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Burgess provides guidance on breast cancer prevention

With October being Breast Cancer Awareness month, it’s important to take the time each year to make sure we talk about the prevalence of breast cancer and the risks associated with it. 

Recently, well-known actress Angelina Jolie made national headlines when she opted to have a radical mastectomy as a preventative measure. 
I have had patients ask me in the wake of her story going public if I thought that was necessary. I say it depends on your family history and your risk of developing cancer over a period of time.  
Jolie did it because someone in her family had breast cancer and she took the BRCA test that shows whether or not you have the breast cancer gene. She is at an age now where she’s at higher risk of getting it. It’s a personal decision, but it’s not a bad decision if you know you have the gene that lends itself toward you getting breast cancer. You are saying that your life is worth more than your breasts. In some cases that’s a smart decision and in others, it’s a little overboard. 
Anyone who has significant family history and has different markers that can turn into cancer should consider taking the BRCA test. If you get the BRCA, you have two choices. You can follow up or go radical. If you are in that category, it’s a really good idea to take the test because it tells you not only how radical you need to be, but it tells you your children’s risk as well.
 If you have no family history or significant risk of breast cancer, insurance will not cover the test and it is very expensive. But the majority of the time if there is enough family history and risk, then insurance will cover it. 
As you age toward your 50s and 60s, if you test positive for the breast cancer gene, your chance of getting it is 50 percent. That’s when a radical mastectomy might be a good idea. In making a decision, your doctor should involve you and what your personal preference is, rather than saying ‘here is what you need to do.’ Every decision is personal and is based on your peace of mind.
Self exams
The most effective ways to screen for breast cancer on a regular basis are routine self exams and annual mammograms, which both play vital roles in early detection.  
You need to do a self-exam because you can notice subtle changes before your practitioner would notice them. Even in the age of advanced technology such as mammography, 30 to 40 percent of issues are still found by a self exam. I recommend not doing your self exam too often or you won’t notice subtle changes. Every three to six weeks is a good target. 
In the United States, the American College of Surgeons still recommends yearly mammograms beginning at age 40. But if you have a significant family history or a first-degree relative who developed breast cancer, you operate under a different set of guidelines. If your first-degree relative contracted breast cancer at a young age, then you need to start having mammograms at a younger age, for example. 
I have been asked if thermography is also a good option for detecting breast cancer, but it is not considered a substitute for mammography. It isn’t as good of a screening tool. It is sometimes used along with mammography, but it isn’t as sensitive or as specific to mammography when it comes to showing the appropriate things. 
Who is at risk?
Every woman is at risk. Family history is a risk factor, however most cancers are still sporadic. Family history is a risk factor just like not having kids, being older, being obese, or being on estrogen therapy are all risk factors. One in eight women will develop breast cancer. If you are a woman, you are at risk. 
As for men, breast cancer in men is so rare its 1 percent of all breast cancers. Breast cancer in men will most often present itself as a mass on one side vs. the other, so in that case, it’s very important you get that checked out by a mammogram and a surgeon. 
Bernie Burgess, M.D. is a board-certified surgeon and breast specialist with Franklin Surgical Specialists. He is also a credentialed physician with Williamson Medical Center in Franklin.

Posted on: 10/16/2013


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