Mam-o-mammogram!

I wonder why it always takes a celebrity diagnosed with some form of disease or cancer or something to bring awareness to medical issues. Yesterday news spread like wildfire that E! reporter and reality TV star Guiliana Rancic has been diagnosed with breast cancer. What's most shocking about the news is that she's only 36 years old, four years younger than the recommended age for women to even have a mammogram. Interestingly enough, it was found incidentally by mammogram that was recommended she get prior to her third IVF procedure. If her doctor had never insisted on getting a mammogram (since IVF treatment involves lots of hormones which could potentially speed up the growth of certain breast cancers), then it wouldn't have been discovered until she was 40. Who knows how much it would have grown and spread by then?

But what makes her any different from the 1 in 8 women who are diagnosed with breast cancer? Nothing really, except that she has the ability to make her diagnosis public and bring more awareness to the issue. It also once again opens up a public discussion and debate over cancer screening. Patients are more confused than ever about health screening and tests. How often to get PAP smears, at what age to get your first mammogram, should men have their PSA tested, do you really need a flu shot..... How do you know what's really necessary and what's not? And if it is necessary, when and how often do you need to be tested? Well, since I've started out talking about breast cancer, and it is breast cancer awareness month, I'll provide some information on screening guidelines per the American College of Obstetricians & Gynecologists.

If you visit the ACOG website, you can find their most recent statement and position on breast cancer screening and mammogram recommendations. They state, "Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when caught early, The American College of Obstetricians and Gynecologists (The College) today issued new breast cancer screening guidelines that recommend mammography screening be offered annually to women beginning at age 40." It goes on to say, "Although women in their 40s have a lower overall incidence of breast cancer compared with older women, the window to detect tumors before they become symptomatic is shorter, on average. The five-year survival rate is 98% for women whose breast cancer tumors are discovered at their earliest stage, before they are palpable and when they are small and confined to the breast. If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms."


Now for women with a family history of breast cancer, the rules are a bit different. You may need to start having mammograms at an earlier age. It depends on who in your family has had it and at what age. I recommend discussing this with your physician, and you can decide together at what age it's appropriate to have a mammogram, or if you need any genetic testing done to test for the breast cancer genes - BRCA1 & BRCA2. Please keep in mind though, that only 5-10% of breast cancers are hereditary. So even if you do have a family history, it doesn't necessarily mean you carry the genes. 


As a medical student, I've done a lot of family practice rotations. The best part of family practice and primary care is being able to practice preventative medicine, meaning making sure patients are up to date on their vaccines, scheduling everyone a colonoscopy once they turn 50, and encouraging women to get their mammograms. So needless to say I've had to field a lot of questions surrounding what's important for cancer screening, particularly breast cancer. And as an (almost) doctor I think it's important to be well educated on the subject and be open to making clinical decisions along with your patient, not just making them for your patient. I want my patients to feel empowered and knowledgable and know that by having their yearly mammogram, they have control over their bodies and facing cancer head on!