2. I don't have a family history of breast cancer. Why did I get it? "Most commonly, breast cancer is sporadic and most people (85 percent to 90 percent of breast cancer patients) don’t have a family history of breast cancer," said Halaharvi. "It’s a common misconception that it’s inherited through a family history. So regular screenings are very important, regardless of what your family history may be. At OhioHealth, we recommend average-risk women begin screening mammograms at age 40." According to the American Cancer Society, women ages 40 to 44 should start having annual mammograms if they want. Women ages 45 to 54 should get mammograms every year, and women 55 and older should switch to every two years, or can continue yearly screenings.
3. What are the most important risk factors for breast cancer? "A previous history of breast cancer, a significant family history of the disease (particularly when a genetic mutation in BRCA1 or BRCA2 are present), and specific conditions such as atypical hyperplasia and LCIS that are only detected when breast tissue is biopsied and examined microscopically," explained Dr. Freya Schnabel, the director of breast surgery at Perlmutter Cancer Center at NYU Langone. Schnabel noted that these risk factors have different magnitudes, and you should try to discuss with your doctor what makes a family history significant (close relatives, diagnosed at young ages, multiple generations).
4. I am a BRCA carrier. What do I need to know? "BRCA carriers are the highest risk group for breast cancer," stated Schnabel. "BRCA1 carriers are at risk for breast and ovarian cancer — their lifetime risk for breast cancer may be as high as 50 to 85 percent. BRCA2 carriers have a 40- to 60-percent lifetime risk for breast cancer, and are at an increased risk for ovarian cancer, and are also at increased risk for pancreatic cancer." According to Schnabel, BRCA carriers have three options to manage their breast cancer risk: intensive surveillance (to maximize the opportunity for early detection of disease should it occur) chemo-prevention (the use of drugs like tamoxifen to reduce the risk of developing breast cancer) risk-reducing surgery (bilateral mastectomies with reconstruction to lower the risk of breast cancer to as low as we can make it)
5. What can you tell me about the alcohol and breast cancer link? While countless studies support that wine is good for your heart health, you have to weigh these benefits against its link to cancer. "There is good evidence that alcohol increases the risk for breast cancer," Schnabel explained. "Specifically, women who drink at the rate of seven drinks per week have about a 20-percent increase in their risk for breast cancer."
6. My mother was diagnosed with breast cancer at 45, when should I start getting mammograms? "If you have a family history of breast cancer, you should start screening mammograms 10 years prior to your family member getting diagnosed," Halaharvi explained. "So in this case, you’d start at age 35. Again, make sure to talk with your physician and discuss your family history."
7. How quickly do I need to start treatment for my breast cancer? When you're first diagnosed, it may feel like there is pressure on you to decide on a treatment plan right away. But Dr. Lisa Newman, a breast cancer surgery specialist at Henry Ford Health System in Detroit, advises clients to take a beat to process everything and make the right decision for you. "You should not feel that you are 'racing the clock' — the cancer is not spreading or becoming more advanced in your breast or your body by the day," Newman said. "You have the time to make sure that you are properly informed about your cancer diagnosis and treatment options before jumping into something irreversible."
8. Should I get a second opinion? For many women, taking the time to weigh their options means getting more than one medical opinion, or looking into clinical trials or research studies, Newman said. "There is no magic deadline," she stressed. "But a general rule of thumb is that we don’t like to see patients delaying the start of their treatment more than four to six weeks after the diagnosis has been made. The stage and type of breast cancer can influence how quickly the treatment should be initiated."
9. There are so many conflicting reports about breast self-exams, should I be doing them? The American Cancer Society no longer recommends frequent breast self-exams because research has found they don't provide a clear benefit or save women's lives. However, it does stress that women should have self-breast awareness — "be familiar with how their breasts normally look and feel and report any changes to a health care provider right away." "Women should be aware of changes to their breasts such as a palpable mass, skin changes, nipple discharge, skin dimpling, nipple inversion and mass underneath the arms such as enlarged lymph nodes," Halaharvi stressed. "You don’t necessarily need to have a mass to have breast cancer such as inflammatory breast cancer (redness, an orange peel appearance) are seen."
10. How and when should I tell my children? This is one of those answers that is tricky, depending on the ages of your children, but Newman offered this advice: "In general it is best to be as honest with them as possible, because they are likely to sense and/or see that something major is happening, and it is important to provide them with reassurance that you are taking care of yourself," she said. "Very young children may need to also be reassured that cancer is not contagious like the flu, and older children may actually feel empowered if they are allowed to help out and provide support during your treatment. All children need to understand that the cancer diagnosis was not anyone’s fault."
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