Q&A: Annual breast cancer screening, early diagnosis important to successful treatment

Key takeaways:

• Genetics, prolonged estrogen exposure, hormone therapy and some lifestyle factors can increase breast cancer risk.
• Routine breast cancer screening can contribute to early diagnosis and treatment.

Women should undergo routine breast cancer screening in order to diagnose and treat breast cancer in its earliest stages for a higher likelihood of treatment success.

“It’s important to emphasize that if breast cancer is caught early, it’s highly curable. Once people recognize that, then there is an increased desire to get the screening,” Neelam V. Desai, MD, breast oncologist at Levine Cancer Atrium Health in Charlotte, North Carolina, told Healio. “Having education early on during annual health visits and talking about family history and other risk factors are the best ways to promote screening.”

Healio spoke with Desai about breast cancer prevalence, the importance of screening and discussing family history of cancer with a health care professional, and treatments currently in the works for women with breast cancer.

Healio: How common is breast cancer in the U.S.? Are certain stages more common than others?

Desai: Breast cancer is the most commonly diagnosed malignancy in women in the U.S. Estimated new cases of breast cancer in the U.S. for this year are around 297,000, and unfortunately, 43,000 women are expected to die from the disease. If you look at it from a broader perspective, one in eight women will develop breast cancer in their lifetime. Fortunately, it’s mostly diagnosed at an early stage when it’s still curable. We don’t see a lot of patients who present with stage IV or metastatic breast cancer, huge thanks in part to screening efforts. The prevalence at diagnosis for stage IV breast cancer is probably around 10%. Now, of course, it’s different if someone had early stage breast cancer and then they ended up with stage IV or metastatic breast cancer recurrence. That number is harder to give an answer to because it really all depends on the stage at which they were diagnosed, the subtype of breast cancer they had and the treatment they received.

Healio: What are some of the most common risk factors for breast cancer?

Desai: Genetics can be a strong risk factor. There are certain genetic mutations or variants that are associated with increased risk for breast cancer. Most commonly, people are familiar with genes BRCA1/BRCA2, but there are other genes involved as well. Usually, those patients do have family history that’s concerning, so multiple family members with breast and/or ovarian cancers or other cancers. Other things that increase the risk for breast cancer in a person are prolonged estrogen exposure, so things like early menarche, late menopause and not having any children at all or having pregnancy at an older age. Hormone replacement therapy has also been linked to increased risk for breast cancer. Some lifestyle things are also associated. There’s a small but increased association of breast cancer with moderate to heavy alcohol use, and other lifestyle factors such as obesity, particularly in the postmenopausal setting, are also associated with increased risk for breast cancer.

Healio: What do recent guidelines suggest for screening?

Desai:

The U.S. Preventive Services Task Force has updated its recommendations. They used to recommend screening mammograms every other year for women aged 50 to 74 years. They’ve lowered the age for starting screening at 40 years. Most of the other societies’ cancer guidelines recommend annual screening. The American Society of Clinical Oncology has always been recommending the screening age to start at 40 years, and in fact, we recommend annual mammograms for most women, so definitely starting at 40 years annually for most women. But also, what’s important is understanding the risks that a particular woman or patient in front of you has, so if they have family history or other concerning risk factors, then sometimes they must start screening earlier than that.

The treatment is extremely tailored depending on the stage of the breast cancer and the subtype of the breast cancer. There are various standard guidelines out there for treatment, but it really is tailored depending on the type and the details of the breast cancer, and of course the patient in front of you and their medical problems, etc.

Healio: What is currently in the works for treatment advances in breast cancer?

Desai: There are a lot of exciting treatment advances in breast cancer, both in early stage and metastatic disease. We’re at a point where we’re trying to what we call “right size” the treatment. Before, we didn’t have a lot of options for treatment, and once we had some effective therapies, we started treating everyone aggressively, but now there’s a recognition that we really want to tailor the treatment according to the risk. So, in patients who have lower risk disease, we want to de-escalate treatment, to give them enough but not too much so they don’t end up with unnecessary side effects. However, at the same time, for patients who do have more aggressive breast cancer, we want to make sure that we are escalating treatment for them and giving them all the possible treatments available to help lower their chance of cancer recurrence. There are many agents that are coming out beyond just regular chemotherapy. We have immunotherapy and we have these antibody drug conjugates, so there are a lot of options.

Healio: Which patients would be best suited for preventive mastectomy?

Desai: So far, the strongest indication is for those who have an underlying BRCA1 or BRCA2 mutation. Preventive mastectomylowers the chance of them having breast cancer to begin with, so it is worth a discussion with these patients. They don’t have to have it. Generally, once someone is found to have a BRCA mutation, they’re referred to a high-risk breast clinic like the one we have at the Levine Cancer Institute, and start getting more intensive surveillance. Again we tailor everything to the person we see in front of us, depending on many factors, but that’ll be the one main indication.

Healio: What are some things about breast cancer that OB/GYNs might not be aware of?

Desai: There’s a lot of awareness around breast cancer, and most people are very well educated. That being said, it is important to tailor care to your patient and ask them more about their family history. Sometimes I see patients where perhaps family history was taken years ago and there was no update, but that impacts whether we recommend genetic testing or not, the age at which to start screening and the type of screening, and maybe what to focus on.

For more information:

Neelam V. Desai, MD, can be reached at neelam.desai@atriumhealth.org.