Breast Cancer Awareness

I could not let October end month end without writing a post about the importance of Breast Cancer awareness. Even though the Breast cancer awareness month is almost over, this doesn’t mean our awareness needs to be over. I emphasize breast cancer screening to all of my patients all year long, not just in October, as we need to be proactive about our health all year long. After skin cancer, breast cancer is the most common cancer in women in US. The estimated new cases of breast cancer this year is over 300,000. 1 in 8 women will be diagnosed with breast cancer. If you’re a male reading this, please don’t stop reading. 1 in 1000 men will be diagnosed with breast cancer (everyone is born with breast cells and breast tissue). About 65% of breast cancer cases are diagnosed while they are still inside the breast. We now have such advanced therapies that the survival rate, when caught at this stage, is 99%. This is why screening is so important! There are more than 3.2 million breast cancer survivors in our country. Let’s continue to increase this number.

Screening refers to detection before a symptom arises. We screen using mammograms, which are X-ray pictures of the breasts, and they use a small amount of radiation. In mammograms the breasts are flattened between two plates for imaging from the front and side views. This produces the 2D mammograms. Nowadays 3D view is available at most imaging centers, and the technology used produces a three dimensional view that allows a more clear view of the breast tissue.

For a woman with average risk of breast cancer, regular screening decreases mortality from breast cancer. However starting screening too early also can have some risks. This can cause unnecessary biopsies due to false positives or detection of some lesions that would never activate (e.g. over-diagnosis and treatment) as well as anxiety and distress. Due to how this benefit to risk ratio can change with varying age and medical history , guidelines of different professional medical societies also vary. USPSTF (U.S. Preventive Services Task Force) and American college of physicians recommend screening mammography of every two years for women aged 50 to 74 years old whereas for ages 40-49 years, only if recommended by their physician after a discussion due to increased risk and limited benefits. Whereas ACOG (American College of Obstetricians and Gynecologists) and American cancer society recommend offering it at age 40 if patient wishes after the discussion, with the American cancer society recommending to go ahead start yearly at age 45 at the latest.

Do not let that difference scare you. This is why it is important to have an appointment with your primary care doctor (if not, then at least an ob/gyn physician) who knows you well or will spend ample time to learn about your risks, and weight those factors to discuss your risk level and the benefits and risks of screening at that time.


Factors that can increase your risk from average to high risk for breast cancer include:

  • Personal history of breast cancer or previous breast biopsies with concerning findings
  • Having close family members who were diagnosed with breast or ovarian cancer. Especially if they were diagnosed at a young age, 45 or younger
  • Having BRCA 1 and BRCA 2 genes that put you for increased risk for breast and ovarian cancer
  • You have a first degree (parents, brothers, sisters, children) family member with positive BRCA 1 and BRCA 2 gene but you have not been tested for it.
  • Exposure to high dose chest irradiation at young age (10-30yo)


Other risk factors for breast cancer

There is a lot past medical, family, and social history that make up some of the risk factors. In addition to aforementioned factors above, these also include family history of other cancers such as prostate and pancreatic cancer, age, female gender, early menarche, late menopause, nulliparity (no pregnancy), hormone therapy, lack of breastfeeding, higher BMI, smoking, alcohol consumption, dense breasts on mammography, ethnicity (increased risk in Ashkenazi Jewish descent).


Modifying other risk factors Although there is a strong genetic component to it, there are also significant environmental risk factors that you can change:

  • Smoking – please quit. There’s nothing good that smoking does for you. It increases the risks for all types of cancers.
  • Alcohol – Do not drink more than one alcoholic drink a day. However if you do not drink any alcohol beverages, then don’t start consuming a daily drink either. It’s been clearly shown that while a drink a day increases breast cancer by 10%, two to three drinks a day increases by 20%.
  • Excess body weight, poor nutrition, physical inactivity – Staying at a healthy weight and increasing exercise can help decrease risk
  • Breastfeed – Are you having a baby? Congratulations. Please breastfeed! This decreases risk.
  • Reduce exposure to carcinogens and when possible, radiation from unnecessary diagnostic tests.
  • Reduce (if not eliminate) the intake of dairy and meats. You won’t see this last one on many health organizations’ websites due to powerful lobbyists.


Routine self-breast exams aren’t recommended any more in average risk women. However, what is highly emphasized is breast self-awareness. Whereas breast self exam is when someone inspects their breasts regularly and repetitively to detect breast cancer, breast self-awareness is one’s awareness of what’s normal for them- the normal appearance and feeling of their breasts. It refers to and emphasizes a women being attuned to any deviations from their normal. Definitely let doctor know whenever there’s mass or pain, redness or nipple discharge, lump in armpit, change in size or swelling in breast.


Go to a yearly physical exam with your primary care doctor. I wouldn’t recommend for you to make this quick 10 minute visit you schedule at an urgent care to get a box checked and blood and urine tested for the paperwork for your employer. Discussing benefits and risks based on your medical history with your physician and their recommendations based on this will allow you to make an informed decision.


Take care and have a great day!

Dr. Efe Sahinoglu

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Dr. Efe Sahinoglu, M.D.

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