Posted by - J. Rand Baggesen, M.D.

As a male doctor, my female patients sometimes find my attention to breast health surprising. Well, maybe a little personal story will explain why I strive to be as informed on this topic as any in preventative medicine.

You see, family history is very important in anyone’s health profile. I am the father of two beautiful daughters whose medical predisposition is linked to their ancestors. My mother experienced both cervical and ovarian cancer in her lifetime, ultimately losing a long and difficult battle with reoccurrence a few years ago. My wife’s mother, whose husband is an OB/GYN, fought and beat breast cancer. I watched my sister lose the battle with breast cancer and die tragically at 28 years old from this second most common cancer death for women.

So how do I as a physician – and a father – help my patients and daughters understand the complexity of breast cancer screening and risk assessment? That is the topic of this month’s “High-Tech Health” column.

Screening for breast cancer has in large part been responsible for the 23.5 percent decrease in mortality from 1990-2000. There has been a lot of recent press regarding the effectiveness of various methods of early detection and screening. Women who are of average risk of breast cancer (no primary relatives with breast cancer/no genetic predisposition) are usually counseled by their physician to undergo the triad of a self breast exam, clinical breast exam and mammography.

Recent large-scale studies have questioned the appropriateness of each of these methods.

Self breast exams have been promoted by physicians (including this one) as an important part of the screening for breast cancer. A Cochrane Review (a study of medical literature regarding a particular topic) found self breast exams actually harmful, resulting in more biopsies and no clinical benefit. The Cochrane group recommended that women should not perform self breast exams and found the practice harmful.

Like so many complicated topics in medicine, some of the most adopted practices need to be questioned, and patients need to understand the limitations of common practice. Women, who choose to perform self breast exams need to follow accepted guidelines of examination, understand the limits of the examination and report any changes to their doctor. The most important factor in self examination has been shown to be the time dedicated to the exam, the average breast taking several minutes to examine lymph nodes, skin changes, nipple discharge and breast tissue lumps.

Clinical breast exams have a wide variation in clinical practice. As the pressures of modern medicine push physicians to see more and more patients, the time dedicated to each patient grows shorter and shorter. Thus accuracy suffers in our overburdened sick care system.

Mammography is the mainstay of radiographic screening and currently recommended by the U.S. Preventive Services Task Force (USPSTF) for women over 40 every 1-2 years. Many studies have been performed that question the effectiveness of mammography, but as the technology has improved, so has the accuracy. Modern high-tech centers utilize R2 ImageChecker computer-aided technology. This system compares the traditional interpretation of experienced radiologists to a computer analysis of the images. If any discrepancy is found, the images are reinterpreted and reviewed for better outcomes. This has resulted in improved detection of 23.4 percent in a large clinical trial.

While there is no current recommendation for breast ultrasound, the technique often is used to evaluate a palpable lump or other abnormality. There may be a role in the use of ultrasound for younger women or in women with dense breast tissue.

MRI technology has been used since the 1980s for screening of breast cancer. It has recently received a lot of press attention as its accuracy has improved along with advances in technology. Studies have shown greater accuracy using MRI versus mammography alone. MRI is recommended for high-risk women, women with previous history of breast cancer and women who carry the BRCA1 and BRCA2 genetic markers where traditional mammography and ultrasonography may not detect early disease.

There are several blood tests that can detect genetic predisposition and serum proteins secreted by breast cancer tumors. These are not recommended as screening tests due to cost and sensitivity.

About 4 percent to 8 percent of all breast cancers are inherited due to currently identifiable genetic markers. The best known of these are the BRCA1 and BRCA2 genes. Serum tumor markers are not yet cost effective for large populations screening, but for the cost of a manicure, they can perhaps give a signal that a more thorough investigation is warranted. CA27.29, CA15-3, CEA and CA125 are examples of cancer tumor markers that can be elevated due to breast cancer.

One risk often overlooked in breast cancer is surveillance after diagnosis and treatment.

We at the Executive Health Evaluation program understand that medical errors are the third-leading cause of death in America and provide a complete medical history in the form of the VitalKey to all of our patients. Best practices of medicine are constantly changing and breast cancer patients are exposed to both extremes of health care — too much and too little follow up. Using the Breast Cancer VitalKey (Pink Key), patients are able to benefit from controlling their own medical records’ history while having special content maintained by the Massey Cancer Center in a constantly updated format. The Pink Key VitalKey has functionality allowed breast cancer patients to control their follow-up appointments and other helpful tools to manage their disease and avoid the pitfalls of follow-up care that can contribute to delayed or inappropriate care.

The practice of true preventative care in relation to breast cancer would not be complete without comment on the importance of diet and exercise on cancer risk. Studies clearly show the benefit of a low-fat diet on multiple cancer types. Exercise is essential to good health.

J. Rand Baggesen, M.D. is the director of Executive Healthcare for the Executive Health Evaluation Program at CJW’s Levinson Heart Hospital, Central Virginia’s premier program for early diagnosis and prevention of heart disease, stroke and cancer. Dr. Baggesen attended the Medical College of Virginia and completed his residency in family practice at Chesterfield Family Practice, a VCU/MCV/Chippenham affiliated program. He served as chief resident and is currently an associate professor of medicine at the Medical College of Virginia. www.Executive-MD.com

At the Executive Health Evaluation Program at CJW’s Levinson Heart Hospital, they utilize an integrated approach to the early diagnosis of cancer. Utilizing the latest biochemical markers with the area’s finest radiographic imaging, they strive to provide for clients the promise of high-tech health, early detection and better outcome.

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