Protective Measures for Women at High Risk

Any woman can make lifestyle choices to reduce her risk of breast cancer. If you are at increased risk because of an abnormal gene or a strong family history of breast cancer, you may seriously consider extra protective measures, including medication and surgery. These are serious options that can significantly change your life. Some of the measures, such as medications, have mostly temporary side effects. Others, such as surgery, involve permanent changes. Some of these options can be combined and some can be used in sequence.

High-quality early detection

Every woman needs to practice early detection measures. But if you are at higher risk, you need to be especially watchful. The goal is to find breast cancer as early as possible, when it's most treatable.

Here are the current recommended guidelines:

• Do a monthly breast self-exam.
• Get a yearly breast exam by a doctor. You may need these exams more often, depending on your personal level of risk.
• Get a mammogram every year, starting at age 40. If you had a relative who was younger than 40 when diagnosed with breast cancer, your doctor will probably recommend that you start this and other breast cancer screening before age 40.

In addition, if you're at high risk of breast cancer, your doctor may also recommend these procedures:

• MRI (magnetic resonance imaging) helps screen women who are at high risk for cancer because of a significant family history of breast cancer or an abnormal breast cancer gene and a prior history of breast cancer. Research has shown that MRI scans are better than mammograms and ultrasound in finding invasive cancers early in high-risk women, especially in younger women who tend to have dense breasts. But MRI is not a substitute for mammography. Still, mammography can be quite useful in young women at increased risk of breast cancer. That's because it's best at seeing groups of microcalcifications — they look like grains of salt — which can be signs of PRE-invasive breast cancer (DCIS or non-invasive disease).
• Ultrasound can be used as a screening test along with mammography in woman at increased risk. Ultrasound can be used in a woman of any age to further evaluate a breast thickening or lump. If you're under age 30, your doctor may recommend ultrasound before mammography to examine a persistent area of concern. As noted above, however, mammography is still important.

If you're at high risk for breast cancer, you may need to have some of these screening procedures more than once per year. For example, the Memorial Sloan-Kettering Cancer Center recommends that women with an abnormal BRCA1 or BRCA2 gene have breast imaging done twice a year, with mammography and MRI scans separated by 6 months. So you might have a mammogram in January and an MRI in June. Talk to your doctor about developing a specialized program for early detection that meets your individual needs and gives you peace of mind.