October is Breast Cancer Awareness Month and we had the opportunity to talk with Dr. Mariam Shehata, a breast radiologist who specializes in interpreting imaging of the breast and performs breast biopsies. Dr. Shehata completed both her undergrad and medical school degrees at the University of Washington and works at Inland Imaging, a partner of PacMed’s Women’s Diagnostic & Wellness Center, and The Polyclinic.

Breast cancer is important to talk about because it’s so common and affects so many lives. 1 in 8 women in the U.S. will get diagnosed with breast cancer in their lifetime and 85% of breast cancer occurs in women with no family history. While risk is greatest for women over 50, the incidence in younger women is rising. We talked with Dr. Shehata about early detection and screening, risk factors, and ways to reduce risk. Below is a summary of what we learned:

Early Detection is key:

• Self-screening: after your menstrual cycle is over, ideally at the same time each month, check your breasts and underarm area. Don’t forget the armpits! This is where your lymph nodes are located.
  • Symptoms to notice: the thickening or swelling of any part of the breast, a persistent rash, dimpling of the breast skin, any nipple changes (flaky skin, redness, nipple inversion, nipple discharge other than breast milk), or any sudden change of size or shape of breast.
• Screen every year with mammograms starting at age 40 for women with average risk, even if there is no family history. Most insurance companies do cover these mammograms, but check with your plan.
  • If you have a higher risk profile, you may need to be screened earlier. Discuss your risk with your doctor.

Where can I get a mammogram?

• Many clinics now and most hospitals offer mammograms. You can call your doctor’s office to see if they offer them onsite.

Risk of breast cancer increases with the following factors:

• If you have a known genetic mutation such as a BRCA1 or BRCA2. Talk to your Primary Care Physician (PCP) or OBGYN for a risk assessment. You may need to be screened earlier.  
• If you have a mother or sister who has been diagnosed with breast cancer.
• People with history of radiation to the chest prior to age of 30 may need earlier screening before 40.
• History of prior breast cancer or history of high risk lesions of the breast (non-cancerous).

How To Reduce Risk:

• Be physically active for heart and cardiovascular health.
• Drink in moderation or abstain from alcohol.
• If you are on or have been on Hormone Replacement Therapy (HRT), talk to your doctor to see if that changes your risk assessment.
• If you have a known mutation, talk to your doctor about ways you can lower your risk.

Final Takeaways:

Despite all our screening tools, Dr. Shehata reminds us that mammograms (and medicine) are not perfect. They are a screening modality, but it’s not 100% sensitive, so it’s good for patients to advocate for their own health. If there’s something persistent that isn’t showing up on the mammogram, continue to talk with your doctors.