Rick and Becca have two elementary school-aged kids. Becca says her mom was diagnosed with stage 4 breast cancer, meaning it spread beyond the breast and is harder to treat. The emotional toll it took on her is her north star as she navigates her own journey.

Becca was diagnosed with non-invasive breast cancer, and she didn’t discover it with a lump; her annual screening caught it in its early stages.

“We caught it early because I do my mammograms like a good girl,” Becca said.

 

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“Mammograms are our gold standard, and there have been some other suggestions of altering the imaging protocol,” Dr. Sharon Rosenbaum Smith, a breast surgeon at Northwell Lenox Hill Hospital in New York City, tells SurvivorNet.

As part of Becca’s treatment plan, she says she’s looking forward to getting a double mastectomy (also called a bilateral mastectomy) to hopefully reduce her chances of the cancer progressing.

“When we’re treating breast cancer in general, whether it’s your first, second, or third cancer, the goal of surgery is to be able to remove the tumor with clear margins,” Dr. Rosenbaum Smith tells SurvivorNet. “So clear margins are the mainstay of treating breast cancer.”

A clear margin means that when a pathologist examines the tissue removed during surgery, they find no cancer cells at the outer edge. That’s a sign the surgeon removed all visible tumor.

“So once you’ve done a mastectomy, technically there should be no breast tissue there anymore,” she says.

 

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“The reason I already know I’m getting a double mastectomy is because of this little tiny thing in March. Then, I had a biopsy on that little tiny thing, and it came back benign. And this was my follow-up in October to that little tiny thing that I got biopsied; it experienced extensive growth and an abnormally shaped calcification,” Becca explained.

Becca’s also hopeful follow-up MRI imaging tests come back indicating that the surgery will be enough and she can avoid additional treatments such as chemotherapy and/or radiation, which come with troublesome side effects.

A Simple Online Tool Can Flag Higher Risk

Not every woman at elevated risk has a known gene mutation or a mother with breast cancer. To catch those cases, doctors use risk models that weigh several factors at once.

“Now, to add one more layer to it, there are certain risk models out there which we can use to calculate a person’s risk to say if they’re high risk or not,” Dr. Rosenbaum Smith explains. “The one that I typically use is something called the IBIS scale,  otherwise known as the Tyrer-Cuzick Risk Calculator for Breast Cancer Risk Assessment.”

RELATED: Your Breast Density Is Not Static; The Way It Changes Over Time May Reveal Your Breast Cancer Risk

The calculator asks for a handful of details:

• Age
• Breast density
• Any previous breast biopsies
• Height and weight
• Use of hormone replacement therapy
• Family history of breast cancer

“It’s a very simple online program where you put in a couple of risk factors,” she says.

“When you put it into that, it gives you a risk score. If your risk is over 20, you are considered at a higher risk of breast cancer.”

That threshold refers to an estimated lifetime risk of 20% or more. Women who cross it qualify for more intensive screening, usually including annual breast MRI.

“And in those individuals, we are starting screening earlier than the age of 40,” Dr. Rosenbaum Smith says.

“So we generally will start MRIs at the age of 30 if you have an elevated [risk] Breast Imaging Reporting and Data System (BI-RADS) score. So we have tools available to us to help individualize the treatment care for patients.”

The American College of Radiology recommends that every woman have a breast cancer risk assessment by age 25, so that those who need earlier or additional screening are identified in time.

What a Mother’s Diagnosis Means for Family Risk

Having one first-degree relative, such as a mother, sister, or daughter, with breast cancer almost doubles a woman’s risk, according to the American Cancer Society. Two first-degree relatives can triple it.

Age at diagnosis matters too. A relative diagnosed after 60 raises risk less than one diagnosed younger. Up to 10% of breast cancers are thought to be hereditary, caused by gene changes passed down in families, such as BRCA1 and BRCA2.

Although breast cancer can happen to anyone, there are certain factors that can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:

• Older age
• Having a gene mutation such as BRCA1 or BRCA2
• Added exposure to estrogen
• Having children after the age of 30
• Exposure to radiation early in life
• Family history of the disease

Dr. Elizabeth Comen, a breast cancer oncologist at NYU Langone, breaks down factors that may increase your breast cancer risk.

“Some people think that breast cancer is only inherited through genes on the mom’s side, but it can also be related to a genetic mutation that can be found on the father’s side,” Dr. Comen explained.

When to Screen for Breast Cancer

The medical community has a broad consensus that women should have annual mammograms between the ages of 45 and 54. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should now start getting mammograms every other year at the age of 40, suggesting that this lowered age for breast cancer screening could save 19% more lives.

The American Cancer Society recommends getting a mammogram every other year for women 55 and older. However, women in this age group who want added reassurance can still get annual mammograms.

WATCH: When you’re getting a mammogram, ask about dense breasts.

Women with a strong family history of breast cancer, a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before the age of 30, are considered at higher risk for breast cancer.

Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk of developing breast cancer, you should begin screening earlier.

Screening Options for Women with Dense Breasts

Women with dense breasts should get additional screening to supplement their mammograms. Dense breasts mean more fibroglandular tissue, and less fatty breast tissue exists.

The dense tissue has a “masking effect on how well we can perceive cancer and find cancer on mammograms,” Dr. Cindy Ly, Chief of Breast Imaging and Vice Chair of Clinical Research and Faculty Affairs at the Stony Brook Renaissance School of Medicine, told SurvivorNet.

Glandular tissue within dense breasts appears white on mammograms, which can help mask potential cancer. The “frosted glass” effect from the glandular tissue can thus mask cancerous areas, especially developing ones. Undetected, these cancers can progress, growing large and advanced. They will then likely require more intensive treatments to cure, or can become incurable altogether.

WATCH: What is 3D Mammography?

“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Connie Lehman, a diagnostic radiologist who specializes in breast cancer at Massachusetts General Hospital in Boston, explains.

“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.

Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and physician’s guidance. These tests include:

• 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
• Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer, could justify obtaining breast MRIs.
• Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.

The Food and Drug Administration (FDA) now requires facilities offering mammograms to notify patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details to share with the patient to make the communication clear and understandable.

Understanding Your Mammogram Report

A radiologist reading mammograms categorizes breasts into four different categories using the Breast Imaging Reporting and Data System (BI-RADS), a classification system developed by the American College of Radiology (ACR). These include:

• Fatty breast tissue: These breasts are mainly fat with very little dense tissue. Found in less than 10% of women, fatty breasts appear dark on mammograms.
  Scattered fibroglandular breast tissue: These breasts contain a mix of fatty and dense tissue (composed of glands and fibrous tissue). On a mammogram, they have dark areas (fatty tissue) intermixed with light areas (dense tissue). Around 40% of women have breasts that fall in this category.
• Heterogeneously dense breast tissue: This type of breast tissue has many areas of dense tissue and some areas of fat. Found in 40% of women, these breasts look mostly light, with some dark areas on a mammogram.
• Extremely dense breast tissue: Such breasts are almost entirely composed of dense glandular and fibrous connective tissues with very little fat. They are found in 10% of women and appear light on mammograms.

Your breasts are usually called dense on a mammogram report if they fall within the heterogeneously dense breast tissue or the extremely dense breast tissue categories.

How Can I Manage Mammogram Anxiety?

It’s common to feel anxious while awaiting mammogram results. This feeling is often called mammogram anxiety.

If you are awaiting test results and your nerves are running rampant, try doing something that relaxes you, such as exercising or listening to your favorite music. Breathing exercises and meditation can also help you relax.

SurvivorNet has more resources to help you manage your mental health while awaiting test results.

Breast Cancer Symptoms & Self-Exams

Women are encouraged to do regular self-exams to become familiar with how their breasts feel normally, so when something unusual, like a lump, does form, it can be easily detected. A self-exam includes pressing your fingertips along your breast in a circular motion.

For some women, that means going to their doctor and walking through what a self-breast exam looks like, so they know what normal breast tissue feels like; if they do feel something abnormal, whether it’s a lump or discharge from the nipple, they know what to ask and what to look for.

Below are common symptoms to look out for:

• New lump in the breast or underarm (armpit)
• Any change in the size or shape of the breast
• Swelling of all or part of the breast
• Skin dimpling or peeling
• Breast or nipple pain
• Nipple turning inward
• Redness or scaling of the breast or nipple skin
• Nipple discharge (not associated with breastfeeding)

Questions to ask your doctor

• With my family history, when should I start mammograms, and how often?
• Do I have dense breasts, and do I need extra imaging?
• Should I see a genetic counselor?
• If my parent is diagnosed, what support is available for caregivers?

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