When Yaffa Leah Field was in her late 20s, she decided to undergo genetic testing.
Her grandmother had been diagnosed breast cancer, and Field wanted to know whether she was among the one of every 40 Jewish women of Ashkenazi descent with either the BRCA1 or BRCA2 genetic mutations, which make them extra susceptible to breast cancer.
If she had one of those mutations, her chances of developing breast cancer by age 70 would be roughly 50% in her lifetime. The test came back negative.
Though temporarily relieved, Field knew that her breast cancer risk is not limited to those with genetic mutations. Roughly one in eight women will develop the disease in their lifetime, and men, too, can have breast cancer. Close monitoring is essential. For women, that means not only regularly checking their breasts themselves for lumps or abnormalities, but getting mammograms.
Field, who works at Sharsheret, the national Jewish nonprofit that offers education, counseling, and support to women facing breast and ovarian cancer, got her professional start as a physician's assistant, so she knew about the importance of screening.
In 2023, a panel of experts serving on the United States Preventive Services Task Force revised earlier guidelines and changed the recommended age that women get their first mammograms to 40, from 50, and suggested that they continue to have mammograms done once every two years. It's not the first time the recommendation has changed.
"In 2016, the US Task Force changed the guidelines from 40 to 50," said Dr. Caryn Gamss, a radiologist at Murray Hill Radiology in Manhattan and member of Sharsheret's Medical Advisory Board. In her practice, she adheres to guidelines from the American College of Radiology that recommend starting yearly screenings at age 40 provided a person has no risk factors.
"Fifty is too late," Gamss said. "People need to think about it younger instead of waiting and then finding out, 'My mother had cancer, my grandmother…'--and they show up at 40 and have cancer, too."
She recommends all women undergo a breast cancer risk assessment by age 25, which entails answering a panel of questions about family and medical history to help doctors determine when and how individual patients should be screened. At-risk women should start their 30s armed with information and a plan.
"If breast cancer has been diagnosed at a particular age, you want to start screening 10 years before that," said Peggy Cottell, Sharsheret's Genetics Program Manager.
In order for doctors to interpret mammograms properly, two specific views of each breast are required. Sometimes doctors observe a change in appearance from the prior year or a fold in the skin; other times the original image failed to capture the necessary view. For some younger women and those with dense breasts, a mammogram may not suffice; doctors may require an ultrasound or MRI to examine the breast adequately.
Field had her first baseline mammogram at age 40 in 2020, just as COVID-19 hit. "It started a roller coaster of diagnostic testing. I wound up with eight biopsies, and, in the end, I had a bilateral mastectomy," she said. "I feel thankful it was found very early."
Her advice: Know your body and your family history.
"Breast cancer doesn't just affect women 40 and older," Field said. "Know your potential risks. Empower yourself to know what you need to be aware of. It shouldn't be a shock. Be appropriately proactive. Most importantly, when you reach the age when it's recommended, get screened. It may be uncomfortable for a few minutes, but it'll give you peace of mind."
Women seeking guidance are encouraged to call
Sharsheret
at 312-767-2045 to connect with therapists and genetic counselors.
This article was sponsored by and produced in partnership with Sharsheret, the national Jewish breast cancer and ovarian cancer organization.
Contact the
Norton and Elaine Sarnoff Center for Jewish Genetics
to learn more about hereditary cancer risk and considerations regarding cancers that disproportionately impact the Jewish community: jewishgenetics@juf.org 312-357-4718.
