Actress Olivia Munn was diagnosed with breast cancer two months after a normal mammogram. Unfortunately, this isn’t that unusual and mammograms can fall short when diagnosing younger patients.
After the reveal of Munn’s diagnosis, Dr. Aliabadi talked to Glamour about breast cancer risk calculation and diagnosis.
Are Mammograms Enough?
Women enjoy having their breasts squished between metal plates and X-rayed about as much as they like a Pap smear or having a cavity filled. That is to say, not at all. And yet the annual mammogram is a necessary ritual we all partake in once we reach a certain age, if not earlier.
There was a time—one not that long ago—when the breast cancer screening method was not routine. In the mid-1980s, right before the promotion of mammography screening became widespread, the death rate from breast cancer in the US remained unchanged for more than 40 years, according to The Journal of the American College of Radiology. Since 1990 it has declined by at least 38%. That’s attributed in large part to early detection with mammograms.
In the decades since, guidelines have changed and misinformation has swirled, but mammograms remain the gold standard for breast cancer screening. “Mammograms are the best tests we have for screening the general population,” says Elisa R. Port, MD, FACS, chief of breast surgery for the Mount Sinai Health System and director of the Dubin Breast Center. “They pick up about 85% to 90% of breast cancers, but they’re definitely not perfect.”
No, they are not. Olivia Munn, 43, highlighted this recently when she shared in an Instagram post that she was diagnosed with breast cancer just two months after a normal mammogram. “I wouldn’t have found my cancer for another year—at my next scheduled mammogram—except that my OBGYN, Dr. Thais Aliabadi, decided to calculate my Breast Cancer Risk Assessment Score,” she wrote in her post. “The fact that she did saved my life.”
Munn’s high score led to an MRI, followed by an ultrasound, and then a biopsy that revealed cancer. “Thirty days after that biopsy I had a double mastectomy.”
This whiplash is a common experience among breast cancer survivors. “In the past six weeks, I learned I am positive for a BRCA2 mutation, had stage 2 breast cancer, then had a double mastectomy,” wrote Today contributor Jill Martin in a personal essay last year. Like Munn, she had a normal mammogram just a few months prior that didn’t catch the cancer. It was an ultrasound and MRI, prompted by her genetic results, that led to her diagnosis and allowed the aggressive tumor to be removed by her surgeon, Dr. Port.
Martin’s and Munn’s stories are a reminder that a “clean” mammogram isn’t always enough, leading some women to make anxious calls to their doctors’ offices to calculate their own risk or ask if they, too, need additional screening. So we asked experts to break down how breast cancer risk assessments work—and why mammograms can sometimes fall short in younger women.
Understanding your own breast cancer risk
In her post Munn encouraged women to ask their doctors to calculate their own breast cancer risk assessment score, as her ob-gyn did for her. But what is the score, and how does it work?
According to Ruth Oratz, MD, breast medical oncologist at NYU Langone Health’s Perlmutter Cancer Center and clinical professor of medicine at NYU Grossman School of Medicine, the Breast Cancer Risk Assessment Tool—also known as the Gail model—calculates the statistical probability of developing breast cancer within the next five years as well as lifetime risk up to age 90. The risk goes up as we age.
You can use the online calculator on the National Cancer Institute website on your own. (In fact, since Munn’s post, the tool has received a “dramatic increase in visits,” NPR reports.) It takes about five minutes to complete and asks questions about reproductive health (like how old you were when you got your first period), whether you’ve had a breast biopsy, and your family history of breast cancer. While you may know the answer to most questions, others can be trickier; that’s why Dr. Port says it’s better to do it in the context of a doctor’s visit under the guidance of someone who knows the benefits and limitations of the models.
“Different breast cancer risk assessment tools are available online, but they are not all the same,” says Thaïs Aliabadi, MD, Munn’s ob-gyn and the host of the new She MD podcast. “Some may underestimate the importance of family history of breast cancer, while others might underestimate the lifetime risk in specific populations, such as African-American women.” It’s the reason why she’s now developing her own breast cancer risk assessment tool to provide women with a more comprehensive and accurate calculation.
“One out of eight women will be diagnosed with breast cancer in their lifetime, and 75% of these women have no family history of breast cancer,” says Dr. Aliabadi. “Given these facts, it’s crucial for every woman to know her lifetime risk of breast cancer.”
Why mammograms aren’t always enough, especially for young women
A clean mammogram followed by a breast cancer diagnosis two months later sounds alarming—but Munn’s case isn’t all that rare, Dr. Aliabadi says.
Remember: Mammograms pick up about 85% to 90% of breast cancers. “Mammograms may not pick up small tumors or subtle changes in younger women because breast tissue is denser in young women, hiding small abnormalities,” Dr. Oratz says.
That’s why women should talk to their doctor about the results of the mammogram and their individual risk factors to see if another screening method is needed. “Ask whether or not additional testing should be done—sometimes an ultrasound or sonogram is added to the mammogram,” Dr. Oratz says.
“Breast ultrasound is used as a supplemental screening tool, especially for women with dense breasts or those with specific concerns such as a palpable lump,” Dr. Aliabadi says. “Breast MRI can detect small abnormalities that may be missed on mammograms or ultrasounds and is typically recommended for women at high risk of breast cancer, such as those with a strong family history or certain genetic mutations.”
The MRI is the screening tool that’s most valuable for younger high-risk women, says Dr. Port. Patients who are BRCA positive may even start MRIs in their 20s.
The important takeaway, at any age: Talk to your doctor about all three tests for breast cancer and when, based on your personal risk factors and health history, you should begin screening.
You are your best advocate.
Approximately 7% of women with breast cancer are diagnosed before the age of 40—which is why Adriana Gini first dismissed the lump she felt on each breast at 33.
Eventually she saw her midwife for a breast exam. She learned she had dense breasts—a risk factor for breast cancer—but was told to “wait and see.” After pushing for a mammogram, and then an ultrasound, both of which came back inconclusive, she eventually had a lumpectomy to rule out cancer. Thankfully, she was cancer-free, but she learned she had atypical ductal hyperplasia, a precancerous condition that affects cells in the milk ducts and is associated with a higher lifetime risk of developing breast cancer.
“My [surgical oncologist] explained I have a 1% to 2% risk higher than everybody else every year of developing breast cancer,” she says. “So if 10 years go by, I have a 10% to 20% higher risk of developing breast cancer than people who don’t have this.”
It took trusting that something wasn’t right—and continuing to advocate for herself for more testing—but she’s now in a high-risk screening program alternating between mammograms, ultrasounds, and MRIs every six months for the rest of her life.
Donbavand’s advice: “You know your body better than anyone else.” She says, “If something feels off, if you find even the smallest something strange, don’t wait to get it tested. I’m alive today because I found that minuscule lump and had it checked out.”
Bottom line, says Dr. Oratz, “Power is knowledge. Be open and have a full discussion with your doctor about your breast cancer risk and your concerns.”
Read the whole article by Kyle Gilbert on Glamour.
Make Dr. Aliabadi your Los Angeles OB/GYN
A breast cancer survivor herself, Dr. Aliabadi is intimately familiar with how a diagnosis can turn your world upside down. Along with her warm, compassionate team, Dr. Aliabadi provides medical care and support to women in every stage of their lives, from routine exams to pregnancy, childbirth, and menopause. If you have questions or concerns about your breast cancer risk, we invite you to reach out to Dr. Aliabadi and her expert team.
Dr. Aliabadi has been a practicing OB/GYN in Los Angeles since 2002. She serves as an official gynecologist for many royal families and “celebrities,” as well as instructing Cedars Sinai Medical Center residents and medical students at the University of Southern California.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi is conveniently located for patients throughout Southern California and the Los Angeles area, near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles, to name a few.
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