Before the end of 2014, the American Cancer Society expects there to be more than 232,500 new cases of invasive breast cancer diagnosed among women in the US.
1 in 8 women are diagnosed with breast cancer in the United States.
Your breast health matters and so does choosing the right team for your breast health care.
We’ll talk about the risks of breast cancer and the steps women can take to reduce them. We’ll also cover the importance of annual screening mammograms and discuss the expertise comprehensive breast centers, like Piper Breast Center, can offer.
Your Breast Health
Featured Speaker:
Dawn Johnson, MD - General Surgery
Dawn Johnson, MD, is the medical director of the Virginia Piper Breast Center, part of the Virginia Piper Cancer Institute, and breast surgeon with Surgical Specialists of Minnesota. She has practiced in the Twin Cities for the past 16 years, specializing in breast surgery. Transcription:
Your Breast Health
Melanie Cole (Host): The average woman has a 1 in 8 chance of getting breast cancer during her lifetime. Fortunately, fewer women are dying from breast cancer, and this is mostly due to improved breast cancer prevention and detection. My guest today is Dr. Dawn Johnson. She is the medical director of the Virginia Piper Breast Center, part of the Virginia Piper Cancer Institute. Welcome to the show, Dr. Johnson. Tell us first what are the risks of breast cancer.
Dr. Dawn Johnson (Guest): The factors that place a woman at higher than average risk include a distant family history, such as a grandmother, aunt, or cousin with breast cancer, those women that have had a previous breast biopsy, even though it may have been benign. In addition, women who have children at age 35 or older are at increased risk, which is really not that uncommon nowadays, and onset of their menstrual cycles at age younger than 12 as well as menopause older than age 55. In addition, no pregnancies is also a risk factor for breast cancer. Now, those factors that actually place a woman at the highest risk include women who are BRCA gene carriers; women who have a family history of a first-degree relative, such as a mother or a sister; and women who have had previous radiation exposure, possibly for other cancers that were treated with radiation to the chest. In addition, women who have had a previous breast cancer, increased risk, or women who have lobular carcinoma in situ, which is actually a risk factor for breast cancer. These risk factors are really not preventable.
Melanie: Dr. Johnson, what can a woman do to reduce her risk of breast cancer? Are there some of these risks that are preventable and controllable?
Dr. Johnson: There are, Melanie. The preventable or the controllable factors include obesity. This really applies to women who are consistently obese throughout their life or those women who actively gained 60 pounds from the age of 18 to age 50. Studies show that the average woman should really only gain 19 pounds in that time interval. The common denominator that links obesity to breast cancer is insulin resistance that develops with obesity. Basically, we recommend a healthy lifestyle, exercising, and maintaining a healthy weight. Now, another risk factor is alcohol consumption. Studies have shown that one alcoholic beverage—and it doesn’t matter what type of beverage; it could be a beer, hard alcohol, wine—but one alcoholic beverage a day, up to age 70, increases the risk of breast cancer by about 7 percent. Now, another modifiable risk factor is breastfeeding. If a woman breastfeeds, she will lower her risk for developing breast cancer in the future. In addition, we know that hormone replacement therapy has also been correlated with the risk of breast cancer. What we really don’t know, though, is the degree of magnitude of that correlation. Studies have actually shown that the risk does dissipate or go away after five years of discontinuing the hormone replacement therapy. We encourage women to know your risks and to actually consider consultation in our Piper High-Risk Clinic to quantify that risk and determine if high-risk surveillance is warranted. We actually have specific mammograms or models that will take into consideration all of these risk factors, and it will compute a 5-year and lifetime risk of breast cancer. Women who have a lifetime risk of 20 percent or higher qualify for high-risk screening program. At our high-risk consultation, we also will have you meet with one of our genetic counselors for a comprehensive review of your family history to determine if genetic testing is warranted as well.
Melanie: There’s been a lot in the media, Dr. Johnson, about the best ways to detect the breast cancer early, about when you should have a mammogram, if you should be having them on a regular basis. Speak about the best ways to detect breast cancer, and also get into a little bit of the controversy about mammograms, the age and the frequency of them.
Dr. Johnson: Sure. We recommend that the annual screening mammogram should start at age 40, and I actually recommend consideration for tomosynthesis or the new 3-D mammography, which we have available at the Piper Breast Center. It actually increases the cancer detection rate and it results in fewer call-backs for additional imaging. In addition, the breast MRI is also available for women with very dense breasts and those who are at high risk for breast cancer. In addition to those mammograms, we encourage breast self-exam to start at age 20. Women need to be aware that not all palpable masses are seen or detected are on screening mammogram, particularly if you have dense breasts. The density of that mass actually blends into the normal surrounding breast tissue on the mammogram. Even if a woman feels a palpable mass and if it’s not seen on mammogram, they need to bring it to the attention of a physician because we will proceed with other imaging tests to further evaluate that. The media has talked about whether these mammograms should start at age 40. I really do believe that those recommendations that are set forth by the American Cancer Society and American College of Surgeons still recommend that we start at age 40 because what we know is that 40,000 women die from breast cancer each year, and 18 percent of those women were actually diagnosed in their 40s. Mammogram screening is associated with a 19 percent overall reduction of breast cancer mortality, which is approximately 15 percent for women in their 40s. But there is a dramatic increase to 32 percent for women in their 60s. Although some would argue the statistics and would actually counter with the fact that there is a high false positive rate—meaning that women in her 40s to 50s have annual mammograms, let’s say, for 10 years, will get called back for more testing for a benign finding in about 61 percent of the cases—some would actually consider that to be a harm to the patient. As I’m actually aware, the United States Preventative Task Force came out with their recommendations about the mammograms beginning at age 50 and happening every two years. Well, in their thought process, they felt that it was actually a harm to the patient to be called back. I think the bottom line is that every woman needs to have their baseline breast cancer risk assessed, and they have to really incorporate that risk into their screening decision. In addition, I think that women really need to be aware of the signs and symptoms of breast cancer. Symptoms such as a palpable thickening or mass that persists through a menstrual cycle should raise concern. In addition, any change in the breast size or shape, possible nipple discharge, and skin changes such as redness or scaling or peeling of the nipple, should all be brought to the attention of a woman’s primary care physician or breast surgeon. Many young women actually present with a palpable mass, and we do see women in 20s with breast cancer. Now, that being said, most young women will have a benign breast tumor, but it will still require a workup, diagnosis, and possible excision. Any of these signs or symptoms warrant a consultation at the Piper Breast Center, and our cancer network guidelines also recommend that clinician breast exams should be done every three years for women in their 20s to 30s and every year for women who are 40 years of age or older.
Melanie: Since you brought up a comprehensive breast center, Dr. Johnson, what is that?
Dr. Johnson: It is a team of healthcare professionals who specialize in breast health. This team includes -- I’m going to list this because it is really a lot of people working together for the patient. It includes breast surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, cancer rehab physicians, and lymphedema therapists, physical therapists. It also includes plastic surgeons, genetic counselors, and cancer care coordinators, who are those people who actually provide the support and the help to navigate patient through this system. In addition, it also includes the healing coaches and the Penny George Institute for Health and Healing, which can offer alternative therapies that actually complement the practice of medicine. We are all working together to bring the best possible care for the patient.
Melanie: Well, it sounds like a very multidisciplinary approach. Wonderful way to get care. Why should a woman consider a comprehensive breast center like Piper Breast Center for their breast healthcare?
Dr. Johnson: Well, we provide all of these specialists in one location. Again, we’re working together as a team with the patient to bring that individual the best possible care. For example, if the patient presents with a palpable lump, she would see the breast surgeon. I would order the appropriate imaging, which we would actually get then that day. Then the patient will have a discussion with both myself and the radiologist regarding the findings and potential image-guided biopsy that day. It’s sort of all-inclusive. Everything can get evaluated in one place, and nothing tends to fall through the cracks, and we make sure that we’ve covered all of our bases. The Virginia Piper Breast Center is really for any man or woman with breast concern. It’s not just to diagnose cancer. Anyone who wishes to have a risk assessment, discuss concerns regarding breast pain, or palpable findings are welcome.
Melanie: Thank you so much, Dr. Dawn Johnson. For more information, you can go to allinahealth.org. That’s allinahealth.org. You’re listening to the WELLcast by Allina Health. This is Melanie Cole. Have a great day.
Your Breast Health
Melanie Cole (Host): The average woman has a 1 in 8 chance of getting breast cancer during her lifetime. Fortunately, fewer women are dying from breast cancer, and this is mostly due to improved breast cancer prevention and detection. My guest today is Dr. Dawn Johnson. She is the medical director of the Virginia Piper Breast Center, part of the Virginia Piper Cancer Institute. Welcome to the show, Dr. Johnson. Tell us first what are the risks of breast cancer.
Dr. Dawn Johnson (Guest): The factors that place a woman at higher than average risk include a distant family history, such as a grandmother, aunt, or cousin with breast cancer, those women that have had a previous breast biopsy, even though it may have been benign. In addition, women who have children at age 35 or older are at increased risk, which is really not that uncommon nowadays, and onset of their menstrual cycles at age younger than 12 as well as menopause older than age 55. In addition, no pregnancies is also a risk factor for breast cancer. Now, those factors that actually place a woman at the highest risk include women who are BRCA gene carriers; women who have a family history of a first-degree relative, such as a mother or a sister; and women who have had previous radiation exposure, possibly for other cancers that were treated with radiation to the chest. In addition, women who have had a previous breast cancer, increased risk, or women who have lobular carcinoma in situ, which is actually a risk factor for breast cancer. These risk factors are really not preventable.
Melanie: Dr. Johnson, what can a woman do to reduce her risk of breast cancer? Are there some of these risks that are preventable and controllable?
Dr. Johnson: There are, Melanie. The preventable or the controllable factors include obesity. This really applies to women who are consistently obese throughout their life or those women who actively gained 60 pounds from the age of 18 to age 50. Studies show that the average woman should really only gain 19 pounds in that time interval. The common denominator that links obesity to breast cancer is insulin resistance that develops with obesity. Basically, we recommend a healthy lifestyle, exercising, and maintaining a healthy weight. Now, another risk factor is alcohol consumption. Studies have shown that one alcoholic beverage—and it doesn’t matter what type of beverage; it could be a beer, hard alcohol, wine—but one alcoholic beverage a day, up to age 70, increases the risk of breast cancer by about 7 percent. Now, another modifiable risk factor is breastfeeding. If a woman breastfeeds, she will lower her risk for developing breast cancer in the future. In addition, we know that hormone replacement therapy has also been correlated with the risk of breast cancer. What we really don’t know, though, is the degree of magnitude of that correlation. Studies have actually shown that the risk does dissipate or go away after five years of discontinuing the hormone replacement therapy. We encourage women to know your risks and to actually consider consultation in our Piper High-Risk Clinic to quantify that risk and determine if high-risk surveillance is warranted. We actually have specific mammograms or models that will take into consideration all of these risk factors, and it will compute a 5-year and lifetime risk of breast cancer. Women who have a lifetime risk of 20 percent or higher qualify for high-risk screening program. At our high-risk consultation, we also will have you meet with one of our genetic counselors for a comprehensive review of your family history to determine if genetic testing is warranted as well.
Melanie: There’s been a lot in the media, Dr. Johnson, about the best ways to detect the breast cancer early, about when you should have a mammogram, if you should be having them on a regular basis. Speak about the best ways to detect breast cancer, and also get into a little bit of the controversy about mammograms, the age and the frequency of them.
Dr. Johnson: Sure. We recommend that the annual screening mammogram should start at age 40, and I actually recommend consideration for tomosynthesis or the new 3-D mammography, which we have available at the Piper Breast Center. It actually increases the cancer detection rate and it results in fewer call-backs for additional imaging. In addition, the breast MRI is also available for women with very dense breasts and those who are at high risk for breast cancer. In addition to those mammograms, we encourage breast self-exam to start at age 20. Women need to be aware that not all palpable masses are seen or detected are on screening mammogram, particularly if you have dense breasts. The density of that mass actually blends into the normal surrounding breast tissue on the mammogram. Even if a woman feels a palpable mass and if it’s not seen on mammogram, they need to bring it to the attention of a physician because we will proceed with other imaging tests to further evaluate that. The media has talked about whether these mammograms should start at age 40. I really do believe that those recommendations that are set forth by the American Cancer Society and American College of Surgeons still recommend that we start at age 40 because what we know is that 40,000 women die from breast cancer each year, and 18 percent of those women were actually diagnosed in their 40s. Mammogram screening is associated with a 19 percent overall reduction of breast cancer mortality, which is approximately 15 percent for women in their 40s. But there is a dramatic increase to 32 percent for women in their 60s. Although some would argue the statistics and would actually counter with the fact that there is a high false positive rate—meaning that women in her 40s to 50s have annual mammograms, let’s say, for 10 years, will get called back for more testing for a benign finding in about 61 percent of the cases—some would actually consider that to be a harm to the patient. As I’m actually aware, the United States Preventative Task Force came out with their recommendations about the mammograms beginning at age 50 and happening every two years. Well, in their thought process, they felt that it was actually a harm to the patient to be called back. I think the bottom line is that every woman needs to have their baseline breast cancer risk assessed, and they have to really incorporate that risk into their screening decision. In addition, I think that women really need to be aware of the signs and symptoms of breast cancer. Symptoms such as a palpable thickening or mass that persists through a menstrual cycle should raise concern. In addition, any change in the breast size or shape, possible nipple discharge, and skin changes such as redness or scaling or peeling of the nipple, should all be brought to the attention of a woman’s primary care physician or breast surgeon. Many young women actually present with a palpable mass, and we do see women in 20s with breast cancer. Now, that being said, most young women will have a benign breast tumor, but it will still require a workup, diagnosis, and possible excision. Any of these signs or symptoms warrant a consultation at the Piper Breast Center, and our cancer network guidelines also recommend that clinician breast exams should be done every three years for women in their 20s to 30s and every year for women who are 40 years of age or older.
Melanie: Since you brought up a comprehensive breast center, Dr. Johnson, what is that?
Dr. Johnson: It is a team of healthcare professionals who specialize in breast health. This team includes -- I’m going to list this because it is really a lot of people working together for the patient. It includes breast surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, cancer rehab physicians, and lymphedema therapists, physical therapists. It also includes plastic surgeons, genetic counselors, and cancer care coordinators, who are those people who actually provide the support and the help to navigate patient through this system. In addition, it also includes the healing coaches and the Penny George Institute for Health and Healing, which can offer alternative therapies that actually complement the practice of medicine. We are all working together to bring the best possible care for the patient.
Melanie: Well, it sounds like a very multidisciplinary approach. Wonderful way to get care. Why should a woman consider a comprehensive breast center like Piper Breast Center for their breast healthcare?
Dr. Johnson: Well, we provide all of these specialists in one location. Again, we’re working together as a team with the patient to bring that individual the best possible care. For example, if the patient presents with a palpable lump, she would see the breast surgeon. I would order the appropriate imaging, which we would actually get then that day. Then the patient will have a discussion with both myself and the radiologist regarding the findings and potential image-guided biopsy that day. It’s sort of all-inclusive. Everything can get evaluated in one place, and nothing tends to fall through the cracks, and we make sure that we’ve covered all of our bases. The Virginia Piper Breast Center is really for any man or woman with breast concern. It’s not just to diagnose cancer. Anyone who wishes to have a risk assessment, discuss concerns regarding breast pain, or palpable findings are welcome.
Melanie: Thank you so much, Dr. Dawn Johnson. For more information, you can go to allinahealth.org. That’s allinahealth.org. You’re listening to the WELLcast by Allina Health. This is Melanie Cole. Have a great day.