Breast Health

FAQs

Mammography - The Only Proven Way to Protect Yourself Against Breast Cancer
When it's time for your annual mammogram, visit one of our Hawaii Pacific Health locations. Women can count on expert care with modern digital equipment, all in a peaceful, spa-like environment, complete with cotton robes and special touches designed with your comfort in mind.

What is a Mammogram?
A mammogram is a breast X-ray. Mammography is recommended as a regular screening examination to detect breast cancer in its earliest stages. Experts estimate that mammograms result in a 30% reduction in breast cancer death. You may be concerned about the long-term effects of regular breast X-rays. Recent advances in techniques and equipment have lowered the amount of radiation needed to produce a mammogram. A standard two-view mammogram of each breast requires less radiation than most routine dental X-rays.

The benefits of early detection

• A breast lump will be found in one in three women at some time during her life. While the majority of lumps found in breasts are benign, breast cancer is the second leading cause of death in women.
• One in eight women will develop breast cancer during her lifetime. When breast cancer is identified at its earliest most treatable stages, a woman's prospects for a healthy future increase dramatically.
• Mammography can identify lumps that are less than one centimeter in size. This is smaller than can be felt by even the most experienced breast exam practitioner.

Who Should Have a Mammogram?
The American Cancer Society and many physicians now recommend a mammogram every year if you are age 40 or older. Your physician also may recommend more frequent mammograms starting at an earlier age if:

• You have a personal history of breast cancer
• Your mother or sister has had breast cancer
• You have never had children or you had your first child after age 30
• You began menstruating before you were 11 years old

Are Mammograms Covered?
Both diagnostic and screening mammograms are covered by most medical insurance plans. Check with your insurance provider to verify your coverage.

Regular Physician Examinations
Starting at age 20, you should have your breasts regularly examined by your physician. The need for routine examinations will vary according to your family medical history, your age and your own uniqueness.

MRI
The American Cancer Society (ACS) recommends MRI in conjunction with mammograms for women at very high risk. MRI is not to be used in place of mammograms for breast cancer screening.

Who falls in the "very high risk" category?
According to the ACS, women who meet the following guidelines should have an MRI annually with their mammogram. Most plans cover this exam with at least one of the following criteria with a pre-authorization:

• BRCA1 or BRCA2 mutation
• First-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
• Lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
• Received radiation treatment to the chest between the ages of 10 and 30
• Has Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative

Why not use MRI to screen all women?
While it is true, MRI is more sensitive than mammograms, it is also more likely to detect abnormalities in the breast that may or may not be cancer. Often, the only way to make a definitive diagnosis is through biopsy. MRI results in more false positives than mammograms. Understandably, this leads to fear and anxiety for the patient, and many unnecessary biopsies. Thus, MRI is not recommended for a woman at average risk, and careful screening is important.

How can I get an MRI?
If you believe you meet the guidelines, please talk with your doctor first. If your doctor refers you for an MRI, a thorough history and evaluation will be completed to confirm that an MRI is appropriate before the exam is ordered.

Are you at Risk for Breast Cancer?
While all women are at risk, some are at increased risk due to family history or previous cancer. An ounce of prevention, the old saying goes, is worth a pound of cure. While there is no vaccine or "magic bullet" cure for breast cancer, early detection gives the best chance for successful treatment and cure since the cancer is detected before it has spread to other parts of the body.

While the cause of breast cancer is still unknown, there are some risk factors that increase your chances of developing breast cancer. One indication of increased risk is breast cancer in another family member - in a woman's mother, sister or daughter. Also, in recent years, research has identified other risk factors that suggest the need for a closer look and more frequent monitoring for some women.

High Risk Breast Program
Kapiolani's High Risk Breast Program is the first high risk program of its kind in Hawaii. The special monitoring program provides women with peace of mind and the satisfaction of knowing they are taking all reasonable steps to manage their risk. The program encompasses imaging services, physician and nursing services, genetic counseling and testing, nutritional counseling, psychological counseling, education and research.

To qualify, a woman must have at least one of the following risk factors: a first-degree relative (mother, father, daughter, sister) or multiple second-degree relatives (first cousin, aunt, uncle, grandparents) with breast cancer; any family history of ovarian cancer; a previous breast biopsy showing signs of atypical (abnormal appearing) cells, which are not cancer but need to be closely followed. Upon entering the program, the woman will complete a detailed questionnaire about her family health history and then will get a physical exam. She will then be assessed as to her specific risk and work with the team to develop a monitoring plan.

Patients will have the opportunity to meet with genetics professionals to help determine if they have inherited genetic risk factors. If indicated, further evaluation can be done with a simple blood test for the two genes associated with inherited breast cancer. Women with breast cancer will be eligible to take part in clinical drug trials offered in collaboration with the National Cancer Institute and the Cancer Research Center of Hawaii.

Kapiolani High Risk Breast Program: 1-808-535-7000