October is Breast Cancer Awareness month. One in eight women will be diagnosed with breast cancer during their lifetimes. The CDC identifies several breast cancer risk factors: age, genetics, breast density, family and reproductive history, a personal history of breast disease or cancer. and lifestyle. The list also includes gender, but one percent of annual breast cancer diagnoses in the U.S. occur in men.
Six years ago, I saw an online news article about the WISDOM study, which compares two approaches to breast cancer screening: annual mammograms versus a personalized screening plan based on a woman’s risk factors. I volunteered for the study because of my family history.
Participating changed how I thought about breast cancer and better understand my own risk. As a result of the study, I sought additional genetic testing and counseling. Through FORCE I learned about and joined other research studies and registries and found a term that describes my situation: I am a previvor.
Here are some of the things that I have learned:
We hear a lot about BRCA genes and breast cancer, but least six other genes are known to increase breast cancer risk; another 14 are suspected. We are still at risk even if we don’t have a breast cancer gene or family history. Discuss your family medical history with your doctor and ask to be referred for genetic testing if there is a history of cancer or other disease, or you do not know your family history. Genetic testing and counseling for those at risk is covered by many insurance plans, although co-pays or other costs may apply.
- Early detection is important. Discuss when you should begin screening with your doctor. Many organizations recommend that women at average risk begin annual screening mammograms at age 40. They are covered by insurance once every 12 months. Some insurance requires a specific waiting period, which means a woman’s mammogram is later every year.
- Just as breasts come in different sizes, they also vary in density, which is reported in our mammogram results. Women with dense breasts have a higher breast cancer risk. Mammograms of dense breast tissue are more difficult to interpret, so cancers may be harder to find.
- Women at higher risk for breast cancer may be referred for additional screening. However, Medicare and some insurance guidelines used to approve that screening do not mention breast cancer risk factors and are based on dated science. If you are denied additional screening, immediately appeal the decision. Your doctor’s office may help with the appeal.
- Laws that would improve screening and care for breast and other cancers have been repeatedly introduced in Congress since 2021. They would require Medicare and Medicaid coverage for genetic testing, risk-reducing surgeries, and additional screening for people with a personal or family history of cancer (7, 8). Both are languishing in committees.
Now that you know what I’ve learned, I hope you'll act. Discuss your family medical history with your doctor and ask to be referred for genetic testing if appropriate. Get your recommended breast cancer screenings. Consider joining a research study or registry—many only involve completing questionnaires and providing a saliva sample.
Finally, contact your elected representatives and encourage them to support legislation that expands access to genetic testing, enhanced screening, and risk-reducing care for those at risk of breast and other cancers.
Linda Zellmer is a retired science and government information librarian and an emeritus professor at Western Illinois University.
The opinions expressed are not necessarily those of the university or Tri States Public Radio.
Diverse viewpoints are welcomed and encouraged.