The Breast Cancer Surgery Center is pleased to present this first in a series of articles on women's health. One of the goals of our Center is to empower women to take control of their own risk assessment, utilize screening tools and other diagnostic modalities appropriately, and choose therapy options that improve their lives.

      This article will deal with evaluating your own personal risk for developing breast cancer, including how it is done, and how it helps you. Future articles will deal with the options that are available to help you manage and even reduce your risk. These include the use of ultrasound exams, magnetic resonance imaging (MRI), ductal lavage, and genetic testing.

      First, a few statistics. These are taken from the most recent data available (2005) from the National Cancer Institute. Our community's statistics generally parallel the national statistics in incidence of breast cancer and also in the therapeutic options chosen by informed women.

      Based on current rates, 13.2% of all women born today will develop breast cancer during their lives. Statistics from periods as recently as ten years ago showed a 12.5% risk and from 20 years ago, a 10% risk. This increase in risk seems to be related to the decrease in deaths from other causes. More women are living to age 90-95. Since breast cancer risk increases with age, the overall risk is increased. Also, since most elderly Americans die from either cardiac or cancer-related causes, decreasing cardiac-related deaths will statistically increase the risk of dying from breast cancer.

      The incidence of breast cancer rises increasingly, rather than steadily, with age. From age 30-39, the yearly risk is 0.44%. In subsequent decades of life the yearly risk is 1.46%, 2.73%, 3.82%, and greater than 5%. Also, as most people know, certain groups of women have an increased risk over this baseline. Those with a strong family history, or even a genetic mutation, can have lifetime risks as high as 90%.

      It behooves each woman, therefore, to know her individual risk, to follow it as her age increases, and to employ those screening tools that optimize the chance of finding any cancer which develops at a stage when treatment offers the highest cure rate. Let's start with screening mammography.

      The function of any screening test is to detect early signs of diseases where no signs or symptoms exist. The test must be relatively low in cost and applicable to the general population. Mammography utilizes an x-ray of each breast. Two types of abnormalities are detected. One is microcalcifications (small deposits of calcium) in the breast. The other is a change in the pattern of soft tissue shadows on the mammogram, raising the suspicion for the presence of cancer.

      Mammography is indicated in all women over the age of 35, even if they are at low risk. Several different recommendations exist for the frequency of early mammograms. Medicare contracts state when they will pay for a screening mammogram, but this may not be frequent enough for all individuals. One plan states that a baseline mammogram should be done at age 35 and if it is normal, begin yearly mammograms at age 40. Another plan is to have mammograms every other year between age 35 and 45 and then yearly. Current guidelines do not indicate that a woman can stop having mammograms at any age, but cancers which arise after the age of 85 generally grow slowly enough that mammography every two years is adequate.

      Several risk models have been developed so that a woman can calculate whether her individual risk is elevated. The most common of these is the Gail Model. So many millions of women have had breast cancer that six "history" factors have been identified (no physical exam findings) that can group women into very accurate risk categories. These factors include age, age when menstruation began, age at first live birth, family history (only mother, sister, or daughter; not grandmas, aunts, or nieces), previous breast biopsy (and, specifically, if atypical ductal hyperplasia was present), and race.

      Several Internet links can provide the calculation tool (see http://brca.nci.nih.gov/brc/). Any search engine using "Gail Model" can usually bring you quickly to a site where the Gail calculation can be performed. The results are generally presented as four numbers. One is the percent chance that women who share the same six characteristics as you will develop a cancer within the next five years. The second number is the percentage of all women your age who will develop a cancer. The third and fourth numbers are similar estimates of total risk to age 90.

      Comparing your risk to that of other women your age tells whether you are at high risk, normal risk, or low risk. If your percentage is lower than other women your age, you are at low risk. If your risk is elevated but less than twice the risk of your age cohort, you are average risk. Patients whose statistical risks are twice that of other women in their age group are considered to be at high risk. Statistical risk assessment does not "guarantee" that you will "fit the model". Low-risk women can get breast cancer, and high-risk women do not always get it.

      One of the projects of the Breast Cancer Surgery Center has been to encourage primary medical care-givers (family practitioners, gynecologists, nurse practitioners and midwives, and physician assistants) to calculate Gail risks for each of their patients. Those who are found to be at high risk can then have a surgical consultation to outline a screening plan specific to them which would maximize the chance of finding a cancer when it is still in an early, curable stage.

      In the next article, we will discuss risk-management strategies including increased observation, chemoprevention and prophylactic surgery. Women who would like to know their risk but are having trouble calculating it, can contact the Breast Cancer Surgery Center at BreCanSurCen@aol.com whereby a free calculation can be arranged.