By: Kamilia Kozlowski, MD
It is amazing to me when I am speaking to women that they are surprised and unaware that 80 % of breast cancers that are diagnosed every year are in women that do NOT have a family history of breast cancer. I think the main reason is that family history is stressed so much in the media. Our statistics at KCBC support this fact as well.
So at what age should the average risk women start screening for breast cancer? There has been so much confusion with the recommendations of the U.S. Preventative Task Force under Obama Care stating that instead of starting at age 40, start at 50 and stop screening at 74. I was even surprised when the American Cancer Society changed their guidelines to recommend starting at 45 doing yearly until 54 and then every other year. Unfortunately, I am seeing physicians not recommending screening for their older patients. We diagnose women in their nineties with breast cancer.
Here is a summary of a study published by the American Journal of Roentgenology In May 2017.
Starting breast cancer screening at 50 means that up to 20% of breast cancers could be missed – offering more proof that women between the ages of 40 and 49 should be screened regularly.
Screening mammography guidelines published by the U.S. Preventive Services Task Force (USPSTF) recommend that women begin biennial screening at age 50, While the American Cancer Society (ACS) recommends annual screening starting at age 45 through age 55, with biennial screening thereafter. Both organizations do state that the decision of when to start screening is up to women and their healthcare providers to discuss.
But these guidelines are dangerous, according to a team led by Dr. Jenifer Pitman of Weill Cornell Medical College in New Your City. Pitman and colleagues conducted a study to determine how many cancers might be missed if women between the ages of 40 and 49 were not screened.
“Women in their 40s would probably be interested in knowing what might happen if they were to choose to follow one recommendation over another,” the authors wrote. We found “that during the study period (2014-2016) women in their 40s overall had 18.8% of screen-detected breast cancers – more than 60% of which were invasive… Increasing the risk of a later stage at diagnosis and thus a poorer prognosis.”
I can support whole heartedly and encourage all women from the age of 40 to have a yearly mammogram. This table is food for thought when reviewing the average risk women in the U.S. that is diagnosed with breast cancer.
Incidence of Breast Cancer
A Woman with Average Risk
(No Family History of Breast Cancer)
1 out of 64 – Forty Year Olds
1 out of 50 – Fifty Year Olds
1 out of 25 – Sixty Year Olds
1 out of 12 – Seventy Year Olds
1 out of 8 – Eighty Year Olds
Average Doubling Time of a Breast Cancer:
80 % of women diagnosed every year have NO
Family History of Breast Cancer.
The proper time interval for screening of All
Women over 40:
Knoxville Comprehensive Breast Center is bringing back bone densitometry (DXA) to our facility.
Many of our patients and referring physicians have asked us to bring this service back to KCBC and we have listened to you!
What is DXA?
A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. The National Osteoporosis Foundation recommends a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.
You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone density test. Some people also call it a bone mass measurement test. This test uses a machine to measure your bone density. It estimates the amount of bone in your hip, spine and sometimes other bones. Your test result will help your healthcare provider make recommendations to help you protect your bones.
Who should have a DXA?
The National osteoporosis Foundation recommends that you have a bone density test if:
you are a woman age 65 or older
you are a man age 70 or older
you break a bone after age 50
you are a woman of menopausal age with risk factors
you are a postmenopausal woman under age 65 with risk factors
you are a man age 50-69 with risk factors
A bone density test may also be necessary if you have any of the following:
an X-ray of your spine showing a break or bone loss in your spine
back pain with a possible break in your spine
height loss of ½ inch or more within one year
total height loss of 1½ inches from your original height
If you have any questions about whether or not you need a DXA, you should call your primary care physician or call KCBC at 865-584-0291 and we will be glad to help you.
Lymphedema is an incurable but treatable medical condition caused by injury, trauma or congenital defects in the lymphatic system.
When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, swelling results as an abnormal amount of protein-rich fluid collects in the tissues of the affected area.
Over time, lymphedema (especially if poorly treated) often results in number of complications including infections, disfigurement, pain, and disability. In fact, it may occasionally prove fatal to its sufferers. But while lymphedema cannot be cured, it can be very effectively managed, thus significantly reducing risk.
The recognized standard of care for lymphedema is Complete Decongestive Therapy (CDT). CDT comprises four interacting elements applied in two phases (acute and ongoing): manual lymph drainage (MLD), compression therapy, lymph drainage exercises, and skin care. Each of these four elements are interdependent and imperative to the overall success of treatment however the most basic element is the application of compression to the swollen body part.
Compression is to lymphedema what medication is to many other diseases – indispensible!
It is estimated that two to three million Americans suffer from lymphedema, possibly more. Due to a lack of awareness, information, and education (even within the medical community), lymphedema is often misdiagnosed or undiagnosed. Delays in diagnosis or treatment can result in rapid and unchecked progression of the disease.
Why This Legislation Is Needed
Currently, Medicare, and consequently many other policies, do not cover one of the critical components of lymphedema treatment, the medically necessary doctor-prescribed compression supplies used daily in lymphedema treatment. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition.
Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in Medicare statute (law). The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, hence the need for this legislation. Please visit and help support:
Lymphedema Treatment Products, Manufacturers we carry at KCBC:
The Cancer Risk Assessment Center at KCBC is here for providers or individuals to learn more about their cancer risk, ways to lower that risk, and provide genetic counseling and testing. Through a risk assessment, we examine information regarding personal and family history that can influence cancer risk. The results will allow us to develop a personalized treatment plan with the expectation of prevention and or early detection for cancer. Below is more information regarding cancer risk and risk factors:
What does cancer risk mean? Risk is the probability that an event will happen. When talking about cancer, risk is used to describe the chance a person will develop cancer.
What is a risk factor? A risk factor is anything that increases a person’s chance of developing cancer. Risk factors influence the development of cancer but usually do not directly cause the cancer. Some people with multiple risk factors never develop cancer, while others with no known risk factors do.
Knowing risk information and risk factors can help a person and providers make informed decisions regarding lifestyle and healthcare decisions such as cancer screening tests (like mammogram or colonoscopy), as well as what age to start screening tests, or if another intervention like surgery or medication is available to lower cancer risk.
Evaluation at the center is available to any person concerned about their cancer risk due to personal or family history. A comprehensive risk assessment may include genetic testing. If genetic testing is appropriate for the individual, then pre and post-test genetic counseling is completed. This counseling becomes critical in order for an individual to know the implications, benefits, and limitations to testing.
Many times in order for health insurance companies to cover genetic testing costs a person needs to be evaluated by a board-certified provider with experience and training in cancer genetics. This can include medical geneticists, physicians and nurses with additional training in genetics, or genetic counselors.
In the past year many changes have occurred regarding breast cancer screening. Multiple recommendations have been released from the American Cancer Society, National Comprehensive Cancer Network, US Preventative Services Task Force (USPSTF), and American College of Obstetricians and Gynecologists. Each agency has different ages to begin and end screening, as well as frequency of imaging. Some of this variability in screening is only in reference to women at average risk for breast cancer. The new recommendations from the American Cancer Society and the USPSTF are not intended for women who have a moderate or high risk for breast cancer. The problem this poses is whether both the healthcare provider and woman know her risk level for breast cancer?
Article by: Elizabeth Shieh
Where achieving and maintaining EXCELLENCE in patient care is a top priority
We are proud to be an ACR accredited facility
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ACR accredited in mammography-A mammogram uses special x-ray technology specially de-signed for breasts to detect abnormal growths or changes in breast tissue. It is currently the best defense against breast cancer, as the x-rays can detect tumors and growths in earlier stag-es than a breast exam alone. Woman age 40 and older should receive a screening mammogram annually. A diagnostic mammogram is usually performed when a woman has a problem such as a lump or pain or to investigate abnormal findings found on a screening mammogram.
ACR accredited in breast ultrasound-Although a mammogram can usually be effectively used to view and diagnose breast tissue abnormalities, there are circumstances where ultrasound may also be used such as on women with dense breasts. Also known as sonography, this type of ultrasound uses sound waves emitted via a microphone-like transducer that bounce off of breast tissues and are interpreted by a computer into black and white images.
ACR accredited in breast MRI-Specifically designed for use in breast screening and diagnostics, a breast MRI involves a specially-designed machine that provides high resolution photos while maintaining breast sensitivity and comfort. The MRI technology – or Magnetic Resonance Imag-ing – takes several photos of the breasts. Those photos are combined to generate detailed pictures of the breast. KCBC is the only facility in the Knoxville area to have the Aurora system designed specifically for breast imaging.
ACR accredited in stereotactic biopsy-A procedure used to diagnose a small mass or calcifica-tion’s seen with the mammogram. Other image guided biopsies such as MRI biopsies and ultra-sound biopsies are also provided at KCBC. Which type of biopsy is best for the patient will de-
The goal of screening exams, such as mammograms, is to find cancers before they start to cause symptoms. Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. Screening exams can find breast cancers when they are small and still confined to the breast.[pl_button type=”primary” link=”http://www.knoxvillebreastcenter.com/request-an-appointment/” target=”blank”]Request An Appointment [/pl_button]
Debra L. Monticciolo, MD, FACR, shares this list with patients, colleagues, family, and friends.
1. The most lives are saved with annual mammography beginning at age 40. Women in their 40’s account for about 40 percent of the years of life lost to breast cancer.
2. Screening saves more years of life for women who get screened every year rather than every other year.
3. The reduction in breast cancer mortality from mammography is significant and has been proven in multiple studies involving millions of women yet it is routinely understated in the press.
4. When presenting research results, being invited to screening is different from being screened. Not all women who are invited to screening actually go through with it. Population-based studies show that breast cancer death decreases by 25–31 percent among women invited to screening, but women who are screened will reduce their chances of dying of breast cancer by 36–48 percent.
5. Entities like the U.S. Preventive Services Task Force underestimate the benefits of mammography and overstate the risks. Radiologists are interested in saving the most lives.
6. Most false positives from mammography are resolved with only additional imaging. Less than 2 percent of women will be recommended to have minimally invasive needle biopsy as a result of screening.
7. Over-diagnosis has been overstated. Studies that properly account for lead time and underlying incidence trends show that the over-diagnosis rate is 1–10 percent, nearly all of which is ductal carcinoma in situ (the presence of abnormal cells inside a milk duct in the breast). The risk of over-diagnosis is small and is outweighed by the mortality benefits of screening.