parts of the body when it is too small to find by just feeling the breast.
Yearly mammograms have been shown to be the best and most reliable way to detect tumors early. The recommendation is that all women above the age of 40 get a mammogram every year. If a woman’s mother or sister had breast cancer, then the recommendation is to start annual mammograms earlier at age 30. This is because about 10% of breast cancers are related to family genetics. If a woman’s mother had breast cancer before age 50, or if multiple women in the family have had breast cancer, then it is likely that such family genetics are involved.
There are several different genetic mutations that place family members at increased risk for breast cancer, but the most concerning and common are referred to as BRCA1 and BRCA2 mutations. These two mutations account for about half of all genetic related breast cancers, thus about 5% of all breast cancers. Approximately 50% to 65% of women born with a mutation in BRCA1 will develop breast cancer by age 70, and approximately 40% to 57% of women with a mutation in BRCA2 will develop breast cancer by age 70. These two mutations also increase the risk of ovarian and pancreatic cancer. Men with one of these two mutations are also at increased risk of breast, prostate, and pancreatic cancer.
Breast cancers associated with BRCA1 mutations occur in younger women, generally late 20’s to early 30’s, and tend to be resistant to hormonal therapy meaning that they are more difficult to treat. BRCA2 associated cancers tend to be in women who have gone through menopause and tend to be highly responsive to hormonal therapy.
We can now screen for both BRCA1 and BRCA2 mutations with a simple swabbing of the inside of the mouth to get cells to analyze. However, testing should only be done along with special genetic counseling so that the results and their implications can be more appropriately understood. Adventist Health is pioneering such genetics testing and counseling with the AHEAD program which stands for Adventist Health Early All-Around Detection. This is under the leadership of Dr. Candice Westgate of Adventist Health St. Helena (AHSH), in Napa. This program will soon be implemented at all the AH clinics in Mendocino County. You can get more information, including taking an online assessment to help determine your level of personal risk, at www.adventisthealth.org/st-helena/services/hereditary-cancer-syndrome-testing
All three of the hospitals in Mendocino County now offer the newest mammogram technology, called 3D mammography. In addition to being more comfortable than older mammography machines, they are 29% better at detecting breast cancers, especially very small ones, which makes even earlier detection possible. The greater accuracy also allows for less invasive biopsies which can be done by needle, thus reducing the number of surgical biopsies which are more invasive and leave a scar.
The 3D mammography machine at Adventist Health Mendocino Coast (AHMC) was purchased through funds raised by the Mendocino Coast Healthcare Foundation, which is a local, independent, not for profit foundation. The majority of the $350,000 price tag for the machine came from a generous donation made by a local family through the Thomas Family Trust, as well as significant additional donations from two other donors. The AHMC mammogram is special in that the room is designed to create a relaxing and calming environment using images and sounds from the ocean. Appointments can be made by calling 707-961-4665.
There are two 3D mammography machines at Adventist Health Ukiah Valley (AHUV). One was purchased through a generous legacy gift made by the family of Bea Scanlon. The other was graciously donated by the Estate of John Athay. One of these machines also allows for stereotactic location of the tumor. This technology is applied right before the patient goes to surgery for a lumpectomy and helps the surgeon more precisely pinpoint the location of the tumor within the breast. To schedule an appointment in Ukiah, call 707-463-7342.
The 3D mammogram at Adventist Health Howard Memorial (AHHM) was purchased through a generous donation by the Frank R Howard Foundation. Appointments can be scheduled in Willits by calling 707-456-3090.
A woman does not need to have a physician’s order to get a mammogram. However, it is strongly encouraged that she be established with a primary care provider who can follow up with her on the test results and who can make referrals for biopsy and treatments if necessary.
All three radiology sites accept women enrolled in Every Woman Counts, which is a California program that provides free breast cancer screening for woman of low income or uninsured. You can find out more at www.dhcs.ca.gov/services/cancer/EWC .
More information on breast cancer can be found at the following websites:
American Cancer Society: www.cancer.org
A helpful resource for women who are dealing with breast cancer or who are cancer survivors is https://www.websiteplanet.com/blog/breast-cancer-survivor-resources/
www.Wikipedia.org is also an excellent resource.
Miller Report for the Week of October 10th, 2022; by William Miller, MD
You can access all previous Miller Reports, including the previous one on breast cancer from October of 2020, at www.WMillerMD.com.
Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.