City of Hope uses the most state-of-the-art lab techniques and imaging strategies to screen patients and, should breast cancer be found, creates personalized treatment plans. An accurate and thorough diagnosis is essential. Monique White-Dominquez, D.O., assistant clinical professor in the Division of Hospital Medicine, Department of Medicine at City of Hope, specializes in breast cancer screening.
The Current Screening Guidelines
Patients may hear different recommendations from the media, the American College of Obstetricians and Gynecologists, and other professional organizations regarding breast cancer screening. White-Dominguez recommends beginning screening at age 40 with mammograms “usually every one to two years, based on the woman’s risk factor. It could start earlier based on if they have a strong family history or genetic predisposition.”
Mammograms and Self-Exams
The No. 1 mainstay for breast cancer screening is still the mammogram. Clinical breast exams are important, too, but the latest Pap smear recommendations have actually created some confusion. “The current recommendation for women between 30 and 39 is to have a clinical breast exam annually. Now, many women used to do this every year at the same time as their Pap smear,” White-Dominguez explained. But, because Pap-smear guidelines have changed, many now get Paps three years apart. “But clinical breast exams by a licensed professional are supposed to be annual, and your breast self-exams should be done monthly,” she said.
For most women, performing an effective self-exam requires teaching yourself the correct technique. “Start with lifting your arm up and begin searching in a circular motion, feeling the breast,” White-Dominguez said. “There’s a pattern in which to do so. Look in Google Self Exams, you’ll be able to see, and everything’s on YouTube. It’s about really feeling your breasts completely. It’s all about quadrants: going from the nipple out to the axilla, or the armpit.”
Other Forms of Screening
Genetic testing can help determine if a woman is at high risk for breast cancer. If there is a history of breast cancer in a patient’s family, an ultrasound is recommended. “Though it is expensive and sometimes limited by the terms of insurance coverage, we may do a breast MRI, with ultrasound used as an adjunct,” White-Dominguez said.
Another exciting new form of mammogram requires radiologists with special training, “The 3D mammogram adds sensitivity and can see areas that wouldn’t have necessarily been picked up with the regular mammogram. This is another procedure that not all insurance companies cover, but is very effective,” White-Dominguez said.
The Basics of Breast Cancer Prevention
White-Dominguez recommends that women stay up-to-date and committed to a responsible schedule of testing. “The woman is the No. 1 proponent of her own health,” she said. “A breast self-exam every month is critical. An average-risk woman should proceed with the current screening guidelines, including an annual mammogram starting at age 40.”
Early detection is key, especially if a woman has cancer in her family history. “High-risk individuals should undergo genetic testing as soon as possible,” White-Dominguez said. “It’s a simple blood test. Screening is helpful for everyone: low-risk, average-risk and high-risk. I urge women to have this discussion with their physician or their licensed health care provider. I’m passionate about screening.”