Expert: Claes-Gustaf Nordquist, M.D. - 4/26/2010

Question
I am 53 with no children, therefore no breast feeding, have been overweight, inactive physically in past though not for last 2 years, menopausal and a number of other characteristics that appear to put me in higher breast cancer risk cateory - including 2 female relatives with it [maternal aunts]. I have 2 year mammograms since aged 40. I have taken multivitamins all my life including extra folate/folinic acid. I have dense breast tissue.
My most recent mammogram came back with a request I return to an ultrasound which I will have soon. The receptionist told me it was because there were changes but the technicians were in disageement about what they meant. The technicians do not know my personal history. I am in Australia and the mammograms are free every 2 years for women over 50 and the only questions I was asked was about risk factors related to my relatives - nonde of the other risk factors were asked about.
My question is about pro-active management when I have multiple higher risk factors.
I have not been genetically tested for BCRA1 or 2, not had breast MRI,PET, biopsies etc. I can afford to have these done myself, so cost is not an issue.
I want to be active in managing my higher risks but not subect myself to unnecessary radiation etc which could be another risk factor in itself.
I am therefore asking a radioaction specialiast in breast cancer how many x-rays of the breast are okay [is there an upper limit and if so what is it?] and for someone like me who is attempting to be pro-active due to presence of multiple risk factors what other tests do you recommend I ask the Dr to send me for so i can be a responsible adult who manages this risk intelligently? Any intelligent questions I should be asking at the ultrasound stage or beyond? I don't want to waste busy professionals time being overly pushy but I also do not want to fall into passivity and potentially overlook something important.

Answer
Most breast cancers found are not connected (yet) to any yet known genetic factors, so I do not see much value for you in any genetic tests. Since you have dense breasts the value of mammography is decreased. That is probably at least one of the reasons why it is combined with ultrasound scans in your case. You can avoid too many x-ray exposures by using MRI breast scans. They do not produce any radiation hazards and they are not hindered in any way by dense breast tissues - but they are expensive. And they do have a tendency of producing false positives - seeing suspected cancers to some extent where there is no cancer. If however they are combined with MRI guided needle biopsies of any unclear lesions seen any bad consequences of that draw back should be possible to avoid. Such screening at least once per year should be able to take care of your situation - if it is available where you are. Good luck!



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