Olivia Munn, the 43-year-old actress, expressed gratitude to her doctor for uncovering her breast cancer, a diagnosis that eluded detection through a genetic test and mammogram. Despite obtaining an all-clear result just two months earlier, Munn’s OBGYN, assessing her disease risk considering family history, recommended further testing, leading to the early detection of luminal B breast cancer in both breasts. A double mastectomy ensued to prevent the spread of the cancer, which can become fatal if left untreated.
The Pitfalls of Mammograms and Genetic Tests:
Although mammograms are considered the gold standard for breast cancer detection, they can miss up to one in eight cases due to factors like tumor size and breast density. Dr. Christoph Lee, a breast cancer screening expert, pointed out that mammograms typically detect 87 percent of tumors but may miss up to 70 percent in cases of dense breasts. Meanwhile, at-home genetic tests, such as 23andMe and Ancestry, should not be relied upon for cancer detection. Munn’s negative test results, including BRCA, known as the “Angelina Jolie gene,” did not align with her subsequent diagnosis.
The Crucial Role of Breast Cancer Risk Assessment:
Munn’s OBGYN calculated her Breast Cancer Risk Assessment Score based on age, family history, and delayed childbirth, indicating a 37 percent risk. This prompted further testing, revealing luminal B cancer. Breast cancer is the most prevalent form of cancer globally, and early detection significantly improves survival rates. Luminal B breast cancer, accounting for 10 to 20 percent of cases, is considered more aggressive than other subtypes.
Challenges with Mammography Accuracy:
Mammograms, while sensitive, are not foolproof. The American Cancer Society estimates that they miss one in eight cancers, with sensitivity dropping in women with extremely dense breasts. Breast density, which is inherited, increases the risk of cancer and affects mammogram accuracy. Unfortunately, about 13 percent of breast cancers remain “mammography occult,” not visible on mammogram images, making early detection challenging.
The Limitations of Genetic Testing:
Genetic tests like 23andMe may detect specific genes but aren’t designed for cancer diagnosis. Dr. Lee emphasized that only a small proportion of breast cancers result from genetic mutations. While genetic tests provide information on familial risk, they cannot determine the exact cancer risk for an individual. It is crucial to consult healthcare professionals for comprehensive breast cancer risk assessments, considering family history and other factors.
The Call for Comprehensive Risk Assessment:
Dr. Lee stressed the importance of breast cancer risk assessments with OBGYNs or primary care physicians. Beyond relying solely on mammograms or genetic tests, individuals experiencing symptoms or with a family history of breast cancer should consider additional diagnostic measures. Diagnostic mammograms, breast ultrasounds, and screening MRIs can enhance detection accuracy, particularly for those with dense breasts.
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