When I blogged yesterday about Christina Applegate's revelation that she carried a breast cancer gene mutation, I didn't realize she was one of the lucky ones. Not in the sense that the actress inherited the BRCA-1 mutation, which greatly increased her odds of breast cancer, but because her doctor recognized early on that she was at increased risk because of her mother's history of the disease. She started having mammograms at age 30 and then switched to high-tech magnetic resonance imaging after having a biopsy last year that turned out to be benign. Applegate told ABC's Good Morning America that she credits her doctor's insistence that she get an MRI with saving her life because it caught the cancer at its earliest stage, before it spread into the surrounding breast tissue or lymph nodes.
Many women aren't as lucky. One reader E-mailed me yesterday that her doctor never flagged her as being at high risk even though she had an extensive family history of breast and ovarian cancer. She wasn't offered additional screening and didn't find out she carried a breast cancer gene mutation until after she was diagnosed with a moderate-size tumor. She wrote that she would have had a prophylactic double mastectomy years earlier had she known she carried the gene. (When Applegate learned, after her diagnosis, that she had the gene, she also opted to get both breasts removed.)
Though there are standard screening guidelines for breast cancer (like annual mammograms starting at age 40), they aren't one-size-fits-all and shouldn't apply to women with a family history of cancer or those who have other factors that give them a lifetime breast cancer risk of over 20 percent. Since gynecologists often lack the training to do the extra monitoring needed for those at high risk, those who are doing the job right often make referrals to a high-risk breast cancer center. Most hospitals designated as cancer centers by the National Cancer Institute have them—click here for a list—including the Huntsman Cancer Center at the University of Utah and New York-Presbyterian Hospital/Columbia University Medical Center. These centers have specialists like genetic counselors and radiologists who perform breast screening MRIs and offer enrollment in research studies. New York-Presbyterian, for example, offers the experimental screening technique called ductal lavage which draws fluid from the nipple to analyze cells for cancerous changes.
Most of us assume that our doctors will see any red flags waving when they take our medical history and will refer us on to these high-risk centers if necessary. Unfortunately, many doctors don't. So the onus is on us to demand more comprehensive care if we see the flags ourselves.