Breast Cancer Prevention (cont.)
What is the risk of radiation with repeated mammography screening over the years?
With modern mammography equipment, the amount of radiation exposure is
extremely small. Although there is no level of radiation without some
theoretical risk, there is no evidence of increased breast cancer risks from
mammography performed in the recommended manner. Furthermore, the benefits of
early detection far outweigh these theoretical concerns.
Are there any controversies in the area of breast cancer screening?
There is debate over the issue of mammography screening
in young women, as discussed previously. There is also the issue of the
emotional trauma of
receiving false positive mammogram reports (mammograms that show abnormal
changes in the breast that subsequently prove to be non-cancerous). However,
after evaluating women who have gone through this process, there does not appear
to be a lasting problem.
There is also no standard recommendation for screening women with high risks
such as women with a positive family history of breast cancer or those who have
inherited defective BRCA1 or BRCA2 genes. After careful counseling, some
patients with BRCA mutations may eventually elect to undergo preventive
mastectomy to reduce
the risks of breast cancer. For those patients who elect monitoring, it is
generally accepted that more frequent breast clinical
examinations and perhaps, periodically, more involved imaging (ultrasound and
MRI) are the minimum measures.
How helpful are BRCA1 and BRCA2 genetic tests in identifying women at risk?
In special circumstances, genetic tests can be very
helpful both in identifying exceptionally high-risk patients and reducing the
level of concern for others. We also now know that the presence of one of these
genetic defects does not cause cancer in every patient. The cancers that do occur may also
behave somewhat differently than non-BRCA-associated tumors. There is some
evidence that they have a better outcome.
Before genetic tests are conducted, individuals being tested must have
thorough counseling. A clear understanding of the limitations of the tests and
the problems they may pose must precede the testing. The patient must know the
meaning of the possible results, whichever way they may turn out, before
testing. They should also have settled on a plan for each possible outcome of
the test results. Often, the best way to evaluate a potential genetic risk is to
test a relative who has already been diagnosed with breast cancer. If the
relative's genetic testing (which must cover a large number of possible
mutations) proves negative, then there is no need to perform genetic testing on
the concerned individual. But the concerned individual should still undergo
close monitoring with breast examinations and mammograms. If the test is
positive on the relative, then that specific mutation is the only one that needs
to be checked in the concerned individual and the other family members.
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