October is Breast Cancer Awareness Month. So what do you really need to know? WestportMoms talked to Dr. Adam Ofer, board certified obstetrician and gynecologist of the Westport Avery Center to find out what information many of us moms should know about breast cancer and breast cancer prevention. Thank you Dr. Ofer!
The good news:
- In the last decade, we have made huge strides in the treatment of breast cancer. More women than ever are surviving without local recurrence or metastatic disease.
- New technology and our understanding of genetics is progressing exponentially, revolutionizing treatment algorithms. Since every woman and every cancer are not the same, genetic markers offer predictive clues about chance of tumor progression and recurrence, allowing for more individualized treatments that help prevent over- or under-treatment.
- With early detection the 5-year survival rate for women compared to their healthy peers is 99%.
Room for improvement:
- This year, over a quarter million women will be diagnosed with breast cancer and over sixty thousand women will succumb to their disease.
- Black women in our country still have much higher mortality rates than white women, likely related to less early detection and poorer access to quality care.
What you can do:
- Know your risk. Not all women have the same risk for breast cancer. Your risk may change due to many factors, including your family history, the age at which you started getting your periods and / or had children, the density of your your breasts and whether or not you have ever breastfed. Ask your doctor to review your risk factors and come up with a personalized plan to reduce your risk. There are many risk-calculators out there to help you assess your chance of developing breast cancer. Each of the many models have benefits and limitations, but here are a few great resources:
Reduce your risk. There are things you can do!
- Get off the couch! Physical activity can reduce your chances of being diagnosed with breast cancer (and many other cancers). Once you hit menopause it may seem much harder to lose those extra pounds, but fat produces estrogen which is likely why being more fit will reduce your chances of breast cancer.
- If you have children and are able to breast feed, that will significantly reduce your risk. Every 12 months of breastfeeding will reduce your lifetime risk of breast cancer by over 4%.
- It appears that a diet rich in fruits and vegetables and / or a Mediterranean diet and reduced consumption of red meat also may reduce your risk of developing breast cancer.
Screen for early detection. When and how often to begin screening with mammography is a major source of debate. Organizations, such as The American Cancer Society, American College of Ob/Gyn and US Preventative Taskforce, disagree on guidelines for mammography screening, which is a big source of confusion and concern for many of my patients. The bottom line is that you should work with your doctor and create a plan of care that is best for you. Consider your personal risk factors as well as your level of anxiety about different screening tests and the potential for false positive findings. Some women feel a sense of empowerment with routine and more sensitive screening options (like breast ultrasound and MRI if they qualify) and feel a sense of security after receiving negative results. Other women may have less risk for developing the disease, but are overwhelmed with the stress of abnormal findings, the potential for biopsy and common false-positive results. Women in this category may decide to start screening later and at 2 year intervals. Factors, such as dense breast tissue, having a close relative with breast cancer (before age 50) or having had a previous breast biopsy showing high-risk cells may sway you and your provider to recommend earlier, more frequent or different types of screening. Your screening should always start at least 10 years prior to the age at which a close relative had cancer and if you have more than a 20% chance of developing breast cancer in your lifetime (see links to risk-calculators above), you may consider having breast MRI which can find cancers as early as 1mm in size.
Know your family history. Advancements in genetic testing have removed barriers to care and increased patient access to life-saving information for themselves and their families. We are now looking way beyond the BRCA gene that Angelina Jolie helped to publicize. Newer genetic panels look at over a dozen genes that can affect your risk of breast cancer. Some of these genes may also raise your family’s risk of colon, pancreatic, prostate and other cancers. Men and women should consider genetic testing if they have a close relative with any of the following:
- Breast cancer under the age of 50
- Triple negative breast cancer at any age (This is a very aggressive form of breast cancer that doesn’t respond well to hormone therapy)
- Ovarian cancer at any age
- Three or more people in the family affected by breast cancer, pancreatic or aggressive prostate cancer. (Aggressive prostate cancer and pancreatic cancers can be associated with the BRCA gene)
- Any men in the family with breast cancer
- If you are of Ashkenazi Jewish descent and have even just one family member with breast cancer at any age, you meet criteria for genetic testing. BRCA genes are much more common in the Jewish population.
More about Dr. Ofer: Dr. Adam Ofer is a board-certified obstetrician and gynecologist in private practice in Westport, CT. He is one of the most experienced laparoscopic and da Vinci gynecologic surgeons in the country. Dr. Ofer’s passions include an interest in minimally invasive surgery, vaginal reconstruction and cancer genetics. He lectures throughout the country and is well-published on the importance of precision medicine utilizing family history screening and the most cutting-edge genetic testing. After attending medical school at Syracuse Health Science Center, Dr. Ofer did his residency in OGYN at Lenox Hill Hospital in New York City where he received the Vietta Award of Excellence in surgery. Dr. Ofer has had numerous local and national network TC appearances as an expert physician, including Access Hollywood Live, Today on NBC and Live From The Couch on CBS. Learn more at DrAdamOfer.com