Breast cancer remains a significant health challenge—being the most diagnosed cancer among women in the U.S.—aside from skin cancer. As advancements in research and treatment continue to evolve, so do the guidelines for screening and risk-reduction strategies. Considering October is Breast Cancer Awareness Month, we asked local oncologists and medical experts to share their insights on the latest breast cancer screening guidelines, advances in treatment, and the importance of getting a second opinion.

SCREENING

Elizabeth Morris, MD, chair of the Department of Radiology at UC Davis Health, emphasizes the importance of early detection. The United States Preventive Services Task Force (USPSTF) recently revised its guidelines, recommending that women begin breast cancer screening at age 40, a decade earlier than the previous recommendation of 50. “The goal of breast cancer screening is to reduce deaths by detecting breast cancer early when treatment is more effective and less harmful,” Dr. Morris says.

This change in guidelines is particularly crucial when considering cancer disparities. While white women are slightly more likely to develop breast cancer than Black women, Black women are more prone to aggressive, advanced-stage breast cancer, and are often diagnosed at a younger age. They’re also 40% more likely than white women to die from breast cancer. To address these inequalities, Dr. Morris advocates for annual screening, especially for women over 40, to catch the disease in its early, most treatable stages.

For women with dense breasts, who represent about half of the population aged 40 and older, Dr. Morris advises considering supplemental screenings. Dense breast tissue can obscure small cancers on mammograms, making it harder to detect the disease early. Techniques like breast ultrasound, contrast-enhanced mammography, or breast MRI can be particularly beneficial in these cases.

TREATMENT

Breast cancer treatment has seen significant advancements in recent years, offering new hope for patients at various stages of the disease. Dr. Morris points out that at UC Davis Health, cutting-edge technologies like digital breast tomosynthesis and a high-resolution 3D breast CT scanner, developed by their biomedical engineers, are enhancing the accuracy of early detection.

“Once diagnosed, patients are often given a choice between mastectomy or lumpectomy, often with radiation,” Dr. Morris says. UC Davis Health is also pioneering minimally invasive techniques, including robotic-assisted surgery and “all-natural” breast reconstruction, which uses the patient’s own tissue for reshaping.

Targeted therapies have revolutionized the treatment of metastatic breast cancer, according to Dr. Morris. These therapies, tailored to the specific tumor type, can slow the growth of the cancer, allowing many women to live longer with the disease. Endocrine therapy, which blocks hormone receptors on cancer cells, is another critical component of treatment, particularly for hormone receptor-positive breast cancers.

Dr. Ramasubbaiah echoes the importance of personalized treatment, noting the use of CDK4/6 inhibitors for high-risk hormone receptor-positive breast cancer and immunotherapy for triple-negative breast cancers. “Breast cancer treatment is highly individualized,” she says. “And we routinely do next-generation sequencing in patients with advanced cancer to tailor therapy based on personalized DNA test results.”

Mari Williams, a breast/gynecological oncology nurse navigator at Dignity Health Cancer Institute of Greater Sacramento, highlights the impact of recent advancements, including genomic profiling, targeted therapies, and immunotherapy. “These developments collectively improve survival rates, reduce side effects, and enhance the quality of life for breast cancer patients,” she says.

REDUCE YOUR RISK

Reducing the risk of breast cancer involves a combination of healthy lifestyle choices and, for those with a family history of the disease, genetic testing. Dr. Morris emphasizes the importance of knowing your family history and considering genetic counseling if a close relative has had breast cancer. Women with BRCA1 or BRCA2 mutations face a significantly higher risk, with 55%-72% of women with BRCA1 and 45%-69% of those with BRCA2 developing breast cancer during their lifetime.

Dr. Ramasubbaiah adds that stress management, regular exercise, a healthy diet, and maintaining adequate vitamin D levels are all crucial in reducing the risk of recurrence and improving treatment outcomes. “Survivorship is extremely important,” she says, encouraging patients to listen to their bodies and not hesitate to bring up concerns with their health care providers.

Williams emphasizes the importance of regular screenings and self-exams, along with lifestyle modifications like maintaining a healthy weight, limiting alcohol intake, quitting smoking, and eating a balanced diet. “Breast cancer is often treatable and curable when found early,” she says.

SECOND OPINIONS MATTER

Given the complexity of breast cancer diagnosis and treatment, all three experts strongly recommend seeking a second opinion. “Patients face a lot of choices,” Dr. Morris says. “And it’s important that they feel confident they are being provided the best treatment options.”

Dr. Ramasubbaiah agrees, noting that a second opinion can confirm the initial diagnosis and treatment plan or offer alternative options. Williams adds that a second opinion is particularly valuable when exploring access to clinical trials or specialized treatment modalities available at tertiary care centers.

Breast cancer screening, treatment, and risk reduction strategies continue to evolve, driven by ongoing research and technological advancements. By staying informed and proactive, women can take crucial steps to protect their health and improve their outcomes in the face of this disease. 

QLARITY BREAST IMAGING

QTscan—the first non-invasive breast imaging technology that provides a true 3D image of the breast’s microanatomy down to a few hundred cells without compression or harmful radiation—is available in El Dorado Hills. FDA cleared and more accurate than mammography and hand-held ultrasounds at identifying certain breast structures, the technology is especially beneficial to women with dense breasts, those who need additional, follow-up imaging after a mammogram, or want the assurance and peace of mind due to a family history of breast cancer or genetic predisposition to the disease. Learn more at qbi.health. 

Rashmi Ramasubbaiah, MD, associate physician at Marshall Cancer Center and UC Davis affiliate, further supports these recommendations. She highlights the American College of Radiology’s (ACR) updated guidelines, which now recommend annual screening MRIs for women with a high risk of breast cancer, including those with a BRCA1 or BRCA2 mutation or a history of chest radiation. “MRI cannot replace a mammogram but serves as an adjunctive tool; each imaging modality provides unique means of cancer detection,” she says.

by KOURTNEY JASON

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