On our March 28 broadcast, we asked for your questions on breast cancer screening. The response was overwhelming. Here, our Chief Medical Editor Dr. Nancy Snyderman, with assistance from Fox Chase Cancer Center in Philadelphia, answers some of the more common questions submitted by you, our viewers:
Question: I have a 15 year old daughter. My grandmother, mother and sister all had breast cancer and my mother succumbed to the disease. My question is: when should my daughter start getting tested via mammogram or MRI ( thank god I have good insurance)?
Thank you, A concerned father
— Douglas West, L'anse, MI
Answer: There is no reason for a 15 year old to get screened, but she may want to consider evaluation at a comprehensive cancer risk assessment center when she is in her twenties. At that time genetic testing may be discussed. Because of her history, she should probably get screening mammography and MRI at age 30. The more information she can put together about her family history, and genetics, and the information she gathers from routine screening and breast self exams, the better off she will be.
Q: How will this MRI affect women who have breast cancer on one side. Will it improve reviews for cancer on the other side?
— Anonymous, Rapid City, SD
A: MRIs may be used in addition to mammography in some women, but the American Cancer Society (ACS) guidelines only specify the use of MRIs in certain high risk women. These guidelines are especially important for women who've already had cancer. Because there is a risk of breast cancer in the other breast, combining MRI with mammogram is a good way of picking up new cancers. In this recent report, MRI found breast cancers 3percent more often in the other breast that mammography alone.
Q: I saw your segment about the new guidelines for getting an MRI in addition to a mammogram. I could have sworn that you said having a history of ovarian cancer would be a contributing factor to high risk. Can you clarify that for me? I am a 7 year survivor of ovarian cancer and I want to know if I should be aggressive with my doctor in pursuing this. Thank you.
— Janice Heidt, Houston, TX
A: While breast and ovarian cancer both have hormonal influences, this recent report did not address women who have had ovarian cancer. Some women with ovarian cancer also have a family history of breast cancer. Also certain gene mutations place women at high risk for ovarian and breast cancer. If a woman has a specific gene mutation, an MRI may be warranted. You may want to consider getting a comprehensive risk assessment at a cancer risk program
Q: My 21 year old daughter has fibrocystic breasts making it very difficult to detect a lump on a self exam. She is too young for mammogram and I was wondering if the breast MRI would be an option? One aunt had breast cancer but there aren't many females in the family to really know her risk.
— Thank you, Kathy Bennett
A: Be reassured that one aunt with breast cancer does not constitute a cancer pattern that you should be worried about. And it does not mean she should get screened any sooner. Unless there is a strong family history of breast cancer the fact that she has fibrocystic disease is also not a reason to start screening early . It's an old wives tale that fibrocystic disease is linked to b breast cancer, and she should start routine screening according to normal guidelines.
Q: My now 15 year old daughter had 3 X-rays for re-occurring pneumonia at the age of 3. Robert Bazell's report mentioned that women who were exposed to radiation at a young age were candidates for MRIs to best detect breast cancer. Do dental X-rays count?
— Donna Brian, Baton Rouge, LA
A: The guidelines state "radiation to the chest between the age of 10 and 30," meaning treatment for cancer not dental X-rays .
Q: How does MRI imaging of the breasts compare to mammogram plus breast ultrasound for women with dense breasts?
— Anonymous, Chester, NY
A: The guidelines say there still isn't enough evidence to recommend for or against MRI screening in women who have very dense breasts. Dense breasts do pose a hurdle for women , not only for breast self exam, but also for routine screening. With that said — the standard still is mammography, adding MRI only when there are other risk factors such as strong family history, genetic mutation, and prior radiation to the chest, such as with Hodgkin's Disease.
Q: I had a Stage 1 breast cancer 7 years ago — took HRT for 13 years and had radiation and tamoxifen for 5 years. I'm due for a mammography in September — should I request an MRI?
— Carol Baumel, Monroe, NJ
A: ACS guidelines find screening MRIs of uncertain value for breast cancer survivors who don't meet the high risk criteria. But you're one of those cases that falls right on the edge of the guideline. For your peace of mind, adding MRI to your screening may make sense. But one note of caution — your insurance company may not pay for it since you 're on the borderline — so be prepared to pay for this out of pocket.
Q: My maternal grandmother had breast cancer at a later age (70s I believe). After a mastectomy, she lived a long and cancer free life. My mother recently read that the radiation from mammograms can linger and raise your risk of getting breast cancer. She is now saying that she is not going to get mammograms anymore. Is this true? Can mammograms cause more harm than good? Also, I am now in my early 30s. At what age should I start getting screened? Thank you!!
— Jenise Lawhorn, TX
A: To your first question: there is no way mammography causes more harm than good and stopping mammography when you turn 50 is playing Russian Roulette. The incidence of breast cancer increases after a woman turns 50. Mammography is an important screening tool for the early detection of breast cancer, and I would urge your mother to have one every year . And to allay her fears, modern mammography machines produce breast x-rays that are high in image quality, and strict guidelines are in place to ensure they use lowest dose of radiation possible.
As to your second question, start screening when you turn 40.
Q: I was diagnosed with breast cancer in the right breast in 2000. In 2006, I had reconstructive surgery with implant on the right side. Is an MRI still possible after having a breast implant?
— Lavonia McDaniel, Leesburg, GA
A: After a mastectomy only a small amount of breast tissue remains and the risk of local recurrence in the area of the treated breast is usually low. If you or your doctor has reason for concern of recurrence after you have a mastectomy with an implant, an MRI may be useful.
Q: My 83 year old mother-in-law just had a mastectomy. I heard it that one of the groups recommended for the MRI are those with a gene mutation. How does my wife go about finding if she it?
— Richard Fox, Highland Falls, NY
A: The test is a blood test and it screens for mutations in BCRA1 and BCRA 2 genes. Generally, this test is recommended for women after a possible risk of inherited breast cancer has been established. Having one family member, even a mother, with breast cancer at an older age, does not indicate an inherited risk. Your wife should discuss her risk with her healthcare provider and consider evaluation at a comprehensive risk assessment program.