Let’s Break to Educate: High-risk Breast Cancer Screening

Video Transcription

Hi, I'm Dr. Kimberly Stigers with CHI Saint Joseph - Breast Care. Thank you for joining us today for Let's Break to Educate. My topic for today is breast cancer screening in women at high-risk. But before jumping into the high-risk categories, I would like to reinforce and stress the most accepted recommendations for screening mammography for average-risk women, which is to begin screening at age 40 and continue yearly thereafter.

Risk Categories

Overall, most of us are in the average risk category. And the biggest risk that we have overall is just that we're women. So in regard to high-risk, we have two issues to be entertained:

1. What exactly constitutes high-risk for breast cancer
2. What do we do about that to provide extra surveillance and screening? 

There are in general, five groups of women that are at higher-than-average risk for breast cancer requiring additional screening and surveillance so that we may optimize early detection.

Genetic Predisposition

The first group are those with a genetic predisposition, and this is really only conferred through formal genetic testing. Having a genetic mutation putting you at increased risk for breast cancer is quite rare, only about five to 10% of breast cancer patients have this. That being said, the majority of people don't have these genetic mutations. 

The most commonly recognized of these are the BRCA1 and BRCA2 genetic mutations, along with a host of others as well. These confer a very high risk of developing breast cancer if one has these mutations. Therefore, we want to provide additional screening and surveillance of these women. So in addition to an annual mammogram, we like to add a high-risk screening and breast MRI. MRI is a very sensitive test for looking for breast cancer. So we add it to these women's regimen. And in general, in all of these categories, when we add MRI to the mammogram, we tend to stagger those exams.

And what I mean by that is if one has the mammogram in January, then we would do the MRI in July. The following January, we would do the mammogram again; the following July the MRI, and so forth. In that way with these high-risk women, we are seeing their breasts in one of our imaging modalities every six months. And each exam is given on an annual basis. In these women with a strong genetic predisposition with a genetic mutation, we also begin screening at 25 rather than at 40.

Family History

The second category is women that have a strong family history of breast cancer, namely a first degree relative that has developed breast cancer before menopause. When we talk about first degree relatives we are referring to your mother or a sister. So a lot of women think they have a strong family history of breast cancer because they have an aunt or a cousin, but it really primarily refers to first-degree relatives.

In addition, if there is a male family member that has had breast cancer, that is a higher risk as well. In these women, instead of beginning mammography at 40, we like to take the start of the mammogram 10 years prior to the age of diagnosis of the first degree relative that had cancer. That means if your mother had breast cancer at 40, we would start doing screening at age 30. 

Now we don't start any of these mammograms in women before age 25, but we would start in this case, we would start at 30. And then we would also add the yearly staggered MRI. 

Health History

The third category is women who themselves have had breast cancer, especially those that had breast cancer prior to age 50. And also those that had breast cancer after 50, who have dense breast tissue and/or other risk factors. In those women, again, we do a yearly mammogram, a yearly breast MRI, and stagger those at six-month intervals.

The fourth category is not very common, but it consists of women who as a child or a teen were treated with chest radiation, which is typically done for Hodgkin Lymphoma. If this radiation and treatment was given before the age of 30, these women are at very high-risk of developing breast cancer beginning eight years after the treatment was stopped. So in these women, we recommend beginning screening mammography and the staggered MRIs eight years after treatment has stopped, but not before age 25.

And then the last category are women that have had a biopsy that is not cancer, but the biopsy indicated entities that confer a higher risk for breast cancer, atypical cells, something called radial scar. And in those women, in addition to annual mammography, the addition of MRI may be beneficial to add.

With this being said, it all may sound a little confusing. You may find yourself or a friend or a relative that may fall into one of these categories. It can be beneficial to actually meet with and talk with a genetic counselor or certainly your primary care doctor or your breast radiologist. 

COVID-19 Vaccine and Mammography

So the second thing that I added to this update, because it's kind of new and hot off the press is the effect of the COVID-19 vaccine on mammography. 

The vaccine, because it's eliciting and wanting to stimulate an immune response, can cause swollen lymph nodes under the arm on the side that the vaccine was given.

And I have to say that I personally had this happen. My lymph nodes were very tender and sore and enlarged. This is a normal response to the vaccine. It occurs in up to about 16% of patients, particularly after the second dose of the vaccine. And the reason this is a little bit concerning is because if the radiologist is reading your mammogram and does not have this history and sees the swollen lymph nodes on the mammogram, it can be a little bit cause for alarm and may elicit a call back for an ultrasound or additional mammographic views, which we don't want to do if we just know it's due to the vaccine.

So recommendations are now in place for this. We recommend that if possible, if you're getting ready to schedule your mammogram, try to schedule it about a month after your second vaccine. If, however, you've already scheduled your mammogram for your screening, particularly if you waited a long time to get that appointment or you're overdue for your mammogram, we certainly recommend that you go ahead and keep that appointment if you like. And also of course, keep your vaccine appointment. We don't want to miss out on getting that.

What is important is to let the technologists know the day of the exam that you had the COVID vaccine. Let them know which dose it is(the first or second dose), the date of that vaccine, and probably the most important thing is which side it was on. Couple days ago, I actually saw three patients in one afternoon with these abnormal kind of swollen lymph nodes, but they were clearly attributed to the vaccine.

So that sums it up for today. If you have any further questions about high-risk screening, or if you might fall into a high-risk category for breast cancer, or any questions about the timing of your mammogram with the COVID-19 vaccine, please don't hesitate to call us at the Breast Center at 859.967.5613. And again, thanks so much for joining us for Let's Break to Educate. Have a great day.