High-risk screening can catch breast cancer early
photo by: Contributed
Mammograms are one of the best forms of prevention and early detection of breast cancer. Women at average risk of breast cancer should begin mammogram screening at age 40, according to the latest recommendations from the U.S. Preventive Services Task Force.
Chelly Sumner knew it was time to have her first mammogram in November 2021. She was at average risk, so she’d scheduled her appointment and didn’t think twice when she had a conflict and needed to reschedule.
“When I went in for my mammogram, I had an assessment to determine my risk for developing breast cancer,” Sumner said. “My mammogram looked fine but I found out that my lifetime risk of developing cancer was 44%. I had two aunts with breast cancer, in addition to my mom having been diagnosed.”
One of the tools LMH Health uses to help prevent breast cancer is a lifetime risk assessment. Prior to a mammogram, you’ll work one-on-one with a mammography technologist to complete a risk assessment form. The team reviews the assessment to determine your risk of developing breast cancer. They use a number of factors to determine the risk, including your age, height, weight, breast density, family history and any previous genetic testing results for the BRCA 1 and BRCA 2 genes.
If the assessment shows you’re at higher risk, the next step is meeting with either Dr. Jennifer Hawasli, a fellowship-trained surgeon with Lawrence Breast Specialists, or an oncologist at the LMH Health Cancer Center who has training from National Cancer Institute-designated centers. They’ll verify the accuracy of the assessment score, go through another evaluation using other lifetime risk calculators to get a better overall picture of your risk, and then discuss your options.
MRIs are more accurate at catching breast cancer at a small size than a mammogram and are especially great for people who have dense breast tissue. Hawasli explained that for those in the high-risk group, meaning their lifetime risk is greater than 20%, MRIs have been shown to improve survival rates because cancers are detected at an earlier stage.
“The National Comprehensive Cancer Network (NCCN) recommends that people at higher risk have an MRI and a mammogram each year,” she said. “At LMH Health, we alternate every six months once established, but offer an MRI to be scheduled after the first appointment.”
Sumner followed Hawasli’s recommendation and returned to LMH Health for an MRI in March 2022.
“I really didn’t think anything would come out of it,” she said. “I was only 44. My mom was 77 when she was diagnosed, but I went and got checked out. That’s when they found something.”
The MRI discovered a mass, so the next step was for Sumner to undergo an ultrasound. When that was inconclusive, an MRI-guided biopsy was scheduled for April 11. She spoke with Hawasli beforehand to go over the risk factors and learn more about what to expect. Hawasli called the next day with the results.
“She told me the diagnosis and they’d found a very small 7-millimeter mass. Most of it had been removed with the biopsy and my prognosis was really good,” Sumner said.
Everything began to happen quickly after the mass was found and Sumner had a whirlwind of appointments within the first couple of weeks. She met with Dr. Jodie Barr, an oncologist with the LMH Health Cancer Center; Dr. John Keller, a plastic surgeon with Plastic Surgery Specialists of Lawrence; and a radiation oncologist.
Developing a plan
The Centers for Disease Control and Prevention has an analogy about locks and keys to help understand cancer treatment. There are three kinds of locks, or receptors — one is for estrogen (ER), one is for progesterone (PR) and the third is a protein called human epidermal growth factor (HER2). To get inside and destroy the cancer, you’ve got to use the right keys for the locks.
The team needed to learn what hormones Sumner’s cancer contained in order to develop a treatment plan. They identified Sumner’s breast cancer as a stage one invasive ductal carcinoma that was estrogen and progesterone positive and HER-2 negative. Barr said that diagnosis helped guide the treatment plan and determine whether chemotherapy needed to be administered before surgery.
In Sumner’s case, surgery was the first step. She chose to have a bilateral mastectomy, meaning that both of her breasts were removed.
“It was the right choice for me. I chose a bilateral mastectomy because of my age and not wanting to worry about a recurrence in the same or the other breast,” she said. “I wanted to have peace of mind.”
Sumner didn’t need to have radiation after surgery and is now on endocrine therapy. She will take a pill once a day for the next five to ten years to prevent recurrence of the cancer.
Advice for those at higher risk
Patients who have a higher risk of developing breast cancer may be referred to the LMH Health Cancer Center for additional care. The center is accredited by the National Accreditation Program for Breast Centers and is one of 11 hospitals in Kansas accredited by the Commission on Cancer. Patients may qualify for genetic testing, which looks for mutations in certain genes that are known to be linked to cancer.
“Our team follows the guidelines set by the NCCN. We’re able to draw blood right here in our offices to test for specific genes and panels. That saves lives because if we find a positive gene, we’re able to closely monitor and manage your care,” Barr said. “We essentially offer everything here that’s offered in the metro. The difference is that you get the answers you need while staying close to home for coordinated, efficient care with a personal touch. Studies show that people have better outcomes when they’re treated close to home.”
Sumner said she’s grateful for the care she received from the team at Lawrence Breast Specialists and the Cancer Center.
“Make sure you’re doing your monthly checks, yearly mammograms, following the team’s recommendations and advocating for yourself,” she said. “I got the best treatment at LMH Health and didn’t feel the need to go anywhere else. They can save your life.”
— Autumn Bishop is the marketing manager and content strategist at LMH Health.