What you should know about Breast Cancer Screening and how to cut your risk.

By Gray Bowen Swor, MD –

breast cancerOctober is National Breast Cancer Awareness month in the US.  It’s an opportunity to get the word out about breast cancer, screening recommendations and ways to reduce your risks.

Approximately 225,000 women in the US will be diagnosed with breast cancer in 2012. Three million women currently have a history of invasive breast cancer. The median age at diagnosis is about 60. Twenty percent of women diagnosed with breast cancer are under 50. Forty percent are over 65. Most importantly, 60% of women are diagnosed with early stage disease currently.1

What’s the big deal about screening—well, if you don’t screen for it, you often don’t find it at an early stage and therefore may miss the opportunity to cure it.

The 5 year survival rate for breast cancer patients has improved dramatically since the mid seventies. In 1975 it was about 75% versus about 90% in the mid 2000’s. The current 5 year survival rate for a woman with early stage breast cancer is 98%! This marked improvement in the past 30 years is primarily due to widespread mammographic screening as well as improvements in treatment—specifically chemotherapy and hormonal therapy.

Screening guidelines for various cancers are often confusing because there are several organizations issuing them. When in doubt, stick to recommendations by the most respected groups like the American Cancer Society, American College of OBGYN, and the American College of Surgeons. Although there is slight variation in recommendations there is a common scheme, which I will try to outline.

Breast Self-Exam (BSE)—Women >= 20 should learn a proper technique for self breast exam by a health care professional. It is ideal to perform BSE monthly but women should be cautioned that most breast cancers cannot be detected on exam. Therefore any breast abnormality should be reported to their health care provider.

Clinical Breast Exam (CBE) For women in their 20’s and 30’s a CBE by a health care professional is recommended at least every 3 years. In women 40 and older the recommendation is yearly, preferably prior to yearly mammogram. That way, if an abnormality is detected a special diagnostic mammogram and possibly ultrasound can be requested.

Mammogram—Mammography is the only imaging modality recommended for routine screening for breast cancer. Most organizations recommend yearly mammographic screening starting at age 40 (earlier if there is a family history of breast cancer). There is no age limit when screening should cease. Screening should be individualized and based on overall health status and life expectancy.

Some patients fear the radiation exposure from mammograms. The exposure is actually relatively low and the benefits of screening outweigh any potential harm. The radiation exposure from a mammogram is approximately 1/16th that of a chest CT scan.

Most health insurance companies will pay for annual breast mammogram screening after age 40. If you do not have health insurance, there are organizations that grant large sums of money for screening the uninsured like the Susan G. Komen foundation. It is required that grantees are able to provide screening as well as treatment if a breast cancer is detected.

MRI—Breast MRI is very helpful in women with a known breast malignancy to help define the extent of disease and to detect disease elsewhere in the breast prior to surgery. MRI should not replace annual mammographic screening. At this time MRI screening is only appropriate for women who are at high risk for breast cancer such as those with a known BRCA gene mutation or first degree relative with BRCA mutation.

Special note—Most breast cancers (90%) happen sporadically—that is, there is no family history. Only 10% are inherited.

Breast Ultrasound—Routine ultrasound screening is not recommended. The test is not very specific for breast cancer and is best used as an aid to an abnormal mammogram or abnormal breast exam.2

What can you do to help defeat breast cancer? Tell all of your friends and family about proper screening. The odds of curing breast cancer are much higher if detected early.

What can you do to lower your risk of developing breast cancer?

There are many things beyond our control, but there are some things we can do to decrease our risk of developing cancer. If your mother told you to eat ‘right’ and exercise—well, she was correct.

Diet—It has been well established that a healthy diet and healthy weight decrease the risk of many cancers. What is healthy? Generally, a low carb, low fat, high protein diet rich in fruit, vegetables, dairy and lean meat is best. Both quality and quantity are important. Interestingly, the better quality the food (basic fresh fruits and veggies) the more quantity you can eat! I always encourage people to choose organic meats, dairy and produce if possible. Learn what organic means and shop wisely. It is more expensive but better in the long run. Also buying local organic products helps support the local economy and is better for you.

Exercise—I’ve heard every excuse—and at one time or another I’ve given every excuse—why exercise is not feasible. We are all busy—work, family, home, friends etc….For some reason it is the hardest thing for people to incorporate into their lives—but once incorporated –the benefits are so obvious, it is easier to stay on track.

Exercise helps maintain a healthy body weight. Obesity is a huge epidemic (pun intended) in our country. Primarily due to fast food, a warped sense of what a serving size is, and lack of regular exercise. There is considerable evidence that maintaining a healthy body weight can lower your risk of cancer as well as other diseases like heart disease and diabetes.

Other known benefits include improving energy, ability to sleep, and overall sense of wellbeing. Regular exercise also reduces anxiety, depression, and stress as well as osteoporosis and symptoms related to menopause.

My personal tips for staying healthy:
1. Don’t allow bad food in your house. Period. If it is not there, you can’t eat it.

2. Plan your meals weekly.
a. Have a stash of organic meat in the freezer (chicken cutlets and veal scaloppini—cook up really quickly).
b. Buy a week’s worth of veggies on the weekend—take an hour and wash and chop them so they are ready to use. Store in zip-lock with a paper towel to absorb any remaining moisture. Figure out what keeps longest and save till the end of the week.
c. Always have olive oil, lemons, garlic, Parmesan cheese and a variety of spices on hand. You can make most any meat and vegetable taste great with a varying. combination of these ingredients. No need to get fancy at the end of a long work day—keep it simple—better for you and tastes great.

3. Try to incorporate exercise into your daily routine.
a. Bike or walk to work if possible.
b. Park far away from where you are going and use the stairs rather than the elevator.
c. Yoga is an amazing exercise for young and old. If you do not have time for a class—get a video and do it at home.

As women, we wear many hats during the day; wife, mother, worker, friend, home manager etc… It is much easier to meet the demands of daily life if you are maintaining a healthy weight, following a nutritious diet and getting plenty of regular exercise. In order to take care of the world, you must first take care of your most valuable resource…YOU!
1. American Cancer Society Journal : 2012 Statistics
2. American College of Surgeons Consensus Conference III: Image Detected Breast Cancer


Gray Bowen Swor, MD
Gray Bowen Swor, MD is a graduate of Virginia Tech. She received her medical degree from Eastern Virginia Medical School in 1990. Dr. Swor performed her Internship at the University of Louisville and completed her Radiation Oncology Residency at Duke University, where she served as Chief Resident in 1993.

Following residency, Dr. Swor was an Assistant Professor of Radiation Oncology at Van derbilt University. She subsequently returned to Duke University as Clinical Assistant in Radiation Oncology until 2000.

Dr. Swor was most recently the Director of Radiation Oncology at Lakeland Regional Cancer Center and was involved with the initial establishment of the radiation therapy facility there. Dr. Swor now returns to her home in Sarasota.

Dr. Swor is a board certified Radiation Oncologist practicing general adult Radiation Oncology with a special interest in breast cancer. She is a member of the American Society for Therapeutic Radiology and Oncology, the American College of Radiology and the American College of Radiation Oncology. She has been involved in cancer research and has authored several scientific articles and abstracts. Dr. Swor is married to
Dr. Michael Swor, a gynecologist in Sarasota. They are very active in the
Sarasota community and enjoy golf and sailing.

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