Q&A Topic: Breast Health

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Karen Arthur, MD, FACS

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Q.  How do you define breast health? What role does it play in my overall well-being?

A. Breast health encompasses doing all you can do to reduce your risk of getting breast cancer, to find breast disease, especially cancer, as early as possible, and to treat breast disease appropriately, if it needs to be treated. To me, that means first knowing your risk of breast cancer. There are a number of computerized risk assessment tools that you can use. Next, it means discussing that risk with your healthcare provider, and determining a strategy for both risk reduction and early detection. It means knowing what lifestyle modifications you can choose as part of a risk reduction strategy, for example, maintaining a healthy BMI, exercising moderately at least 150 minutes per week (or 75 minutes per week of intense exercise), not smoking, and drinking no more than one alcoholic drink per day.

Q. How do I determine what is considered “normal” for my breasts?

A. Breasts come in all different sizes and shapes, and they all feel different. In fact, women often notice that their breasts feel different at different times in their menstrual cycle and certainly at different times of their lives. They change with pregnancy, with breastfeeding, and after weaning. They change as women get older, with breast tissue often being partly replaced by fatty tissue. One of the best ways to know what’s “normal” for you is to do breast self-exams, to become familiar with how your breasts feel. Sometimes, if women are anxious, it helps to do the breast self-exam with a medical provider who can help identify what is normal.

Q. When is it appropriate to consult my doctor?

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A. It is important to know your risk and discuss it with your doctor, perhaps as a baseline discussion at age 30.  At that time, you can determine when and how often to reassess your breast health strategies. Certainly, if your family history of breast or ovarian cancer changes, a discussion is important. In addition, if your breasts look different (a change in the appearance of breast skin or nipples), if you notice nipple discharge (clear or bloody), or if you feel a lump, which feels different from the lumpiness you normally feel, you should consult your medical provider.

Q. What screenings and diagnostic tests should I make sure I have?

A. The type and timing of screening and diagnostic tests is currently being discussed a great deal both in medical literature and in the general media. In 2009, the United States Preventive Services Task Force (USPSTF) updated their previous analysis and found a 15% reduction in breast cancer mortality in favor of screening with an even greater benefit for women over 60. But, the false positive rate was the highest with the highest rate of more imaging and unnecessary biopsies for women ages 40 to 49. Therefore, it’s important to look at the risks and benefits of screening. I support the American Society of Breast Surgeons recommendations, which are:

1. For asymptomatic average risk women (less than 15% lifetime risk): discuss with your doctor to consider screening mammography at age 40 to 44, based on a balanced discussion of risks and benefits. Annual screening with mammography for women ages 45 to 54. Annual or biennial screening for women 55 and older based on a shared decision making discussion regarding risks and benefits of screening timing. Biennial screening for women over age 75 if life expectancy is greater than 10 years.

2. For asymptomatic intermediate risk women (over 15% but less than 20% lifetime risk of breast cancer): consider use of annual screening mammography or recommend entry into clinical trials evaluating risk based screening.

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3. For asymptomatic high risk (20-25% or greater lifetime risk): discuss annual screening with both mammography and breast MRI.Types of screening need to be discussed with your doctor. Breast tomography shows promise in increasing the cancer detection rate and decreasing the false positive rate, especially in women with dense breast tissue, and multiple large screening trials are currently underway to determine recommendations for its use. Women with dense breasts also may benefit from screening ultrasound. Breast MRI is generally reserved for women with a high risk of breast cancer.

Q. Are there any other support tools that might be helpful in maintaining breast health?

A. The Breast Institute at NWH has just started a breast health program designed to help women navigate some of these issues. Women will undergo a computer assessment of their breast cancer risk, an assessment of their risk of having a genetic mutation to increase their breast cancer risk, an assessment of their current lifestyle, a clinical breast exam, and a review of breast self-exam. The risks and benefits of imaging will be discussed. Then, a personalized breast health plan is developed just for you.Board-Certified in surgery and a Fellow of the American College of Surgeons, Dr. Karen Arthur currently serves as the Medical Director of Northern Westchester Hospital’s Breast Institute at Yorktown. Before joining Northern Westchester Hospital as a breast surgeon, Dr. Arthur served as Chief of the Department of Surgery at the Westchester Medical Group, was Chief of the Department of Surgery at Northeast Permanente Medical Group, and was a partner at Southern California Permanente Medical Group. She also was a clinical instructor in surgery at the University of California–Irvine from 1979 to 1987.

Northern Westchester Hospital
Medical Director, The Breast Institute at Yorktown
Learn More About Dr. Arthur

Learn more about Breast Health

Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).

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