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Play it smart in assessing breast cancer risks

Dr. Jim O'Donnell
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Dr. Jim O’Donnell is a long-time local physician who specializes in women’s health. After decades of treating women for breast cancer, he shares his observations about breast exams, genetic testing, hormone risks and lifestyle factors in this question and answer interview.

Dr. O’Donnell practices medicine at Glenwood Medical Associates.

Q: What is the first thing you want to say about women and breast cancer?



A: Over the many years of my career, women have said to me they don’t do breast self-exams or get mammograms because there is no family history of breast cancer, so they don’t have a risk. The first risk factor for breast cancer is having breasts, and family history may start with you. Be aware of that.

Q: So you advocate self-exams and mammograms?



A: Recently breast self-exams and mammograms have been downplayed, and I feel strongly such advice is inappropriate. First, women should know what their own breasts feel like, not just for finding lumps, but to know if there is anything that feels different in those areas as time passes.

Mammograms should start with every year or two when a woman is in her 40s, and then should happen every year from 50 on.

Don’t let anyone talk you out of having a mammogram. I’ve had numerous patients in their 40s whose mammograms picked up breast cancers. The anxiety around having the procedure done is minor compared to treating breast cancer. Women with higher risk factors can have a breast MRI, but it should be very specific.

Q: What about genetic testing for breast cancer?

A: If you do have it in your family history, then we do have to look at it. There are very definite genetic indicators.

Were there women in your family who had both breast and ovarian cancer? Have there been any young women in your family diagnosed with breast cancer? If so, that might call for genetic testing.

If there are two or more first degree relatives (a mother or sister) diagnosed with cancer under the age of 50, then you would qualify for genetic testing. But also realize that genetic testing is a Pandora’s box

Q: Do hormones add to breast cancer risk?

A: First, know that birth control pills have never been connected with an increased risk for breast cancer. Post menopausal hormone replacement use has shown a slight risk increase. Compared to other choices we make in our lives in regard to our bodies and our health, the increase in breast cancer from the use of hormones is quite small.

Q: It seems like every week there are new warnings about what can contribute to a woman’s risk of developing breast cancer. What have you seen in your practice in regard to such trends?

A: Keeping an ideal body weight and consistent exercise seem to decrease breast cancer risk. Use alcohol in moderation. Excessive use of alcohol can be harmful in many ways, so watch your consumption overall.

Understand that women with breast cancer are not allowed to use soy, but you would have to eat a lot of soy to really increase the estrogen load in your body. For women with post menopausal symptoms, soy milk and edamame might help and probably won’t increase risk. If you think you are doing something positive for yourself, you’re probably getting better.

Nothing in medical literature validates that the level of stress hormones is an issue in breast cancer risk, and personally I’m not overwhelmed that it’s an issue. But I do know that women who are worried about getting breast cancer may do more testing than is necessary, such as extra mammograms or biopsies. If you have a biopsy, it pushes you into a higher risk category. Don’t set yourself up for self-fulfilling prophecy.

Q: What is the big picture for each woman regarding this issue?

A: Trust your doctor with your level of concern, and let him or her guide you in the right ways to manage that concern.

You can’t do anything about your age or what your mother did. All you can control are your lifestyle choices, your level of vigilance, and your choice of a health care provider who will respond appropriately to your health care concerns.


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