By Amanda Sun, MD (Oncology, Kaiser Permanente Tacoma Medical Center) and Yan Liu Baum, MD (Family Medicine, Kaiser Permanente Tacoma South Medical Center)

Jane is just about to celebrate her 50th birthday. The last time she was seen at clinic was six years ago, but she came for a physical exam today. In the last few years, Jane’s primary care physician’s office has asked her come in for a physical exam, but she did not respond and never came in. At the last physical visit, she had a pap test, confirmed her blood pressure was good, she didn’t have diabetes, and her heart disease risk factor is low. The physician ordered a screening mammogram, but Jane never completed it.

Now she has had several coworkers diagnosed with breast cancer. One of them in an advanced stage, so she was concerned and wanted to discuss it with her physician. Jane mentioned that she does not want to screen for breast cancer because she does not want to know. If she has breast cancer, she said, she does not want to have any treatment because she wants to have good quality of life.

When people talk about breast cancer these days, they are afraid. So Jane’s physician shared some important information with her:

Breast cancer, like colon cancer, is one of very few cancers that can be detected early. Breast cancer is the most common cancer in women – so common that one in eight women in the US will develop breast cancer in their lifetime. According to the American Cancer Society, in 2019 about 268,600 new cases of invasive breast cancer will be diagnosed, and about 41,760 women will die from breast cancer.

The good news is breast cancer can be cured, if found early and has not metastasized. People can die from breast cancer if it is found too late. If found late, the survival rate will decrease from above 95% (stage 0) to less than two years life expectancy (stage 4). 

Breast cancer can happen in both breasts at the same time or at different times. It can develop while patients are young – if you have any doubt about something in your breast, please consult with your physician: do not assume it is benign tumor. 

Smaller breasts can have breast cancer. Sometimes, smaller sizes of breasts are denser, which can make cancer difficult to be detected by regular mammogram.  Breast cancer, like colon cancer, is influenced by genetics in only about 10% of cases. Most breast cancer happens without any family history. 

Screening strategies physicians use depend on each patient’s risk of developing breast cancer. There are models that can predict the risk. Family history of breast or ovarian cancer, certain genetic mutations such as BRCA 1/BRCA 2, or radiation exposure to the chest wall at young age all can increase the risk. If the predicted lifetime risk of developing breast cancer is above 20%, in addition to mammogram, physicians might recommend annual breast MRIs for screening. For average risk women, mammograms ever year or every two years are often recommended. Shared decision-making between patient and physician is often used in deciding the screening strategy that is right for an individual.  

We’re also seeing new 3D mammograms available. Both 2D and 3D screening mammograms are effective in detecting breast cancer at early stages – early enough for a cure. 3D mammograms are better for women with dense breast tissue and insurance coverage for 2D and 3D mammograms are identical under Washington state law.  

Treatment is constantly evolving to help more and more patients have good outcomes. Many new drugs are regularly approved by the FDA, which has improved the cure rate of breast cancer significantly in last decade. Prevention and screening are vital for the cure to be possible. Effective treatment of breast cancer requires a multidisciplinary approach involving surgery, chemotherapy, radiation therapy, endocrine and targeted therapy. At Kaiser Permanente, we work as a team at delivering high quality, evidenced based, individualized cancer care to help women with breast cancer to achieve a cure and live a healthy, productive life.  

Patients can start now by reducing their risk of breast cancer with simple lifestyle changes. Research shows that exercise and maintaining a healthy weight can reduce breast cancer risk, along with stopping smoking and limiting alcohol consumption. Additionally, patients who have their first baby before age 30 or who breastfeed for at least six months have a reduced risk of breast cancer. Synthetic menopausal hormone replacements can increase breast cancer risk.

After learning all of the above, and the more advanced treatment options for breast cancer, Jane understood that breast cancer can be cured in many situations. She will schedule her mammogram this week. Talk to your doctor today about screenings and prevention that you can take to keep yourself cancer-free.

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