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With cancer rates soaring among young people, oncologists are pleading with Americans to monitor their risks with simple tests they can do at home.
The test that saved the life of actress Olivia Munn, who was recently diagnosed with breast cancer at age 43, is called a risk assessment tool, according to her gynecologist, eminent obstetrician and gynecologist Dr. Thais Aliabadi.
Speaking at Fortune’s Youth Cancer Summit this week, Dr. Aliabadi said it is used by oncologists across the country and is recommended for some people who are too young to be considered for mammograms.
While an inherited genetic mutation is often considered the most important factor in early-onset cancer, experts increasingly warn that there are a number of other factors that can largely determine risk.
This includes the woman’s age at her first menstrual period, age at the birth of her first child, and family history of breast cancer.
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Olivia Munn has revealed that she was diagnosed with luminal B breast cancer last year, after undergoing four surgeries in the last 10 months. She credited her obstetrician (here) for ‘saving my life’
Dr. Thais Aliabadi insists that the risk takes more things into account, such as the age of the woman during her first menstruation.
Breast cancer rates in people under 50 have increased over the past two decades.
A recent study of Canadian researchers found that over the past 30 years, breast cancer rates in 20-somethings have skyrocketed 45 percent.
All types of diseases have increased by a third in people under 50 in the last 20 years.
However, screening tools are rarely applied to women under the age of 40, leaving a gap that allows more women to fall through the cracks.
Such is the concern that the US Preventive Services Task Force recently lowered the minimum screening age to 40, rather than 50.
Dr. Aliabadi’s breast cancer risk assessment was able to pinpoint Olivia Munn’s risk, even though mammograms and other scans failed to detect the tumor.
The most popular risk assessment tool is the National Cancer Institute’s Breast Cancer Risk Assessment Tool. (BCRAT)sometimes known as the Gale model after Dr. Mitchell Gail, who developed it in 1989. The test can be accessed through the NCIBC website..
Dr Aliabadi said: “If you are tall, if you had children after 30, if you have dense breasts, if you have a family history, if you are overweight, you add up your risk factors and you get a risk score.”
‘If it’s 20 percent or more, that means you fall into the high-risk category and you have to start having the scans at 30, not 40, and you have to add MRI.
“That’s exactly what you did for me, Olivia Munn.”
About 12 percent of American women will be diagnosed with breast cancer during their lifetime, studies show.
And Dr. Aliabadi says it’s difficult to predict which women will be among that 12 percent.
He continued: ‘Olivia had a negative mammogram and ultrasound, but because her lifetime risk was 37 per cent, I added an MRI (a more detailed scan that can detect tumors in dense breasts).
‘All his friends were telling him why his doctor is so paranoid. And with my paranoia, she had three cancerous lesions in her right breast and one in her left breast.’
Women who begin menstruating at a younger age are exposed to estrogen for longer, making them more susceptible to cancer.
This also applies to women who go through menopause at an older age, as they are also exposed to estrogen for a longer period of their lives.
And pregnancy improves breast cells, making them more resistant to cancer. Having a baby at an older age reduces that protective effect.
The test takes into account age, age of first menstruation, age at birth of your first child (or has not given birth), family history of breast cancer (mother, sister or daughter), number of biopsies previous breast , number of breast biopsies showing atypical hyperplasia, and race/ethnicity.
Ms. Munn had a negative mammogram and ultrasound, but because her lifetime risk was 37 percent, Dr. Thais Aliabadi added an MRI.
While mammograms are recommended for women age 40 and older, the diy risk assessment tool It can be done independently at home at any age.
A high risk score is considered to be above 20 percent.
And with cancer rates in those under 40 rising, it can be a lifesaver. An MRI is generally not recommended as a screening test alone because it may miss some cancers that a mammogram would find.
But we know that what was lost has been found. Very high-risk women, like Olivia Munn, are recommended to have a mammogram or MRI every six months.
In addition to dense breast tissue, an MRI can detect small lesions and detailed information about a tumor, its size, shape and extent.
However, doctors are often reluctant to order MRIs because of the risk of detecting false positives: lesions that would never become cancerous.
MRIs can also be prohibitively expensive, especially if a person does not have health insurance.
Dr. Aliabadi says genetic tests that indicate whether a person has genes that could increase their risk would also be helpful.