Q4 Women

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In recent decades, breast cancer awareness campaigns have helped raise the profile of the disease and prompted more women to tune in to their bodies. But knowing what to look for, and when to ask a doctor about additional screening, isn’t always easy. Dr. Shivani Duggal, a breast surgeon with Pennsylvania’s Allegheny Health Network, helps to point you in the right direction.

Q: What are the most common types of screening for breast cancer?

Dr. Duggal: The most commonly ordered imaging test is a screening mammogram, which usually begins at age 40 as part of an annual exam. It should coincide with your annual clinical exam with a physician, which can be your primary care provider or your gynecologist. Another form of screening is 3D tomosynthesis (a 3D mammogram), which is usually done on women who are high risk or have dense breasts.

What about getting an ultrasound?

Screening ultrasound is not recommended because it doesn’t pick up calcifications, or a mass, and it doesn’t give an accurate picture of the entire breast tissue. Ultrasound is usually ordered when we’re trying to look for something further.

Are there reasons for women under 40 to get a mammogram?

If they have a high-risk family history. Or every now and then, we get the patient who feels a lump at age 30. A lot of times those women get screened, but that’s going to be at the discretion of the doctor.

Women with specific genetic mutations that cause the most serious types of breast cancer often get additional screening. How do you know if you could be at risk for those mutations?

Usually if the patient is very young and has a diagnosis — a young patient under the age of 50 — gets genetic testing, period. Or a patient under the age of 60 with really bad breast cancer, they get testing. The other reason is if you have a family member diagnosed at a younger age. That’s first-degree relatives: mom, sister, dad.

There’s been some controversy over whether breast self-exams are useful. Do you recommend that women do them regularly?

We tend to think that self-examination might prompt a lot of unnecessary testing because people feel benign things all the time. But we still recommend here to do a monthly self-breast-exam starting at age 20, and then an annual clinical breast examination.

Are there any major risks to common screenings like mammograms?

With 2D mammography, the radiation exposure is so minimal that the benefit outweighs the harm — otherwise we would never recommend it.

Women, including celebrities like Angelina Jolie, have been more outspoken in recent years about experiences with breast cancer screening and decision-making to prevent cancer. Are younger women wondering what they can do?

Absolutely. Anytime there’s a celebrity that promotes awareness, it definitely catches on. We do get younger women coming in and saying, “I practice breast self awareness.” Breast tissue is very dense at a younger age, so we don’t jump to mammography. But I tell these women the same exact thing: You have to know your own personal risk factors, and do your self-exams.

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