By Erin Tech
While family history is a risk factor for breast cancer, well more than half of breast cancer cases occur sporadically and are not hereditary, said Dr. Helen Krontiras, who provided the Dr. Joe W. and Virginia Hursey O’Neal Endowed Lecture for the College of Community Health Sciences on May 2.
Krontiras, a breast surgical oncologist and Medical Director of the UAB Multidisciplinary Breast Clinic in Birmingham, Alabama, spoke about the importance of prevention and early detection of breast cancer. She is also co-Director of the Breast Cancer Prevention and Risk Assessment Clinic at UAB.
The endowed lecture was created by Dr. Joe O’Neal, a long-time Tuscaloosa surgeon, to support the teaching of breast cancer prevention and early detection and to honor his wife, Virginia Hursey O’Neal, who died from breast cancer in 2001.
Krontiras said early detection of breast cancer has improved because of better screening.
Mammograms, which provide an x-ray picture of the breast, can be used to check for breast cancer in women who have no signs or symptoms of the disease, or to check lumps or for other signs of breast cancer. But there are limitations, Krontiras said, as a diagnosis via mammogram is more difficult for women with dense breasts. In 2013, Alabama passed the Breast Cancer Prevention Education Act, which requires that patients be informed of their breast density.
MRIs, for example a Tomosynthesis Mammogram (3-D), allows radiologists to evaluate the breast one “slice” at a time, Krontiras said. The method improves cancer detection rates and lowers screening “call backs,” she said.
For patients who can’t have an MRI, contrast-enhanced spectral mammography provides the next best means of screening, she said.
With increased screening, however, comes the potential for overtreatment, Krontiras said. Studies have shown there is the possibility for overtreatment in regard to ductal carcinoma in situ (DCIS), which is the presence of abnormal cells inside a milk duct in the breast and considered to be the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn’t spread out of the milk duct to invade other parts of the breast. Some studies have suggested not taking action for DCIS.
Because “finding cancer early does not always save lives,” Krontiras said prevention is important. She recommends breast health awareness and clinical breast exams beginning at age 40, and to have a lifestyle – maintain a healthy diet, exercise, and limit alcohol consumption. Obesity, high caloric intake and lack of physical activity could be a greater cause of breast cancer than tobacco by the year 2030, she said.
Krontiras earned her medical degree and completed her residency at UAB before completing a surgical breast fellowship at Northwestern University in Evanston, Illinois. She is also a senior scientist at the UAB Comprehensive Cancer Center and her primary research interest is chemoprevention of breast cancer.
The late Dr. Joe O’Neal played a key role in the early years of the College, assisting with surgery education efforts. He earned a medical degree in 1954 from the Medical College of Alabama in Birmingham and, after completing residency training, established a surgical practice in Tuscaloosa.