Doctors of USC

With the busy lives that many women lead, preventive health care can often take a backseat to the demands of the day. It may seem easier to simply bypass testing or screening, and hope for the best. But when it comes to breast cancer, preventive care can be a lifesaver.

“The growth rate of breast cancer tends to be much more rapid” than other cancers, says Christy A. Russell, M.D., director of the USC/Norris Breast Center at USC/Norris Cancer Hospital and associate professor of medicine at the Keck School of Medicine of USC. That means that for women, getting screened for abnormal growths while they’re still in their earliest stages is vital.

But with new research and information about breast cancer coming out seemingly constantly, it might be tough to know where to start. In fact, new recommendations were finalized and released as recently as last year by the American Cancer Society (ACS). High-risk women are now encouraged to get yearly breast magnetic resonance imaging (MRI) in addition to yearly mammograms, starting at age 30.

To determine what kind of screening a woman will need, Russell says, it helps to know her risk.

“We divide people into regular risk and high risk,” she explains. “The standard is for all women over the age of 40 at [regular] risk of developing breast cancer to undergo an annual mammogram.”

Done by compressing each breast between two plates, a mammograms looks closely at the underlying tissue. Although the process might be uncomfortable for some women, the actual compression only takes “30 seconds or so,” says Russell.

For each breast, the mammogram produces an x-ray of each breast, which the doctor examines for calcifications or masses that might be caused by cancer. If anything abnormal is found, says Russell, the woman would then follow up with diagnostic testing (usually a biopsy) that would reveal whether or not cancer is present.

Like a mammogram, an MRI looks for calcifications or masses that might be caused by cancer. According to the ACS, because of its higher sensitivity, an MRI can detect some cancers that a mammogram might miss. The drawbacks, says Russell, are that the procedure is much more intensive (it can take up to an hour), and it carries a higher risk of false positives, which could mean that more women would get biopsies unnecessarily. Because it involves being inside the MRI machine for the duration of the test, it may also be uncomfortable for women who are claustrophobic.

Most clinics perform both procedures at the same time, says Russell, although some alternate every six months.

So what exactly does “high-risk” mean? Defined by the ACS as having a 20 percent or higher lifetime chance of developing breast cancer, this includes “women who are known to be gene carriers of the BRCA1 or BRCA2 gene [mutation], any woman who has a first-degree relative who is known to carry that gene mutation, or a woman who was treated with radiation to the chest for Hodgkin’s Disease,” according to Russell.

Some women might want to start by finding out if they themselves are carriers of a BRCA1 or BRCA2 gene mutation by visiting a genetic counselor. “If a woman had a significant family history of breast cancer or ovarian cancer,” says Russell, “she should ask her primary care physician about being referred to a genetic counselor. The genetic counselor would be able to give her testing.”

The testing involves “verbal counseling and a blood test,” Russell explains, which will determine whether a woman has a mutation of the BRCA1 or BRCA2 gene. “The blood test takes about two weeks to come back, and the person [then] meets with the genetic counselor again to go over the results.” If she tests positive, says Russell, her risk for developing breast cancer goes up to 50-70 percent. In that case, a woman would consult with her doctor to decide on a follow-up course of action.

Not all women with a family history of breast or ovarian cancer choose to be tested, for myriad reasons, but women who are high-risk still need to be screened more vigorously.

Russell recommends that in addition to being screened, women maintain an active lifestyle to reduce their risk for breast cancer. “The most powerful thing women can do to reduce risk of breast cancer is maintain a healthy body weight,” she says.

For many women, especially those who have seen a loved one go through breast cancer, the possibility that screening offers to detect a cancer before it spreads through the body is reason enough to schedule yearly appointments at a local center or clinic.