Women at Higher Risk of Breast Cancer
Women at Higher Risk of Breast Cancer
Estimating breast cancer risk can be complex. Your physician, genetic counselor and other specialized health care providers in the risk assessment program at the Northwestern Medicine Gavers Breast Center will use several tools to determine your individual risk.
Before you pursue any type of treatment aimed at reducing risk, it is essential that you have an accurate estimate of your breast cancer risk, as well as a complete understanding of the implications of any treatments. Genetic counseling can provide that vital information and help you navigate whether genetic testing will be useful in your unique situation.
It is important to remember that even though you may have a higher-than-average risk, this does not mean you will develop cancer.
Breast cancer screening in higher-risk women typically involves:
- Annual digital mammograms beginning five to 10 years before the age of the youngest affected first-degree relative (mother, sister, daughter) or by age 40, whichever comes first
- Clinical breast examinations twice a year by a qualified health care provider
- Monthly self-breast exams
In addition to the above screenings, some women who have a higher-than-average risk may benefit from a screening breast MRI or, depending upon breast density, 3-D mammography, which is also known as tomosynthesis.
Breast examinations, regular mammograms and MRIs increase the chance of finding breast cancer before it spreads. If breast cancer is found by mammogram or MRI before it can be felt by physical examination, it is more likely to be successfully treated than a lump that is large enough to be felt.
Risk-reducing treatment options
In addition to taking measures to detect and treat breast cancer early, some women at high risk for developing breast cancer choose to take additional steps to reduce their risk. A woman must decide for herself whether taking a medication or having surgery is worthwhile. This decision may be influenced by a woman’s estimated risk, her perception of the level of her cancer risk, her experiences with cancer in herself or loved ones, her personal philosophy of life and her lifestyle.
- Medication: Using medication to prevent the development of cancer is called chemoprevention. Certain medications approved by the U.S. Food and Drug Administration are used to reduce breast cancer in women at high risk for developing the disease. Chemoprevention has been shown to lower the risk of breast cancer by about 50 percent in women who have never had breast cancer. The medication is taken for five years but can have possible side effects so the choice to take one of these medications should be discussed in detail with your oncologist.
- Surgical options: Using surgery to reduce your risk of breast cancer is elective, and there are no precise guidelines defining who should have surgery. A number of factors — medical and personal — are taken into consideration. A surgeon will help you decide if risk-reducing surgery is right for you.
- Prophylactic Mastectomy: Risk-reducing mastectomy, also known as prophylactic mastectomy, is the surgical removal of both breasts to reduce the risk of breast cancer in women who are at higher risk for developing the disease. Research studies show that prophylactic mastectomy of both breasts may lower the risk of breast cancer by 90 percent.
A prophylactic mastectomy alone often requires up to a two-night stay in the hospital. The procedure takes two to four hours. If you also would choose breast reconstruction, the procedure usually takes three to six hours and a longer hospital stay depending on the type of reconstruction performed. Your breast and plastic surgeons will explain how to prepare for surgery and how to care for yourself after surgery.
This is a safe surgery, and most women recover well with no complications. However, as with any other surgery, complications can occur. Mammograms are no longer needed after prophylactic mastectomy but examination of the chest wall by a physician would need to be done annually. If reconstruction involved placement of breast implants, MRIs of the breast are typically performed three years post-surgery to evaluate breast implant integrity.
- Prophylactic Oophorectomy: Another surgical option available to higher risk women is removal of the ovaries or oophorectomy. Prophylactic oophorectomy decreases breast cancer risk by about 50 percent in high-risk women if done before menopause. If a woman is also at risk for ovarian cancer, risk-reducing oophorectomy can decrease the risk of developing ovarian cancer by up to 90 percent. Sometimes, prophylactic oophorectomy can be done concurrently with prophylactic mastectomy to minimize the number of anesthetics and recovery time.
In premenopausal women, removing the ovaries significantly reduces the amount of estrogen and progesterone their body produces. Removal of the ovaries does induce some side effects that should be taken into consideration. In premenopausal women, oophorectomy causes premature menopause. A physician can help with the management of these symptoms.