October is Breast Cancer Awareness Month

In a world overflowing with COVID-19 testing and treatment news as well as speculation of when a vaccine will be available, maintaining regular health screenings, exercise plans and good eating habits are falling by the wayside.

National Breast Cancer Awareness Month provides a needed reminder that engaging in routine actions that offer optimal health outcomes is more important than ever as underlying health conditions are proving to worsen outcomes in unexpected health challenges like COVID-19. While we have limited control over the pandemic, we control our own actions such as getting an annual mammogram.

Finding breast cancer early and getting state-of-the-art cancer treatment are the most important strategies to prevent breast cancer deaths, so schedule your mammogram today if you have not already done so. According to the American Cancer Society, breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most critical factors in predicting the prognosis (outlook) with this disease.

The American Cancer Society guidelines for women at average risk for breast cancer apply to women who do not have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene) and has not had chest radiation therapy before the age of 30. Recommendations for those at average risk are as follows:

• Women between 40 and 44 have the option to start screening with a mammogram every year.

• Women 45 to 54 should get mammograms every year.

• Women 55 and older can switch to a mammogram every other year or choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

Women at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. This includes women who:

• Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history.

• Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing).

• Have a first-degree relative (parent, brother, sister or child) with a BRCA1 or BRCA2 gene mutation and have not had genetic testing themselves.

• Had radiation therapy to the chest when they were between the ages of 10 and 30 years.

• Have Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.

The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%. There is not enough evidence to make a recommendation for or against yearly MRI screening for women who have a higher lifetime risk based on certain factors, such as:

• Having a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH).

• Having “extremely” or “heterogeneously” dense breasts as seen on a mammogram.

If MRI is used, it should be in addition to, not instead of, a screening mammogram. Although an MRI is more likely to detect cancer than a mammogram, it may still miss some cancers that a mammogram would detect.

Most women at high risk should begin screening with MRI and mammograms when they are 30 and continue for as long as they are in good health. But a woman at high risk should decide to start with her health-care providers, taking into account her personal circumstances and preferences.

Mammograms

In recent years, a newer type of mammogram called digital breast tomosynthesis (commonly known as three-dimensional [3D] mammography) has become much more common, although it is not available in all breast imaging centers.

Many studies have found that 3D mammography appears to lower the chance of being called back for follow-up testing. It also seems to find more breast cancers, and several studies have shown it can be helpful in women with more dense breasts. A large study in which Feist-Weiller Cancer Center is a participating site is now in progress to better compare outcomes between 3D mammograms and standard (2D) mammograms.

Breast Cancer Research & Clinical Trials At LSU Health Shreveport, one of only 152 academic medical centers in the U.S., has been engaged in breast cancer research and clinical trials for over three decades.

Current breast cancer clinical trials include: 1) A study to determine if taking an aspirin can prevent cancer from coming back. Studies have linked aspirin with a lower risk of death from cancer.

You may be eligible for this research study if:

• You have completed chemotherapy and/or radiation at least 30 days ago.

• You are not currently using aspirin (including low-dose/baby aspirin) and have not used it for at least 30 days.

• You are between 18 and 70 years old.

• Your breast cancer has not recurred.

• You are not currently taking any oral or injectable blood thinners.

If you are interested in this study, please speak to your doctor and the members of your health-care team who can refer you into the study. If you have questions related to this study, email jmil12@lsuhsc.edu.

2) A study enrolling patients in the national TMIST (Tomosynthesis Mammographic Imaging Screening Trial).

This randomized breast screening trial will help researchers learn about the best ways to find breast cancer in women with no symptoms. It compares two types of Food and Drug Administration (FDA)-approved digital mammography: standard digital mammography (2-D) and a newer technology called tomosynthesis mammography (3- D). 2-D mammography takes pictures from two sides of the breast to create a flat image. 3-D mammography images are taken from different angles around the breast and then built into a 3-D-like image.

The goal of breast cancer screening is to find breast cancer early when it may be easier to treat. Researchers are doing this trial because they do not know if 3-D is better than 2-D mammography for breast cancer screening.

Another important aspect of the trial is to build a tissue bank for future research. All women who join the trial will be asked to submit tissue samples, such as blood and swabs of cells from inside their mouths. Researchers hope that the information from these tissue samples will help personalize the way we screen for breast cancer in the future by taking a person’s genetics and other personal risk factors into account.

Who Can Enroll in TMIST

Women ages 45 to 74 who are planning to get a routine screening mammogram are eligible for this trial. Women can also contact a participating site to ask about joining the study.

TMIST is supported by National Cancer Institute is coordinated by the ECOG-ACRIN Cancer Research Group. If you are interested in learning more about or enrolling in the T-Mist study at Feist-Weiller Cancer Center, please email hjohn3@lsuhsc.edu.

To learn more about the history of Feist- Weiller Cancer Center and its impact on the community, go to www.lsuhs.edu/fwcchistory

Dr. Gary Burton is board certified in internal medicine and medical oncology and is a professor of internal medicine at LSU Health Shreveport.