Prevention & Screening | Johns Hopkins Aramco Healthcare
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Prevention & Screening

Breast cancer detected early, when it's small and hasn't spread, is highly treatable. Regular screening is the best way to find breast cancer early, often before any symptoms appear. Our comprehensive breast health program emphasizes prevention and early detection through screening, risk assessment, and education.

JHAH strongly advocates for breast self-awareness and regular mammograms as essential steps in breast cancer prevention.

JHAH Recommendations for Breast Cancer Screening

JHAH recommends that average-risk women aged 40-74 receive a mammogram annually. This screening is a crucial tool for detecting breast cancer early, when it is most treatable.

High-Risk Women Need Enhanced Screening

Who Is High-Risk:

  • BRCA1/2 or other gene mutation carriers
  • First-degree relative with BRCA mutation
  • Lifetime risk ≥20% by risk assessment models
  • Prior chest radiation therapy (age 10-30)
  • Personal history of breast cancer
  • Certain benign breast conditions (atypical hyperplasia, LCIS)
  • Dense breast tissue combined with other risk factors

Enhanced Screening Protocol:

  • Annual mammography starting at age 30 (or 10 years before youngest family diagnosis)
  • Annual breast MRI in addition to mammography
  • Clinical breast examination every 6-12 months
  • Consider risk-reduction strategies

Screening Methods

Our screening methods are designed to detect breast cancer early, often before symptoms appear. Regular mammograms and risk assessments are the best way to protect your breast health.

Digital Mammography

  • X-ray imaging of the breast
  • Can detect cancers 2-3 years before they can be felt
  • Brief compression of breast for clear images
  • Takes about 20 minutes

3D Mammography (Tomosynthesis)

  • Multiple images create 3D view of breast
  • Better detection, especially in dense breasts
  • Fewer false positives (fewer callbacks)
  • Slightly longer procedure
  • Preferred method when available

What to Expect:

  • Schedule when breasts are least tender (week after period)
  • No deodorant, powder, or lotion on exam day
  • Two views of each breast
  • Results typically within 1-2 weeks

For High-Risk Women:

  • Most sensitive screening method
  • No radiation exposure
  • Uses contrast dye (injected)
  • 30-45 minute procedure
  • Must be done at specific time in menstrual cycle
  • Used in addition to, not instead of, mammography

Benefits:

  • Detects cancers not visible on mammography
  • Especially valuable for BRCA mutation carriers
  • Better visualization in dense breast tissue

Limitations:

  • More false positives than mammography
  • May require additional biopsies
  • Not appropriate for everyone
  • More expensive

Supplemental Screening:

  • For women with dense breast tissue
  • No radiation
  • Can distinguish fluid-filled cysts from solid masses
  • Often used to evaluate abnormalities found on mammogram

Not a Replacement:

  • Does not replace mammography
  • May miss some cancers
  • Used as additional tool, not primary screening

Our medical oncologists specialize in breast cancer and are experienced in treating all types of this disease, including unusual and complex cases. They provide:

  • Chemotherapy
  • Hormonal therapy
  • Targeted therapy (HER2-targeted treatments)
  • Immunotherapy
  • Treatment of metastatic breast cancer
  • Precision medicine approaches

Know Your Normal

  • Become familiar with how your breasts normally look and feel
  • Notice any changes in size, shape, or texture
  • Report any changes to your doctor promptly

Changes to Report:

  • New lump or thickening
  • Dimpling or puckering of skin
  • Nipple changes (inversion, discharge, scaling)
  • Redness or swelling
  • Persistent pain in one spot
  • Changes in breast size or shape

Important: Most breast changes are NOT cancer, but all should be evaluated.

If an abnormality is found, our diagnostic imaging and biopsy services provide an accurate diagnosis, ensuring you receive the most appropriate care from the start.

Learn more about our Diagnosis & Testing services

Breast Density and Your Screening

Breast density refers to the amount of glandular and fibrous tissue compared to fatty tissue in your breasts. About 40% of women have dense breasts, which contain more glandular and fibrous tissue than fatty tissue. This is completely normal, but it's important to understand how density affects your screening and risk.

Why Breast Density Matters

Dense breast tissue appears white on mammograms, just like potential cancers do, making it harder to detect abnormalities. Additionally, having dense breasts is an independent risk factor for developing breast cancer. Radiologists classify breast density into four categories: almost entirely fatty, scattered fibroglandular densities, heterogeneously dense, and extremely dense.

Your Screening Plan for Dense Breasts

If you have dense breasts, we'll notify you after your mammogram. This doesn't mean you have cancer or need to worry, but it does mean we should discuss your screening strategy. You should continue annual mammography, and depending on your other risk factors, we may recommend supplemental screening with ultrasound or MRI to ensure we're getting the clearest possible view of your breast health.

 

Understanding Your Risk

Risk Factors You Cannot Change

  • Being a woman (99% of breast cancers occur in women)
  • Getting older (risk increases with age)
  • Inherited gene mutations (BRCA1/2, others)
  • Family history of breast or ovarian cancer
  • Personal history of breast cancer
  • Dense breast tissue
  • Prior chest radiation therapy

Risk Factors You Can Influence

  • Being overweight or obese (especially after menopause)
  • Physical inactivity
  • Alcohol consumption
  • Never having children or having first child after 30
  • Not breastfeeding
  • Use of hormone replacement therapy

Genetic Counseling and Testing

Genetic counseling helps identify whether you carry inherited gene mutations that increase breast cancer risk. You should consider genetic counseling if you were diagnosed with breast cancer before age 50, triple-negative breast cancer before age 60, or cancer in both breasts. It's also recommended for men with breast cancer, women with both breast and ovarian cancer, or anyone with a family history of breast, ovarian, pancreatic, or prostate cancer. If your family has a known gene mutation, genetic counseling becomes especially important.

The Testing Process

Genetic testing begins with a counseling session where we review your personal and family history. Testing requires only a simple blood or saliva sample to analyze BRCA1/2 and other cancer-related genes. Once results are available, our genetic counselors explain what they mean for you and your family, help you develop a management plan, and provide guidance on whether family members should consider testing.

Managing Positive Results

If testing reveals a mutation, we create a personalized risk management plan. This may include enhanced screening with mammography and MRI starting as early as age 25-30, risk-reduction medications like tamoxifen or raloxifene, or discussion of preventive surgery options. We also monitor for other cancers associated with your specific mutation, ensuring comprehensive protection for your health.

Prevention Strategies

While we can't eliminate all breast cancer risk, research shows that certain lifestyle choices and medical interventions can significantly reduce your chances of developing the disease. Our prevention program helps you understand which strategies may benefit you most based on your individual risk factors, empowering you to make informed decisions about your health.

Maintain Healthy Weight:

  • Especially important after menopause
  • Even modest weight loss can reduce risk
  • Combine diet and exercise

Exercise Regularly:

  • At least 150 minutes moderate activity weekly
  • Or 75 minutes vigorous activity weekly
  • Reduces risk by 10-20%

Limit Alcohol:

  • Even small amounts increase risk
  • If you drink, limit to 1 drink per day or less
  • Less is better; none is best

Breastfeed If Possible:

  • Especially if breastfeeding for 1+ years
  • Reduces risk for mother and child

Avoid Hormone Therapy:

  • If needed for menopausal symptoms, use lowest dose for shortest time
  • Combined estrogen-progestin increases risk more than estrogen alone

Don't Smoke:

  • Smoking linked to increased breast cancer risk
  • Especially in premenopausal women

Selective Estrogen Receptor Modulators (SERMs):

  • Tamoxifen (premenopausal and postmenopausal)
  • Raloxifene (postmenopausal only)
  • Reduce risk by about 50% in high-risk women
  • 5-year course of treatment

Aromatase Inhibitors:

  • Exemestane, anastrozole (postmenopausal)
  • Alternative to tamoxifen
  • Reduce risk by about 50%

Who Should Consider:

  • Lifetime risk ≥20%
  • LCIS or atypical hyperplasia
  • BRCA mutation carriers (though many choose surgery)

Discuss Benefits vs. Risks:

  • Side effects (hot flashes, joint pain, blood clots)
  • Individual risk-benefit calculation

Prophylactic Mastectomy:

  • Removes breast tissue to prevent cancer
  • Reduces risk by 90-95%
  • For very high-risk women (BRCA mutations)
  • Major decision requiring careful counseling
  • Reconstruction options available

Prophylactic Oophorectomy:

  • Removes ovaries
  • For BRCA mutation carriers
  • Reduces ovarian cancer risk
  • Also reduces breast cancer risk (removes estrogen source)
  • Usually done by age 40 after childbearing complete

Continue Your Care Journey

Prevention and screening are the first steps in breast health. Based on your screening results and risk factors, our comprehensive breast cancer services ensure you receive the right care at the right time.

Our Diagnosis & Testing team uses advanced imaging and molecular analysis when abnormalities require closer examination. For those at elevated risk, our Specialized Programs provide targeted expertise, from genetic counseling to enhanced surveillance protocols.

If treatment becomes necessary, our multidisciplinary team creates Personalized Treatment Plans using the latest advances in surgery, radiation, and systemic therapy. Throughout every phase, our Support & Survivorship Services help you navigate the practical and emotional aspects of your journey.

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