Some women are “100 percent convinced” they’ll get breast cancer, says M. Michele Blackwood, M.D., director of the Center for Breast Health and Disease Management at Saint Barnabas Medical Center. Others are confident they won’t. In reality, says the doctor, neither group can be sure.
It’s impossible to know for certain who will get this potentially lethal illness. But risk-assessment tools are getting better at identifying women with a greater likelihood of contracting it. And that enables breast specialists like Dr. Blackwood to perform more frequent and targeted screening tests to better their chances of catching the disease early, when it is most easily treated and cured.
Still, she says, “risk is a very difficult thing for people to understand.” Actually, for the average woman, the chance of developing breast cancer is 12 percent. “Women say, ‘Everyone I know has breast cancer,’” says Dr. Blackwood. “The fact is most women will never develop breast cancer.”
But the danger is greater for some women. Those who carry the genetic mutation known as BRCA are more likely than others to develop breast or ovarian cancer. That mutation is often found in women of Ashkenazi Jewish descent, so that ethnic background is also considered a risk factor. Caucasian women contract breast cancer more often than others, but African American and Hispanic women tend to develop more fatal forms of the disease. Family history of breast cancer is a risk factor, of course; so are dense breast tissue, menstruation before age 12, menopause after 55, never giving birth, and other things. “They all factor into overall risk,” says the doctor. To help women more accurately assess their risk, the Breast Center at the Barnabas Health Ambulatory Care Center recently in- vested in a sophisticated computer program called the Hughes Risk Assessment Tool. Patients who come to the Breast Center use an electronic tablet application to input personal health history and data. The app, which actually combines four separate risk assessment models, calculates the woman’s risk and creates a printout that she can discuss with her physician.
“As a breast surgeon, I automatically run risk factors through my head and can guesstimate a woman’s risk with pretty good accuracy,” Dr. Blackwood says. “The computer can give very good statistical models of whether the patient will develop cancer.”
That knowledge helps the doctor create a plan of action for preventive screenings. “It also gives the patient a better chance of having more advanced screenings or genetic testing covered by her insurance,” Dr. Blackwood adds. One patient of hers, for instance, was a woman in her 40s of Ashkenazi descent who had dense breast tissue and whose mother and grandmother had had breast cancer. “She had never been told that she was high-risk and might have the gene mutation,” Dr. Blackwood says. “So I sent her for genetic testing.” If she is positive, she may consider prophylactic mastectomy. “If it comes back negative, I will still follow her for regular testing, possibly including advanced imaging such as an MRI [magnetic resonance imaging] or ultrasound.”
Another patient, who was also Ashkenazi with dense breast tissue but BRCA negative, did know she had about a 35 percent chance of developing cancer, and Dr. Blackwood has been following her closely for seven years. Her last mammogram revealed what turned out to be early-stage cancer, and she is having a mastectomy.
“There are also medications for high-risk women to reduce their risk,” Dr. Blackwood says.
The Hughes tool is available free to any woman who has a mammogram at the breast center. “If you do find you are high-risk, you should see a specialist,” she says. “If you’re not high-risk, you can still get cancer, so you still need regular screenings. Nothing in life, or in medicine, is 100 percent accurate, and finding out one’s risk can be daunting to some women. But I feel that knowledge gives you power. When you learn something, you can do something about it.”