Predicting your chance for developing breast cancer seems futuristic, but for some women, the future is now and it’s lifesaving. For a select group of breast cancer patients, the cause can be traced to inherited genetic mutation called the BRCA 1 and 2 (pronounced “bra-ca”). Knowing whether you’re at risk for having the mutation can help you and your physician create a prevention strategy specifically for you.

“Everyone has the BRCA genes, but not everyone carries the harmful mutation that increases the risk for breast and ovarian cancers,” explains Donald Sweet, Medical Director of Cancer Services on staff at Adventist Bolingbrook Hospital. Men can also have this mutation. For them, it means an increased risk for colon and prostate cancer, as well as an increase in the risk for breast cancer.

Since genetically determined breast cancer is relatively rare, most women won’t need to worry about whether they are carriers of the BRCA mutation. But, according to Dr. Sweet, there are some factors to be aware of:

• Having a mother or sister who was diagnosed with breast or ovarian cancer before age 50.
• Having Ashkenazi (Eastern European) Jewish heritage.
• Having family members who had more than one cancer develop at the same time.

If one or both of your parents carried the BRCA mutation, chances are higher that you inherited it as well. However, having the mutation doesn’t mean you will definitely develop breast cancer.

Genetic counseling helps determine your risk for breast cancer
Talking to a genetic counselor – a health care professional trained in genetics and cancer – if you meet one or more of the criteria for carrying the BRCA mutation can help you understand your risk and your options.

“During genetic counseling, we go into great detail about your family history on your mother and father’s side, especially where breast and ovarian cancers are concerned,” says Dr. Sweet. “Gathering that information allows us to calculate your risk for having the genetic mutation.”

If your genetic counselor thinks your risk is 10 percent or more, a blood test may be ordered to pinpoint whether you are carrying the BRCA mutation. Then, if you do have the BRCA mutation, your doctor will explain your personal risk for breast and ovarian cancers.

Once your risk has been assessed you have a few options:
• Monitoring your breast tissue using mammography or MRI.
• Drug therapy (also called chemoprevention) with drugs like tamoxifen.
• Prophylactic mastectomy (removal of the breasts as a preventive measure).

“Even though a woman may have up to a 50 percent risk of developing breast cancer, there is still a chance she may never develop it. That’s why we take time to talk to women about options and make sure they’re making an informed decision about prevention,” says Dr. Sweet.

What’s best for you depends on your stress level, whether you can handle the emotional impact of mastectomy and your ability to cope with uncertainty. “It’s not at all easy to find out you’re at a higher risk for cancer,” Dr. Sweet says. “I always recommend genetic counseling before genetic testing. If counseling shows you’re only at a 2 percent higher risk, you may not want to go through genetic testing.”

What every woman can do to decrease her breast cancer risk
“A family history doesn’t always mean you’re going to be BRCA positive,” cautions Dr. Sweet. Because 11–12 percent of all women will develop breast cancer, there’s a chance of developing the disease regardless of whether you have a genetic predisposition.

All women can help reduce their risk for breast cancer by:
• Eating a low-fat diet.
• Getting 30 minutes of exercise 3-5 days per week
• Maintaining a healthy weight.
• Avoiding hormone replacement therapy.
• Getting regular mammograms starting at age 40.

If you think you might be at risk for carrying the BRCA mutation, talk with a qualified genetic counselor like the kind on staff with Adventist Midwest Health. “We help put your risk in perspective and help you make the decision that’s right for you,” says Dr. Sweet.  

Source: Keeping Chicago Well. (September 2011). Deep Links: Understanding Genetics and Breast Cancer. Retrieved from: http://keepingchicagowell.com/articles/deep-links-understanding-genetics-and-breast-cancer-0

Why Breast Self-Exams Still Matter (with Dr. Schneiderman)

A no-cost, low-risk method to detect breast cancer may seem too good to be true, but there really is such a method: monthly self-exams. You may have heard the debate over the effectiveness of self-exams, but the fact is up to 20 percent of women with breast cancer identified their own lump using this method.

“Being familiar with your breast makes it easier for you to notice when something is out of the ordinary, helping you detect early stage breast cancer,” says Elyse Schneiderman, MD, Hematologist and Medical Oncologist on staff at Adventist Hinsdale Hospital.  “It’s very common to feel some lumps when you do your exam; the key is to recognize what’s normal and what’s changed.”

Breast self-exams for every stage of your life
Starting monthly self-exams in your 20s will familiarize you with how your breasts look and feel. As you age, these exams will help you recognize natural changes in your breast tissue. It’s never too late to start, especially if you won’t be getting your first mammogram until you turn 40.

Make the most of your self-exam by following Dr. Schneiderman’s tips:

• In your 20s, 30s and 40s: Perform your self-exam about a week after your period. “The week prior to your period causes swelling and tenderness in the breast which can change the feel of the exam. Waiting until the week after your period is over makes the exam more accurate,” Dr. Schneiderman explains.

• If you’ve gone through menopause: Perform your exam any time during the month, but be consistent.  “Pick a time of the month that’s easy for you to remember,” suggests Dr. Schneiderman.

• If you’re pregnant or breastfeeding: It’s more difficult to perform self-exams because your breasts are changing. This makes the exam more difficult to interpret because the normal landmarks are altered. “Breast cancer is rare in women of childbearing age, but if you’re concerned about anything, don’t hesitate to talk with your doctor,” says Dr. Schneiderman.

• If you have breast implants: Breast tissue may be obscured by your implants, but self-exams are still beneficial. “Lumps may be harder to feel, but it can be done,” Dr. Schneiderman says. “Women with breast implants should also pay close attention to changes in skin color and breast symmetry.”

When a lump is more than a lump
Since most breast tissue is naturally a little lumpy, knowing what to look for can save you some stress when performing your self-exam. If you notice any of the following conditions during your self-exam, it could be cause for concern:

• Hard or gritty feeling mass(es).
• Thick areas of tissue that don’t go away or seem to be growing.
• Inversion of the nipple (if that is atypical for your breast).
• Asymmetry in a way that is unusual for your breasts.
• Dimpling under the skin.
• Red skin or a rash, especially if it feels hot. (See a physician for an evaluation right away. This could be a symptom of a rare type of breast cancer).

“If you find something unusual during a self-exam and you are not sure what it is or it seems to have gotten worse during your next monthly self-exam, get evaluated by a physician,” urges Dr. Schneiderman.

Even if you’re getting mammograms or a yearly clinical exam by your physician, breast self-exams are a simple way to play an active role in your own breast health. After all, “A mammogram or doctor only examines your breasts once a year,” says Dr. Schneiderman. “You’re in a position to notice small changes from month to month and be an advocate for yourself.”

You don’t have to wait to get screened for breast cancer. Call 630-856-7061 today to schedule your next-day mammogram through Adventist Midwest Health.

The Self Breast-Exam
Step-By-Step

Source: Keeping Chicago Well. (September 2011). Why Breast Self-Exams Still Matter. Retrieved from: http://keepingchicagowell.com/library/breast-cancer/why-breast-self-exams-still-matter