A recent article published in JAMA Network Open highlights the positive impact of individual cancer risk assessment on a patient undergoing mammography screening.
Screening mammography saves lives. In fact, in the last 25 years, 40% fewer women have died from breast cancer. However, differences still exist across racial and ethnic groups, with a higher percentage of Black and Hispanic women dying from breast cancer compared to women who are non-Hispanic White.
Several studies indicate these differences exist due to delayed diagnosis and more advanced breast cancers at the time of diagnosis. This difference is primarily due to skipping or delaying screening mammography.
The article states, “Public health initiatives and advances in cancer research aim to reduce screening mammography disparities among racial and ethnic minority women. Strategies that improve screening mammogram uptake are opportunities to promote equity at a population level. Scalable solutions include breast cancer risk assessment programs to inform patients about their risk and the role of screening mammography in reducing breast cancer mortality.”
Cancer risk assessment is calculated for the vast majority of female patients at Elizabeth Wende Breast Care (EWBC) as part of their annual screening. We collect the data needed for this risk assessment on our detailed health history form. This assists our doctors, and clinical staff in customizing screening recommendations based on the outcome of the risk assessment. These recommendations could include adding supplemental screening ultrasound, or screening breast MRI (Magnetic Resonance Imaging), and identifying patients who may be a candidate for genetic counseling and testing. These recommendations are shared on the patient’s mammogram report and sent to referring providers for review.
Sharing this information helps better engage patients in conversations with their providers about their risk level, the appropriate age to begin screening, and which tests are most appropriate. The results of a cancer risk assessment can be overwhelming and challenging to understand. Having a conversation with a trusted medical professional about these results creates an opportunity to ask questions and learn what actions can be taken.
The recent study found that 52.1% of patients were at average risk and 47.9% at high risk for developing breast cancer. In addition, 60.6% of the patients self-identified as African American, 37.2% as Hispanic, and 2.1% as other racial and ethnic groups. A nonsignificant increase in screening mammography uptake was found, from 38.6% during usual care to 48.7% after risk breast cancer risk assessment. Additional analysis found a significantly higher rate of newly identified high-risk women having screening mammography after learning their risk status (51.1% vs. 36.6%).
This is evidence that cancer risk assessments can change patients’ behavior and increase their likelihood of beginning screening at the appropriate age. We hope that women, especially Black and Hispanic women, will begin having conversations with their medical providers about their individualized cancer risk and use this information to guide them to appropriate screening recommendations. This advancement alone can save lives and decrease the health disparities surrounding a breast cancer diagnosis.
If you have questions about your cancer risk assessment, please contact our high-risk/genetics department at (585) 758-7050.
Are you part of a medical practice seeking to implement cancer risk assessment into your workflow? Our providers routinely provide training for existing medical practices and assist them in implementing a risk assessment program.
Dense breast tissue has been established as a risk factor for breast cancer.
The presence of dense breast tissue identified on a mammogram is a two-fold concern: simply having dense breasts increases your chance of developing breast cancer compared with women with non-dense breasts. But in addition, dense breast tissue may obscure breast cancer because both dense tissue and breast cancer appear white on a mammogram. As breast density increases, the sensitivity of mammography decreases (meaning it is more difficult to identify a suspicious finding in the midst of dense tissue which may hide it). Due to this, other screening options have been offered to women with dense tissue, ultrasound primarily being the modality of choice.
With about 43% of screening-aged women having dense breast tissue, a large percentage of the population needs additional screening.
Several studies have evaluated the performance of supplemental screening ultrasound in women with dense breast tissue, showing improved cancer detection for this population. It is important to note that many of these studies included women with other risk factors, in addition to having dense tissue, such as a family history of breast cancer or personal history of breast cancer. The benefit of ultrasound in women at average risk (i.e., with no known risk factors) has remained unclear.
A recent large study evaluated asymptomatic women aged 40 to 49 regardless of their breast density having supplemental screening ultrasound adjunctive to mammography. In their analysis, researchers found supplemental ultrasound was associated with increased sensitivity – with the potential to improve detection of early-stage and invasive breast cancers across both dense and non-dense breasts.
These findings confirm the benefit of performing screening ultrasound for women with dense breast tissue and bring up the interesting point of performing supplemental ultrasound for women at average risk.
If you have heterogeneously dense or extremely dense tissue, your mammogram result letter will indicate that and recommend that you talk to your referring health care provider about your breast cancer risk and whether you may benefit from additional testing. If you and your primary care physician wish to have a screening ultrasound because your breast tissue is dense, Elizabeth Wende Breast Care (EWBC) can provide that service at any of our seven locations.
At EWBC, we believe screening ultrasound provides value in our patient population with dense tissue and advocate for utilizing it as an additional tool for breast cancer detection.
The American College of Radiology (ACR) and Society of Breast Imaging (SBI) jointly published updated breast cancer screening guidelines in June 2021 in the Journal of the American College of Radiology (JACR). The updated guidelines have a few main points. The guidelines state that all women should have a risk assessment by age 30 – especially minority women. It also emphasizes the importance of screening in overlooked or underserved populations, including transgender individuals and Black women. The ACR and SBI continue to recommend annual screening beginning at age 40 for women of average risk.
The new guidelines point out that certain factors such as sex assigned at birth, hormone use, and surgical histories place transgender individuals at increased risk for breast cancer, and describe that “due to hormone use, biological males transitioning to female are at increased risk for breast cancer compared to other males.” Further, biological females transitioning to a male who does not undergo mastectomy remain at their previous risk for breast cancer – this is important to note as many transgender individuals are less likely to undergo routine checkups and screening. This is true, too, for many minority women, “said Dr. Emily Conant, one of the authors of the guidelines. Minority women are 72% more likely to be diagnosed with breast cancer before age 50, 58% are more likely to be diagnosed with the advanced-stage disease before 50, and 12% more likely to die from the disease, compared with white women.” Therefore, it is vital that all women undergo a risk assessment by age 30 and start screening at age 40 – delaying screening until 50 will result in unnecessary loss of life to breast cancer, particularly in minority women.
Since the 1980s, when annual screening mammography became widespread, it has been proven to decrease breast cancer mortality by 40%. To maximize the benefits of screening mammography, annual screening should be followed without an upper age limit. Dr. Stamatia Destounis, one of our very own Elizabeth Wende Breast Care (EWBC) physicians, and author of the new guidelines, and the Chief of the ACR Breast Imaging Commission said, “new evidence continues to support annual screening starting at age 40, with closer attention given to minority women in underserved populations…. mounting data and more inclusive screening recommendations should remove any thought that regular screening is controversial.”
Reference: Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung J, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021, article in press.
If you are a patient of Elizabeth Wende Breast Care, you will LOVE our new PATIENT CONNECT APP! You can easily access your appointments, documents, messages and manage your personal information including address, phone numbers, insurance information, and consent preferences. Android version coming soon!
It is important to develop a lifelong relationship with your breast imaging specialists dedicated to the early detection of breast cancer.
Most women of average risk will begin having annual screening mammograms at the age of 40. Current guidelines from the Society of Breast Imaging and the American College of Radiology state that patients should continue having annual screening mammograms as long as they are in good health, which for many could be well into their late 70-80s. This potentially means patients could have a 40-year relationship with EWBC! Every year for 40 years! But, WHY?
What is so important about coming to EWBC compared to going to another facility that also does mammograms? Aren’t all mammograms and radiologists the same? From the first time you call our office to schedule an appointment and step into one of our seven locations, you can tell why EWBC is different. Our professional and supportive staff is led by a team of highly trained breast imaging radiologists who double read every screening mammogram. All EWBC technologists are specifically focused on mammography, and our sonographers are specialized in breast ultrasound.
Our goal is to provide the type of care for our patients that we would expect our loved ones to receive. We take time to explain every step along the way and make sure you are as comfortable as possible. If you have an unexpected problem or concern, we can typically see you within 24-48 hours. Most importantly, we’ve invested in the latest technology to provide you with quick and accurate results. Our doctors go the extra mile to answer questions, review results and provide support. Whenever patients have a biopsy, they leave the office with the doctor’s cell phone number and are encouraged to call if needed. If you have a diagnosis that requires surgery or treatment, we are always available to answer questions.
We adhere to the recommended screening intervals set forth by the Society of Breast Imaging and the American College of Radiology. Their guidance allows us to remain focused on our patients and provide the most appropriate care for each patient. Our experience of opening the first dedicated breast clinic in the nation sets us apart.
In recent months, our patients have been receiving texts and emails from facilities other than Elizabeth Wende Breast Care (EWBC) stating they are due for their mammogram. This has confused patients as it is not yet time for their yearly appointment.
Please be aware of marketing emails or texts sent to you by other facilities suggesting you are due for a mammogram and take note of the medical facility sending that message.
Any communication regarding your scheduled appointment at EWBC will be emailed from email@example.com OR via text message.
You can always verify your past and future EWBC appointments on our patient portal or by calling the office at 585-442-2190.
We value you as our patient and thank you for choosing EWBC for your breast care needs.
For the past 28 years, Elizabeth Wende Breast Care (EWBC) and Cancer Services Program (CSP) has provided no-cost breast cancer screenings for uninsured patients.
Founded in 1993, CSP-FLR* is part of a larger statewide initiative run by the NYS Department of Health’s Cancer Services Program. CSP-FLR promotes age-appropriate breast exams for the uninsured and underinsured.
Services are provided through arrangements with health providers in each county, allowing screenings offered close to home.
The CSP-FLR does not perform the screenings but pays for clinical breast exams and mammograms. The program also pays for follow-up diagnostic exams if there is an abnormal finding during a screening. In the unfortunate instance that cancer is discovered, the program will enroll eligible patients into the Medicaid Cancer Treatment Program (MCTP) to fully cover treatment services.
EWBC has been a proud participating provider with the Cancer Services Programs across NYS since its inception. Over the years, EWBC has provided breast care for thousands of uninsured women. The physicians at EWBC volunteer a few Saturdays a year to screen, exam and work up patients with breast problems or concerns. This service is unique to the partnership between EWBC and CSP. as no other facility in the area offers CSP patients results and full diagnostic workup on the same day.
Elizabeth Wende Breast Care believes women deserve access to high-quality healthcare regardless of their barriers. Statistics have shown that people without quality health insurance delay receiving care, prolonging diagnosis, or negatively impacting prognosis. EWBC, along with the Cancer Services Programs in NYS, are committed to offering annual screenings to eligible women with the hope to find cancer at its earliest and most treatable stages.
Women with a family history of breast cancer, concerns about their risk, or issues paying for their screening mammogram should take advantage of this free event.
Saturdays 7:30 am until noon:
May 8, 2021 October 16, 2021 December 11, 2021 Other days available for your convenience. Give us a call to make an appointment that works with your schedule
Appointments at 585-442-2190
* The Cancer Services Program of the Finger Lakes Region (CSP-FLR) was formerly known as the Cancer Services Program of Monroe County and previously as the Women’s Health Partnership
Breast Cancer Facts
Breast cancer is the most common cancer found in women
1 in 8 women will be diagnosed with breast cancer in their lifetime
Starting annual screening mammograms at age 40 saves life. Despite this fact, depending on who you ask, confusing recommendations remain, with some organizations recommending delaying screening until age 50. The thing is, there is no scientific or biological reason that the age of 50 was selected as the age to begin screening. It is scientifically proven that breast cancer incidence increases substantially around age 40, with one in 6 women diagnosed with breast cancer being a woman in her 40’s.
Starting screening at age 40 results in the greatest mortality reduction, with current research proving between 30-40% reduction in breast cancer deaths since mammography screening became widespread in the early 1990s. Not initiating screening at age 40 would be detrimental to women in the 40–49-year age group. Their cancer would clinically present later as a palpable mass, more advanced in stage, and more difficult to treat successfully. As the goal of screening is to detect breast cancer early, it is imperative to screen at age 40 to give women the best opportunity for just that, early detection.
It is confusing for women when major health organizations present different guidelines regarding when to start screening and how frequently. But it is important to note that every major American medical organization with expertise in breast cancer cases (American Congress of Obstetricians and Gynecologists, American Cancer Society, American College of Radiology, National Accreditation Program for Breast Centers, and Society of Breast Imaging) all agree starting at age 40 saves the most lives. Updated breast cancer screening guidelines from the ACR and SBI (June 2021) highlight the importance of annual screening for all women.
Those in disagreement with this place more importance on the risks they perceive with mammography instead of the benefits. They worry about the anxiety a woman feels after a false alarm, such as a callback, or the potential for overdiagnosis, which identifies a tumor that may not advance during the woman’s lifetime and leads to unnecessary treatment. However, the research does not support these concerns. The anxiety women feel after a call-back is short-term, and in fact, research has shown that even after a call-back, women still support routine screening. The overdiagnosis theory is frequently overhyped, with the real overdiagnosis rate cited by experts as less than 10%.
Science at this time cannot tell for certain which small tumors will progress to deadly cancer versus some that will grow very slowly over time; therefore, all women 40 years and older should be screened annually. Mammography screening beginning at 40 results in the most lives saved and the most life-years gained.