Breast Cancer Screening in Ann Arbor
Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- Breast Cancer Screening in Ann Arbor. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to discuss an important healthcare decision females and yes- males need to consider as we age: Breast Cancer Screening
Breast Cancer Screening in Ann Arbor
Breast cancer is a cancer that occurs when individual cells in the breast grow uncontrollably. Inside the breast, there are different areas where breast cancer can begin including lobules, ducts, and connective tissue.
Lobules are glands the produce breast milk
Ducts are tubes that carry breast milk to the nipple
Connective tissue- like the force- is around everything and holds everything together
Why Breast Cancer Is Important
Breast cancer is the second most common cancer among women in the United States, only behind lung cancer. White women and black women get breast cancer at about the same rate. However, discrepancies in diagnosis and treatment exist because black women have a higher morbidity than white women.
While most commonly discussed among females, breast cancer can actually affect males as well. Nearly 1 out of every 100 breast cancers diagnosed is found in a man. While rare compared to females, it is not to be ignored as males are more likely than women to be diagnosed with advanced breast cancer, most often attributed to a decreased awareness.
In 2017 for the State of Michigan, there were 7,582 breast cancer related cases reported- nearly 119 new cases for every 100,000 females screened. Recent epidemiological studies have suggested that incidence rates for breast cancer has been slowly increasing since 2004. Recent studies have concluded that increases in body mass index (BMI) and declines in the average number of births per woman (both breast cancer risk factors) have likely contributed to the recent increases.
Breast Cancer Screening
The American Cancer Society (ACS) recommends for women at average risk to begin breast cancer screening at age 45. Women should get mammograms every year until the age of 55, at which point they can switch to every other year or continue yearly screening.
Factors for individuals to be considered average risk include not having:
A personal history of breast cancer
A family history of breast cancer
A genetic mutation known to increase risk of breast cancer (eg- BRCA gene)
Has not had chest radiation before the age of 30
It is mentionable that the United States Preventative Task Force (USPTF), another major panel that develops evidence-based recommendations for clinical preventive services, continues to recommend screening starting at age 50 years of age.
Why the difference in Screening Recommendations? It comes back to the harms versus the benefits of screening. Ahh yes, too much of anything can sometimes be fraught with unintended consequences. As example, the sensitivity of mammograms is generally higher in older women because of less denser breast tissue than younger women. However, If you’re reading this blog post, you have already accomplished the awareness for the need of screening. That’s a win, let’s leave it there for now.
Breast Cancer Risk Factors
Risk of breast cancer is due to a number of factors, with the main risk being a women and getting older. Most women have some risk factors. However, most women will not get breast cancer. Other risk factors include:
Genetic mutations such as BRCA1 and BRCA2
Menstrual history of having periods before age 12 or after age 55
Dense Breasts
Family history of breast or ovarian cancer in a first-degree relative (mother, sister, daughter)
Previous radiation therapy to the chest
Lack of physical activity
A higher body mass index (BMI)
Tobacco use
Breast Cancer Screening Tests
Once risk factors have been determined or a female has reached a particular age, the decision to be screened for breast cancer should be started. Below I discuss the most common types of breast cancer screening we encounter.
Mammography
This is a low-dose X-ray of breast tissue and currently the gold-standard in breast cancer screening. Early detection of breast cancer by mammography reduces the risk of breast cancer death and increases treatment options, including less extensive surgery and/or use of chemotherapy.
3D Mammography
This is called Digital Breast Tomosynthesis (DBT) and is actually a combination of multiple breast images, along with 2D breast mammography to construct a 3D image of the breasts She studies have found 3D mammography to be more sensitive, however this is not a wide spread imaging test available to all and may not be covered by insurance.
Thermography
Thermography utilizes a special camera to measure the temperature of the skin on the breast’s surface. It is based on the ideas that cancer cells are growing and multiplying faster, thus blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. It involves no radiation.
In regards to radiation, I can certainly appreciate the concern to be less invasive and more natural. However, according to Wakes Medical Campus (Chapel Hill, NC), the total radiation dose for a typical mammogram with two views each breast is about 0.4 mSV. As perspective, they say we are normally exposed to 3 mSV of radiation each year just from our natural surroundings. Additionally, breast cancer screening via mammography is statistically about x20 more sensitive than thermography. Meaning, a radiologist may find a mass with thermography at stage 2, they likely could of found that same mass at stage 1 with mammography- and thus differing survival rates.
Breast Self Awareness
While monthly self-breast exams are no longer recommended based on increases in rates of false positive, all women should become familiar with both the appearance and the feel of heir breasts. Any changes should be promptly reported to their physician.
Other Tests
Such as breast magnetic resonance imaging (MRI) and ultrasounds are sometimes used on a case-by-case basis depending on risk factors and history of abnormal results.
Why You Should Have Breast Cancer Screening
At Beyond Primary Care, we encourage females to be proactive about their breast health and work with imaging centers that perform mammography screenings. The Affordable Care Act (ie- Obamacare) requires that Medicare and all new private health insurance plans cover screening mammograms without any out-of-pocket expenses to patients.
Note: screening mammograms are only covered through insurances. If your initial screening returns and advises follow-up, either a diagnostic mammogram, a breast ultrasound or MRI, working with Beyond Primary Care to determine your out of pocket costs is advised as some imaging price are more affordable without health insurance.
Please contact Dr. Jeff O’Boyle or Dr Janelle Lindow directly with any questions or to schedule an appointment to discuss further. We look forward to hearing from you!
Thank you for reading.
Dr. Jeff O’Boyle with Beyond Primary Care
