Under age 40? Don't ignore your breast cancer risk
SIOUX FALLS (Oct. 1, 2008) - While most women don't start thinking about breast cancer until around age 40 when mammography screenings begin, some confront the issue much earlier in life - as a woman at high risk, or as a woman with breast cancer.
Aimee VanHorssen of Sioux Falls became one of those women, when she learned her grandmother was a carrier of an alteration or mutation of the BRCA1 gene. Testing showed that VanHorssen tested positive, placing her at a 50 to 87 percent risk of getting breast cancer sometime in life. That was seven years ago.
As she recently approached age 35, she began thinking more seriously about her breast cancer risk, which would increase significantly at age 40. She and her husband, Brian, have four young children, between the ages of 11 and 4. "We realized that there really is no good time to get breast cancer, even if it happened when I was a grandmother," VanHorssen said.
After consulting with surgeons and oncologists, she opted to have prophylactic removal of her breasts with reconstructive surgery, as well as a hysterectomy, because the BRCA1 mutation also put her at higher risk for ovarian cancer. Now, after her surgery, her cancer risk is less than 5 percent.
The process was not easy - either physically or emotionally. Yet VanHorrsen doesn't regret her decision to have major surgery - even though she was perfectly healthy. "How many people get a heads up that they might get cancer someday? What a gift we had with this information. We didn't want to take the chance. It's a highly personal choice."
Dr. Amy Krie, oncologist at the Avera Cancer Institute, said an estimated 11,100 women under age 40 will be diagnosed with breast cancer this year. "Breast cancer is typically considered a disease of postmenopausal women, however, younger women can and do develop breast cancer." In her practice, Dr. Krie has seen breast cancer in women as young as 26.
Breast cancer is considered to be hereditary more often in younger women, and can be associated with alternations of the BRCA 1 or 2 genes.
Women with a family history of breast or ovarian cancer should start considering their risk of breast cancer earlier than age 40, Dr. Krie advised. She recommends a thorough discussion of family history with a physician.
Typical lifetime risk for breast cancer is one in eight, or about 12 percent. If lifetime risk is estimated to be 25 to 30 percent, mammography screenings may begin early. Another screening tool is breast MRI. Because it provides the clearest images available, the American Cancer Society now recommends breast MRI as a screening mode for high-risk patients.
Aside from early detection, the drug Tamoxifen can be used as a preventative treatment in women at high risk. "That's an individual decision, because there are risks with the drug itself. One has to balance the risks of the drug with the risks of getting breast cancer," Dr. Krie said.
Some women at high risk may choose genetic testing. Women who test BRCA positive may choose to have prophylactic removal of the breasts, as well as removal of the ovaries - if they are done having children. "These genetic mutations also put women at higher risk for ovarian cancer, which is much more difficult to detect," Dr. Krie said.
Treatment for breast cancer is most effective when it's detected early. "Unfortunately, there's often a delay in diagnosis in young women because we don't screen them," Dr. Krie said. Lumps can easily be passed off as fibrocystic breasts.
Women should be proactive when it comes to their own health. They should know their family history, and share this with their doctor. Any woman who feels a lump or notices a breast change should be persistent, and be her own advocate for further testing. "If you feel a lump, and your intuition is telling you something is going on, keep expressing this concern," Dr. Krie said.
October is Think Pink for Breast Health Month. For more information, go to www.AveraThinkPink.org.
