Breast Cancer Screening and Strategies for Supporting Breast Health

By Dr. Sarv Varta Khalsa

October is breast cancer awareness month. Breast cancer is the most common cancer in women in the United States (except for skin cancer). The American Cancer Society’s estimates for breast cancer in the United States for 2023 are: about 297,790 new cases of invasive breast cancer will be diagnosed in women. About 55,720 new cases of ductal carcinoma in situ (DCIS) will be diagnosed. About 43,700 women will die from breast cancer in 2023. Overall, the average risk of a woman in the United States developing breast cancer sometime in her life is about 13%. This means there is a 1 in 8 chance that a woman living in the United States will develop breast cancer.

Breast Cancer Screening Options:

• Mammogram
• Ultrasound
• MRI
• Thermography
• Physician exam
• Self exam

Mammograms:

• A mammogram is an X-ray picture of the breast.
• How much radiation exposure occurs during a mammogram?
  • A typical screening mammogram uses 0.4-1.0 millisieverts of radiation.
  • As a comparison, a three-hour plane ride delivers about 0.1 millisieverts of radiation.
  • We are exposed to about 3 mSv of background radiation in our natural everyday surroundings on an annual basis. 
  • Getting a mammogram is the equivalent of about 7 weeks of normal everyday life.
• 2D vs 3D mammograms. Which is better?
  • 2D mammography: Benefits: less radiation, down side: not as accurate with dense breast tissue.
  • 3D mammography: Benefits: more accurate with dense breast tissue (better detect breast cancer by up to about 80% compared to regular 2D mammography), fewer false positives. Down side: more radiation because it often combines 2D and 3D images.
  • 3D mammography is also called Tomosynthesis: A “new” type of digital x-ray mammogram which creates 2D and 3D-like pictures of the breasts. 
  • Developed in 2011 and is now the standard of care. Improves the ability of mammography to detect early breast cancers, and decreases the number of false positive findings that may lead to further imaging and/or a biopsy.
• Guidelines for mammogram screening:
  • General: Every 1-2 years (if no risk factors).
  • In May, 2023 the United States Preventive Services Task Force (USPSTF) issued new recommendations for breast cancer screening that lowered the age at which women should start screening from 50 to 40 years old.
  • Start breast cancer screening at age 40 instead of the previously recommended age of 50.
  • Get screening mammograms every other year from ages 40 to 74.
• American Cancer Society recommendations:
  • Women between 40 and 44 have the option to start screening with a mammogram every year.
  • Women 45 to 54 should get mammograms every year.
  • Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. 
  • Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

Ultrasound:

• Breast ultrasound uses sound waves to create computer pictures of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that can be harder to see on mammograms.
• Most commonly used as secondary imaging to further evaluate abnormalities seen on a mammogram.
• Can also be used to evaluate breast tissue but is not the standard of care.
• Most imaging centers won’t perform a breast ultrasound unless a mammogram has already been done.
• Women who prefer to not get a mammogram but want just an ultrasound: HerScan. 
• HerScan: A mobile Breast Ultrasound Screening company: Cash pay, no Rx needed. 
• An ultrasound can increase the detection of breast cancer from approximately 48% to 97%, particularly in women with dense breasts. 
• Ultrasound screenings are capable of detecting cancers that cannot be found by mammography and physical exams alone.
• Benefits: No radiation, no breast compression (pain).
• Cost: $285 
• Results are emailed within 7-10 business days.

MRI:

• Breast MRIs are not usually used for screening because they are not typically covered by insurance.
• They can be too sensitive leading to an unnecessary biopsy. 
• If breast cancer has already been diagnosed, a breast MRI is sometimes done to help determine the exact size and location of the cancer, to look for other tumors in the breast, and to check for tumors in the other breast.
• Recommended to alternate mammogram and MRI every 6 months in women with increased risk for breast cancer.

Thermogram:

• A Thermography produces an infrared image that shows the patterns of heat on or near the surface of the breast which can indicate increased circulation, stagnant lymphatic flow, or inflammation. 
• Though this is a way of looking at the breast tissue it is not as reliable for screening for masses. 
• A good option for people that don’t want to get a mammogram.
• Not considered standard of care.
• An abnormal thermogram will recommend a mammogram.

Breast Exams:

• Physician exam: Recommended annually as part of a well woman exam.
• Any possible abnormalities felt can be further evaluated with a mammogram or an ultrasound.
• Self breast exams: Recommended monthly. 
• General guidlines:
  • Lay on your back with arm over your head.
  • Choose a pattern that you use each time.
  • Do your self exam is 3-5 days after your period ends. 

Genetic Testing for Breast Cancer:

• Natera: Hereditary Cancer Testing.
• Individuals with hereditary cancers have a higher than average chance of developing certain cancers in their lifetime. These individuals are also at risk of developing cancer at a younger age. 
• Who should get tested?
  • Personal or family history of cancer at age 50 or younger.
  • Ashkenazi ancestry
  • Personal or family history of ovarian, male breast or pancreatic cancer.
  • Multiple cancers on the same side of the family.
• Natera offers comprehensive testing for 81 hereditary cancer genes. 
• It is evaluated with a simple blood test.

Prevention/Tips to Support Breast Health:

• Eat a healthy, balanced diet
• Maintain a healthy weight
• Get regular exercise
• Prioritize sleep
• Limit alcohol
• Avoid smoking
• Get yearly physicals and blood work with your doctor.

Diet to Support Healthy Breasts:

• Eliminate sugar, white flour and refined/processed foods. These foods increase insulin like growth factor-1 (IGF-1) which has been linked to increase breast cancer growth.
• Eliminate methyl xanthines such as coffee, tea, chocolate, colas, and other foods or beverages that contain caffeine. Caffeine and coffee increase estrogen. 
• Eliminate red meat and fowl: unless organic or grass-fed (not treated with hormones).
• Decrease fats, especially animal fats. Research shows that a low fat diet was found to reduce breast cancer occurrence.
• Decrease dairy products such as milk and cheese. Dairy cows are often treated with rBGH (growth hormone) to increase milk production but can increases IGF-1.
• Increase complex carbohydrates such as vegetables and whole grains: these contain fiber which helps in the elimination of estrogen and contain important nutrients that help protect against breast cancer. 
• Increase the consumption of garlic and onions: These foods contain Sulphorophanes, which have been shown in studies to reduce breast cancer expression and growth. 
• Increase Cruciferous vegetables: Broccoli, Brussels sprouts, kale, cauliflower, collard greens, bok choy, mustard greens, and radish. These foods contain DIM which helps eliminate the “bad estrogen”.
• Eat fruits and vegetables rich in beta-carotene: Any fruit or vegetable that is red, orange or yellow in color. These foods may reduce the risk of breast cancer.
• Eat fruits and vegetables rich in Lycopene (antioxidant): Strawberries, tomatoes, and any fruit or vegetable that is red in color. Lycopene might be protective against breast cancer.
• Eat Healthy Fats: nuts and seeds, avocados, olive oil, wild caught salmon. These foods can decrease the risk of developing breast cancer.
• Consume spices that are anti-inflammatory: Turmeric, ginger and garlic. Reducing inflammation in the body can help reduce the risk of developing cancer. 
• Eat ground flax seeds: Suggested dose: 1-3 TBSP/day. Studies suggest that flaxseeds reduce estrogen stimulation of breast cancer cells. They also help to eliminate estrogen. 
• Eat organic berries: These foods contain phytochemicals that have been shown to help reduce cancer growth.
• Eat medicinal Mushrooms: Maitake, Shitake and Reishi. These foods may be protective against cancer.
• Drink Green Tea: It may reduce the risk of breast cancer recurrence, cause cancer cell death, helpful in reducing total circulating estrogens.
• Limit Alcohol Consumption: No more then 3 servings per week. Drinking more than 1 serving per sitting may increase your breast cancer risk.

In conclusion, breast cancer is a common cancer among women. Screening for breast cancer is vitally important in order to detect it early and treat it successfully. There are many different options for screening. An ounce of prevention is worth a pound of cure so make sure you are getting your preferred screening tests as recommended by your doctor. Healthy diet and lifestyle choices can help to decrease your risk of developing breast cancer.