~ by Linda M. Girgis, MD
The patient sitting in front of me was a 24 year old and she was frightened. A few weeks ago, she discovered that she had a lump in one of her breasts and her first thought was cancer. After examining her, my clinical impression was that it warranted further investigation so I ordered a diagnostic mammogram and ultrasound. She scheduled the appointment and went there only to be told that she was too young to receive a mammogram. Immediately, the picture of another 24 year old came to mind, one who developed metastatic breast cancer and struggled to stay alive for the sake of her 2 young children.
While breast cancer does strike women at an older age, it truly does not discriminate based on it. I am diagnosing more women in their 30’s with breast cancer. Needless to say, I went to battle on behalf of my scared patient and she finally was allowed to be tested. Fortunately, she came back cancer-free.
According to the CDC , breast cancer is the most common cancer in women despite race or ethnicity and the second most common cause of cancer deaths in women. An important fact that many people often over-look is the fact that this is a disease not limited to only women. While approximately 42,000 women die of breast cancer every year, there are also over 400 men who die from it as well.
There are several screening guidelines that exist discussing when and how to screen women for breast cancer. Research and clinical observation clearly demonstrates that women (and men) who are diagnosed at an early stage of disease tend to have better clinical outcomes. In recent years, the guidelines are being disputed as to whether breast self-exams are beneficial and how often to do screening mammograms.
In my practice, I still recommend that women do monthly self- breast exams (SBE). Some studies showed that clinical outcomes are not improved by doing so. However, I personally have diagnosed many women with breast cancer based on a lump they found on their own. While the guidelines look at numbers needed to treat (NNTT) in order to derive a benefit for a given diagnostic intervention, I am responsible for every single person coming to my exam rooms. And I observed clear benefit from this simple cost-free intervention.Mammograms, as well, have fallen under dispute. Some studies revealed no clear benefit from doing annual exams and it in fact drives up healthcare spending by the increased number of biopsies performed based on abnormal mammogram results. Again, many women that I have diagnosed were asymptomatic and their breast cancers were found at a very early stage because of these abnormal mammogram results. I recommend a baseline mammogram at the age of 35 and an annual one over the age of 40.
Special consideration is given if there is a family history of breast cancer. We have all seen Angelina Jolie and her BRACA testing results. Genetic factors play a huge role in breast cancer and those with significant family histories should be offered genetic testing at an early age. The following are recommended to be considered for genetic testing:
- A known BRCA1/2 gene mutation in the family
- A personal history of breast cancer at age 45 or younger
- A personal history of breast cancer at age 50 or younger and a family member (parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece or first cousin) diagnosed with breast cancer at any age
- A personal history of triple negative breast cancer (breast cancer that is estrogen receptor-negative, progesterone receptor-negativeand HER2/neu receptor-negative) diagnosed at age 60 or younger
- A personal history of ovarian cancer
- A personal or family history of male breast cancer
- Ashkenazi Jewish heritage and a personal or family history of breast or ovarian cancer
- A family member (parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece or first cousin) diagnosed with breast cancer at age 50 or younger
- A family member (parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece or first cousin) diagnosed with ovarian cancer at any age1
Many women come to see me and do not want to be tested and many have not been screened in many years. Some claim that mammograms are too uncomfortable. While it can be uncomfortable, chemotherapy, surgery and radiation therapy can be much more uncomfortable. While we have made great advances in detecting breast cancer earlier and curing many women, we still need to do better. We need to step up our surveillance and convince women on the importance of being screened. And, we cannot forget that men are victims as well. Men often have it worse because they are diagnosed later and their treatment is not so standard like it is in women. Many of them must go to women’s healthcare centers for treatment.
As October rings in and the leaves start falling, breast cancer awareness month comes as well. Let’s all step up and do a better job for all people at risk and suffering from this deadly disease.
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician’s Weekly and MedicalPractice Insider as well as a guest columnist for Medcity News and HIT Outcomes. She has had articles published in several other media outlets. She has authored the books, “Inside Our Broken Healthcare System” and “The War on Doctors”. She has been interviewed in US News and on NBC Nightly News.