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Who's At Risk And What To Do

This week, The Early Show co-anchor Rene Syler has been sharing her journey - from her family's struggle with breast cancer to the very real fears she faced while confronting her own breast-cancer scare.

She concludes Friday, National Mammography Day, with advice on who should get mammograms and how often.

On The Early Show, Dr. Alexandra Heerdt, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City, discusses microcalcifications, the warning sign on Syler's mammogram, and explains why it puts her at risk. The doctor specializes in patients at increased risk.

The dictionary of the National Cancer Institute describes microcalcification as: "A tiny deposit of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present."

The vast majority of microcalcifications don't require biopsy. It depends on pattern - irregular, clustering, suggestion of lump. Most breast cancer occurs in the milk ducts of the breast.

Syler has been diagnosed with hyperplasia atypia. Heerdt explains hyperplasia means there are two or three layers of cells. Atypia is when the cells become irregular. The progression ends when irregular cells fill the duct (D.C.I.S.) This is the first, non-invasive stage of breast cancer. The final stage is invasive breast cancer, when cells break through the duct walls and can then travel to the lymph nodes.

She says to Syler, "It's important to think of your breast as having a spectrum of changes. Initially, in the ducts, which are the tubes that run through the breasts, there is a normal, naturally, a single layer of cells, which is the growth of the breast. What happens with time is that they can overgrow and when they grow to a bigger size, then we call that hyperplasia. As those cells, though, change, and there are many things that can do that, we call that atypical. That's the condition that you have. That's something where we know you are now considered to be at higher risk for breast cancer."

The bottom line is being vigilant. Dr. Heerdt says the key is early detection. She says, "Every single study done has shown that mammography is our best tool for detecting cancer early."

The following are the suggested guidelines for getting regular mammograms:

Screening Guidelines:

  • Baseline mammogram at age 40
  • Yearly thereafter

High Risk Women
  • Baseline at 10 years before the youngest person in family diagnosed with breast cancer
  • Not before age 25
  • Consider ultrasound
  • Consider MRI

Even if you have a normal mammogram and normal ultrasound, you should still see a physician. If you have a suspicious lump or other suspicion, even if all the tests are negative, you should still consult your doctor. Women should also have a yearly exam by gynecologist.

A specialist should examine women at high risk. For denser breasts, consider ultrasound as a screening device.

Best mammograms can miss 10 percent of cancers, which is why ultrasound and MRIs are effective. But no tool is 100 percent effective.

Given Syler's diagnosis and the fact that both her father and mother had breast cancer, Heerdt says she is at increased risk of developing breast cancer over her lifetime. Heerdt recommends getting genetic counseling primarily because of father's history. She should be screened with MRI as well to pick up physiologic changes in the breast. And she also needs to be screened on a more frequent basis.

Statistics have shown for years that women of color are diagnosed less often with breast cancer but still die at a rate that is 30 percent higher than their white counterparts. Heerdt says though it is not clear why African-Americans tend to get cancer at a young age and why it tends to be more aggressive, she recommends women to be as knowledgeable as possible and adamant about asking for screening tests.

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