Breast Cancer risk Assessment

Professor Jack Cuzick to address Breast Cancer risk assessment seminar in Dublin 

Since http://www.Beingdense.com began 3 years ago I have read numerous papers written by Prof Jack Cuzick, so I am just a little bit chuffed that he will be Guest Speaker an event in UCD Dublin, next week – organised by Breast Predict

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Eventbrite Risk Assessment in Breast Cancer(1)

Breast cancer risk assessment is an important area in Breast cancer screening and prevention and women should be encouraged to talk to their doctors about their own personal risk factors, including breast density.

The link below gives an insight as to why breast density needs to be seriously addressed by our Breast Cancer Screening Partners and the medical profession in general.

Please read the transcript below and share this post to increase education and awareness of this little talked about risk to women’s Breast Health.

The major breast cancer risk factor you’ve never heard of

Dr Mark Porter BBC4 looks at the major risk factor for breast cancer that you may have never heard of: breast density.

First broadcast on Inside Health, 9 August 2017.

The biggest risk factor Breast Density Link to Audio here

Professor Jack Cuzick Profile link here is Head of the Centre for Cancer Prevention at Queen Mary, University of London.

Karla Kerlikowske Profile link here is Professor of Medicine, Epidemiology and Biostatistics at University California San Francisco.

Transcript fom Dr Mark Porter’s Health Matters BBC4 Below….

Kerlikowske 

So we did the largest study that’s ever been done with over 18,000 breast cancer cases and over 200,000 women.  By and large breast density was the most important risk factor, whether you were pre-menopausal or post-menopausal.  Breast density accounted for over a third of breast cancers in pre-menopausal women and in post-menopausal women it was 26%.  Other risk factors, such as family history of breast cancer, less than 10% of breast cancer develops because of having those risk factors.  And I always give the analogy is if you get rid of smoking you would basically eliminate 70% of lung cancers.  And you can think of this in a similar way.  If all these women who had high breast density, if we could reduce them to have average breast density, in pre-menopausal women we’d eliminate the development of 39% of breast cancers and in post-menopausal women 26%.

Porter

And would the woman herself have any idea, assuming she’s not been told by the doctor, that she has dense breasts, is it related to size, to the nature of the breast, how they feel – can you tell externally?

Kerlikowske

You cannot tell externally, it really is a radiographic term.  So in the United States on every mammogram report we assign the assessment of breast density.  And in qualitative terms we put it in one of four categories.  Least dense, then there’s scattered fibro glandular densities, that’s – there’s a little bit of density but not much.  So those are both considered non-dense.  And then there’s the two dense categories, which is heterogeneously dense or extremely dense.  Because of that there’s now laws in 32 of our 50 states saying you have to tell the woman what her breast density is because we feel it is an important risk factor.

Porter

What determines breast density?

Kerlikowske

Breast density is primarily determined by genetics.  It’s estimated 45-60% of breast density is heritable and then that other 45% of breast density can be modified.  And one of the things that modifies it the most is ageing – after menopause there’s a slow decline in breast density.  Breast feeding is thought to reduce breast density.  Tamoxifen or drugs that prevent breast cancer can reduce breast density.

Porter

What proportion of women have dense breasts?  I mean this grade three or four, the ones that you’d be more likely to worry about.

Kerlikowske

If you look at the population that generally gets screening mammography, which is between age 40 and 74, it’s about half of all women.

Cuzik

It’s actually very common and really not known at all.

Porter

Professor Jack Cuzik is Head of the Centre for Cancer Prevention at Queen Mary, University of London.

Cuzik

In terms of the more common factors it dominates things like weight or like alcohol consumption.  It’s more important than things like hormone replacement therapy.  So it really is an important factor.  The problem with dense breasts is that it essentially makes, in some cases, the breasts completely white.  Now the way you would detect a cancer with standard mammography is to look for white spots on the breasts, so they’re completely hidden and you just can’t see them.

Porter

You get a sort of white out of the picture effectively.

Cuzik

You get essentially a white out, so you can’t actually always see cancers, they’re hidden by this whiteness, that’s called masking.

Porter

So not only are they at increased risk but actually if they do have an early cancer that it’s harder for a radiologist to spot, so it might be missed.

Cuzik

That’s correct, it might be missed yes.  And it’s very clear that it is being missed in many cases.  So there’s a lot of discussion about women who have dense breasts probably don’t get as much protection from a mammogram so they need additional screening – ultrasound screening, in some cases MRI screening.

Porter

And does MRI get round this sort of snowflake in a snowball problem of the cancer being whited out by the density?

Cuzik

Yes it does.  MRI uses a completely different mode of detection, it’s not x-rays, it’s magnetic changes in the breast.  And they don’t see the white, they can actually see through it.

Porter

What are we likely to see change in the UK as a result of this latest research?  I mean are women going to start being told whether they’ve got dense breasts or not?

Cuzik

There’s ongoing work that’s actually really very much been developed in Manchester really trying to report this back to women and it should really be part of an overall risk assessment.  We have a risk tool that integrates all of the other factors, like family history and weight and hormone replacement therapy use, and breast density’s a very major part of that.

Porter

We heard there about the four gradings of density and three and four being potentially the problem groups but obviously there are some women out there who are grade one, who’ve got less dense breasts than normal, does that mean that they’re at considerably lower risk than the average woman?

Cuzik

You’re right, they’re really are two aspects to this.  Some women have got dense breasts, they need more screening, more attention, some have fatty replaced breasts, it’s either fat or dense tissue, they need less screening and I think that will be a sort of political issue as whether or not we can tell women that they don’t need to be screened quite so often in some cases.

Porter

But if we’ve known that women with denser breasts are at higher risk I mean has there not been a case for looking at screening these women more often, more aggressively?

Cuzik

I think there is a case for that and that’s only now being recognised because the screening programme has been very much unless you’re at very high risk, based on family history, they’ve always been one size fits all and that’s something we hope to change.

Porter

What about the way that we screen these women, what does the research tell us so far, I mean you say that mammograms are difficult to interpret, should we be doing more tests routinely on women with breast density?

Cuzik

There’s a lot of interest, there’s a so-called new development called fast MRI in which you can do an MRI in about three minutes rather than a typical half an hour.  And this of course will bring the cost down.  One of the challenges of MRI is that it’s very expensive.  So bringing the cost down will make this much more attractive and I think quite a good option.  One of the interesting discoveries is that for women at high risk, where we offer preventive therapy, the benefits of preventive therapy can be measured immediately in terms of a reduction in breast density and that’s quite exciting because some women get big reductions in breast density and they’re the ones that seem to get the best response to these treatments.

Porter

And that’s using medications like tamoxifen is it – giving these high risk women – and you can actually see their breast density shrink along with their risk?

Cuzik

Absolutely.  It takes about six to 12 months for this to happen but rather than wait five years and hope for the best, which is what we do with these treatments now, we are beginning to get a signal at about six months as to whether the treatment is actually working.

 

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