Susan Uhle, CNP Richmond Surgical Henrico Doctors' Hospital |
Early detection is currently the cornerstone of the
arsenal in the war against Breast Cancer.
This is accomplished through annual Mammographic Screening, and, at
times, other imaging methods such as Ultrasound and Breast Magnetic Resonance
Imaging (MRI). Combined with genetic screening, we look to identify signs of
the disease early and improve the chances for a favorable patient outcome.
Screenings and tests tell us many things about a
patient’s overall risk, and findings from Mammography can lead to Needle
Biopsy, where results can range from benign, to benign but abnormal, to
cancer. These results dictate the next
action, which may include surgery or closer surveillance. The results also allow us to better stratify
individual risks, and determine next steps for investigation or treatment.
There are many paths that further tests and detection can
take. As an example, Christina undergoes a Screening Mammogram, leading to a
Needle Biopsy; results show Atypical Ductal Hyperplasia (ADH), which is a
benign lesion of the breast that indicates an increased risk of Breast Cancer. Her risk of developing cancer is now known to
be four times that of a woman her age without those findings. There are certain measures she can take to
decrease that risk, including lifestyle modification, surveillance, and
chemoprevention (the use of natural, synthetic, or biologic substances to
reverse, or prevent the development of cancer).
Family history plays a significant role in incidence of
Breast Cancer, and there are individuals with a personal or family history, who
should be further evaluated at the time of Mammography or during the office
visit. We know that a family history in
a first degree relative (mother, sister, or daughter) confers an increased risk
for development of Breast Cancer.
There are many available options to pursue if unfavorable
results are found after Mammography or other screening activities. If we find
that there is a malignant tumor, and the Breast Cancer was one of several types
(early onset, two separate Breast Cancers, Male Breast Cancer, Ovarian Cancer,
Multi-Generational), we would consider whether there is an inherited mutation
in the family. Although this is present in only 5 to 10% of individuals, the
Breast and Ovarian Cancer risk is as high as 87% and 44%, respectively, in the
patient’s lifetime, depending on many factors.
Fortunately, there are many options for treatment and
future preventive activity. Preventive Mastectomy and removal of ovaries is the
choice of many, but not all, women. This reduces the risk of Breast and Ovarian
Cancer, but not to zero. This prevention, one form of risk management, was
chosen by Angelina Jolie after she discovered she carries a mutated copy of the
BRCA1 gene, with wide media coverage after the announcement. This is a personal
decision, to be made with all facts in place and with information from a health
care provider with extensive knowledge in this area. For those at a lesser
risk, at the opposite end of the continuum, one would start with lifestyle
changes and medication.
Because more data allows us to make informed decisions
regarding the next steps in the path to prevention, early detection is the most
important piece of the puzzle, and options have never been more readily
available for preventive care.
For further inquiries about breast cancer and genetics, or to set up a
consultation for a breast health screening, contact Susan Uhle, CNP, of Richmond Surgical, at 804.285.9416.