With an influx of medical breakthroughs and recent changes to FDA guidelines, it can be difficult to keep up with all the new developments when it comes to breast cancer, especially breast cancer detection and treatment. To help us get our facts straight, Flow Space spoke with Dr. Elizabeth Comen, a medical oncologist specializing in breast cancer at NYU Langone Health and author of All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today, a USA Today bestseller that dispels the myths and misconceptions around women’s health and how these outdated notions continue to impact healthcare today.
At what age should someone get their first mammogram?
For average risk women, we recommend that you start screening at age 40 with a mammogram. Now, how do you determine your risk? That’s something that you can do with your doctor, and there are some online tools, like the breast cancer risk assessment tool.
Ideally, as an oncologist, I would recommend yearly mammograms.
One really important thing to ask when you get your mammogram is if you have dense breasts. If you have dense breasts, you may need additional imaging, such as with an ultrasound or an MRI, and if you have a greater than average risk of breast cancer, you may need to start screening before the age of 40. In general, we start thinking about imaging for breast cancer 10 years before the diagnosis of the mother having had breast cancer.
What’s changed in mammogram imaging?
There’s a lot that’s changed over recent years, including that we are often using what’s called tomosynthesis, or 3D mammograms, which are additional images, as compared to the 2D mammograms that we historically did.
What are dense breasts?
Dense breasts are actually really common. Almost half of women over the age of 40 have dense breasts. And it’s not something that you could see or you can feel; it’s actually something that is determined based on a mammogram, and it has to do with the ratio of fat, which can look black on imaging, to breast tissue, which looks white.
What makes this confusing is a lot of times breast cancer can also look white, so if you have a lot of breast tissue compared to fat in your breast, trying to find a cancer can be complex. That’s why with dense breasts, we sometimes use additional imaging, such as breast ultrasound or breast MRI, to better detect a subtle cancer.
What’s the difference between a mammogram, ultrasound and MRI?
A mammogram is the first step, and it’s like an X-ray, where they flatten your breast and look at it with X-ray technology. Ultrasound does not use X-ray technology, but uses what’s called ultrasound waves. So, it’s a different modality that can pick up different aspects of the cancer that you may not see on a mammogram. An MRI is a different type of technique, which uses magnetic resonance imaging, totally different than a mammogram or breast ultrasound, and sometimes, we use all three to detect breast cancer.
What do we need to know about alcohol and breast cancer?
So in our culture, we often celebrate with alcohol, and that may be OK in some settings, but in many instances, we’ve normalized almost binge drinking. And up to 5% of cancers worldwide, including breast cancer, are attributed to alcohol consumption. Alcohol is a carcinogen.
So, I tell patients, if they want no risk as associated with alcohol, don’t drink at all. But in general, less than three glasses a week is considered a lighter amount of drinking and is less likely to be associated with an increased risk of breast cancer.
How have treatment options changed?
Key important studies have showed that in some instances, for early stage breast cancers, we can actually de-escalate the type of treatment that we give, meaning less chemotherapy, more personalized therapy, and for those patients who are diagnosed with metastatic disease, the treatment landscape has entirely changed to be much more individual and much more specific to the type of cancer that a woman has.
The other part, no matter what stage a woman has been diagnosed with, is that there is far more attention to lifestyle now, quality of life, the things that we can contribute to a patient’s care to help them not only live with their diagnosis, but live better.
So, should we normalize mocktails and mammograms?
I would say that a mocktail after a mammogram is your best option, but if you really want to have that glass of wine and you’ve allotted for it during the week, go for it.