Q: My mom had breast cancer when she was 45 years old. When should I start getting tested, and which tests are the best?
A: First, I hope your mom is doing well. I am sure having such history in the back of your mind can cause you to pause and take a deep breath on a regular basis. I would say, though, don’t worry. Instead, be proactive. The best combat we have for breast cancer is still early detection.
Generally we recommend beginning screening mammography 10 years early that the age of the youngest first-degree relative developed breast cancer, down to the age of 30 – so for you, that would be 35. However, if a woman is BRCA positive, or has other genetic high risk breast cancer markers, then beginning a program of breast MRI at 25 would be reasonable.
In addition, even at the age of 35, one should perform a formal risk assessment test. If you have over a 20 percent lifetime risk, you will benefit from a breast MRI as well. Some mammogram centers do such an assessment for no charge. There are also online versions that a woman can do at home. However, if you do one of these, please take the results to your primary doctor and discuss with him or her what they truly mean. There is a lot of bad information on the internet these days, and I would not want you to become unduly scared without having the proper meaning and proper context of your risk factor assessment.
Two risk model calculators that I trust are Tyrer-Cuzick (one of the most comprehensive) and BRCAPRO. You can ping both of these websites with a search engine to get more information and to take an online assessment that should be reliable.
A nice synopsis of this breast cancer risk and guidelines is available at auntminnie.com.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center. You can reach him at firstname.lastname@example.org.