-
At what age should women begin breast cancer screening?
Screening programs vary in most countries. In Austria, the screening program begins at age 45. Participation is possible on request after age 40, but not earlier. After 40, women are entitled to a mammogram every two years.
-
Tell us about genetic testing?
Screening programs do not include genetic testing. The goal of screening is to detect breast cancer as early as possible. Genetic testing is used to determine whether a woman is at increased risk of developing breast cancer. Generally, the risk is about 12%. However, certain genetic mutations increase the risk by up to 80%. This means that two out of three women with a genetic mutation will definitely develop the disease.
For women with mutations, the screening process changes. Examinations begin at age 35 and are conducted every 6 months. Mammography and MRI alternate.
Some women with a genetic mutation undergo prophylactic mastectomy to reduce their risk. This is an extremely personal decision for each woman. As doctors, we never force patients to do it. This type of recommendation contradicts Austrian law. Women must make the decision themselves whether to undergo a mastectomy. Our only obligation is to inform them about the risks and prognosis associated with the procedure.
-
„Are you for or against breast self-examination? Specialists in the United States consider it an ineffective method.
In my opinion, it is important for women to perform self-examinations because they can feel lumps in their breasts. This does not replace mammography, but is an additional and harmless method.
-
How do breast cancer screening and prevention differ?
Screening does not prevent, but only allows for early detection of cancer. Prevention includes measures to reduce the risk of its development. For example, in women with high-risk genetic mutations, mastectomy is an invasive form of prevention.
We are using the special injection Prolia with the active ingredient denosumab (monoclonal antibody), administered every 6 months, to improve bone health and protect patients with genetic mutations. The connection is not absolutely clear, but a global study is being conducted in America and Austria to prove the hypothesis.
For women with mutations such as BRCA1 and BRCA2, we offer endocrinological treatment. When the risk of developing cancer is high on the Gail scale, we prescribe tamoxifen to reduce it. Data indicate that tamoxifen reduces the risk by up to 70–80%.
-
In the UK, the use of anastrozole has been approved for prevention in postmenopausal women at high risk. How does it compare to tamoxifen?
I do not believe that preventing breast cancer through endocrinological treatment is advisable. I do not prescribe this type of treatment, neither tamoxifen nor anastrozole, as the side effects are serious.
There are important lifestyle changes that women should adopt to prevent illness. Ladies should be physically active and maintain a healthy weight. Nutrition should be balanced and include little sugar and meat, and more omega-3s, fish, and vegetables. These measures are important in the prevention of all types of cancer. Last but not least, you should be happy, as happy people do not get sick as often. We do not know the reason, but statistics show that happy people get sick less often.
