Assessing the Risks

I lie on an exam table as nurse practitioner Theresa Harrington Stukus uses the pads of her fingers to palpate each breast and armpit. The nonstop tapping reminds me of typing. I place my right arm above my head to spread the tissue as she examines my right breast; I do the same with my left arm when she moves to that side.

As she works, Stukus asks about my overall health and my sister’s post-cancer status. She has me sit up while she performs another palpation and listens to my heart and lungs. Then she steps back and studies the symmetry of my breasts as I raise both hands above my head and again as I lower them to my sides.

“We’re looking for redness, lumps, puckering, any irregularity,” she says.

The procedure, which lasts ten minutes, is similar to the exam a gynecologist provides. The difference is that the radiologists, oncologists, surgeons, and nurse practitioners at Ourisman specialize in breast care. The facility houses state-of-the-art equipment including high-resolution ultrasound and digital mammography; the computer images are thought to be more effective than regular film mammograms in analyzing dense breasts.

“The idea was to have all the diagnostic services a breast patient would need under one roof,” says Robert Warren, an oncologist and the center’s codirector.

On my last visit, Stukus circled areas of suspicion on both breasts with a pen—areas she especially wanted examined by the radiologist who would interpret my mammogram. I left looking like a human scratch pad. Today there are no marks.

“You didn’t draw on my breasts,” I say.

“I know!” she says with a laugh. “I didn’t find any lumps.”

The results are identical minutes later when Warren performs his own exam.

“Is it because my breasts are becoming less dense as I age?” I ask.

Warren shrugs, rubs his beard, and tells me my lump-free status could be due to any number of things, from the amount of caffeine I consumed to the phase of my menstrual cycle. “Maybe it’s just a good day,” he says.

A woman may note changes in her breasts throughout her life, according to the NCI. Many changes are due to hormones, such as when breasts feel lumpy or tender at different times during a woman’s cycle. Changes may also occur as a woman approaches menopause, during pregnancy, while breastfeeding, or when taking hormones such as the birth-control pill.

I take the pill to combat ovarian cysts. I’ve been on it for six years. Stukus suggests I stop the medicine next year, when I turn 50, the age most women enter menopause. If I don’t, she says, menopause may be unnaturally delayed and the estrogen in the pill may begin to act as a type of hormone-replacement therapy, which may increase my breast-cancer risk. I agree to her plan.

Having dense breast tissue or certain benign conditions such as complex fibroadenoma (noncancerous tumors) and atypical ductal hyperplasia (an accumulation of abnormal cells in a breast duct) can increase risk. So can having had previous chest radiation; starting menstruation before age 12 or entering menopause after 55; being obese after menopause; not having children or having them late in life; and having mutations to breast-cancer-susceptibility genes 1 or 2, known as BRCA1 and BRCA2.

My sister tested negative for both BRCA1 and BRCA2—which account for 5 to 10 percent of breast cancers—but it’s possible other genes linked to breast cancer exist and haven’t been discovered. Our mother died before genetic testing was available, but it’s unlikely she had the genes because women who do have them frequently develop cancer in both breasts. A woman who has inherited a mutation in BRCA1 or 2 is five times more likely to develop breast cancer, according to the NCI. She is also at increased risk for ovarian cancer.

Other factors are age and race. According to the American Cancer Society, one in eight invasive breast cancer cases is a woman younger than 45, while two out of three invasive breast cancers are found in women 55 and older. White women are slightly more likely to develop breast cancer than African-American women, but African-Americans are more likely to die of the disease. Reasons for this survival difference are unclear but, according to the American Society of Clinical Oncology, probably involve both socioeconomic and biological factors. Asian, Hispanic, and Native American women have a lower risk of both developing breast cancer and dying from it.

Women can assess their breast-cancer risk by using a simple risk calculator on the NCI Web site.