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Feature
Breast Cancer Awareness Month
OBy Maureen L. Beurskens, MD benefits and harms attributable to mammography.
ctober (breast cancer awareness The American College of Obstetricians and Gynecologists
month) is upon us. For some, 2020
has flown by, but for most of us it 2017 Practice Bulletin on Breast Cancer Risk Assessment
has been a slow journey through and Screening in Average Risk Women emphasizes shared
uncharted territory. If it has been difficult decision-making between a patient and her provider. The
for us as physicians and providers, it has
been even tougher for many of our patients. recommendations for women at average
During the stay-at-home order, patients were risk for breast cancer include: clinical
being seen only for emergent issues, but now breast exam offered every one to three
patients can be seen for well visits.
years for women ages 25-39 and
More than in previous years, when I see yearly after age 40; and screening
patients for their annual exams now, mammograms offered at 40, but
I try to address all concerns they have, as started no later than 50 if not
well as encourage them to keep up with
screening tests that have been shown to For some, 2020 has flown by,
be beneficial. Annual exams provide us but for most of us it has
with an opportunity to reassess personal
and family history and identify women been a slow journey through
who may be at higher risk for breast uncharted territory. If it has been
cancer, as well as to refer those patients who may benefit difficult for us as physicians and
from genetic testing for genetic counseling. By identifying providers, it has been even tougher
women at highest risk for breast cancer, we can offer more
intense screening and recommend chemo-preventive therapy for many of our patients.
when appropriate.
already initiated. Mammogram screening should be annual or
Breast cancer is the most common type of cancer in women. biennial, and mammograms should be continued until age 75,
It is the second leading cause of cancer deaths among women. although the decision to discontinue screening should be based
Fortunately, breast cancer mortality rates have decreased on a shared decision-making discussion of a woman’s health and
over the past 50 years. The overall five-year survival rate for anticipated longevity.
women diagnosed with breast cancer is now at about 90 percent
compared to 75 percent in 1975. The reduction in breast cancer Emphasizing screening for breast cancer is part of promoting
mortality is attributable to early detection and improvements in overall health and wellness. There are various reasons a patient
breast cancer treatment. may have for being reluctant to have a mammogram. When
concerns are addressed openly, a patient is more likely to return
The primary risk factors for breast cancer are female sex and and provide us with another chance to encourage screening.
increasing age. Other breast cancer risk factors include: family
history of breast or ovarian cancer or other breast and ovarian We are fortunate to have a number of active nonprofit
cancer syndrome, known deleterious gene mutation carriership organizations in the Charlotte area that work to support women
(such as BRCA1 and BRCA2), prior breast biopsy positive for who have been diagnosed with breast cancer or work to advance
atypical ductal or lobular hyperplasia, early menarche, late research, treatment and prevention of breast cancer. Those
menopause, long interval between menarche and first birth, organizations include Susan G. Komen Charlotte, the American
nulliparity, postmenopausal hormone therapy with estrogen Cancer Society, Carolina Breast Friends, Pretty in Pink Foundation
and progesterone (decreased risk with estrogen only), certain and Nothing Pink. There also are support groups through our
ethnicities, high body mass index, smoking, high alcohol intake, hospital systems.
dense breasts on mammogram and prior therapeutic chest radiation
for Hodgkin lymphoma in young women (ages 10-30). Our area mammography providers are following all the
guidelines known to reduce the spread of COVID-19. For our
There are some differences among professional societies in the patients who are due or overdue for their screenings, we can
recommendations for when to start screening mammograms in promote the fact that they may get their mammograms safely.
average-risk women, how often women should get mammograms
and when screening should stop. Most of these differences in
recommendations are based on variable interpretations of the
8 | October 2020 • Mecklenburg Medicine
