Breast cancer remains the second leading cause of cancer death in U.S. women, but a diagnosis today isn’t necessarily a death sentence. The mortality rate among women with breast cancer has fallen 44% since 1989, saving more than half a million lives, according to the American Cancer Society’s biennial update on breast cancer statistics.
Thanks to early detection, women are being diagnosed with the disease at younger ages. Breast cancer diagnoses in women under 50 have risen by 2% annually for the past five years, according to the Breast Cancer Research Foundation.
“We attribute the increase in detection of breast cancers in women who are younger and younger being a result of women being more willing to get their mammogram and having more access to those mammograms,” says Molly Sebastian, a breast surgeon at VHC Health in Arlington.
In fact, one of the biggest changes in health guidance in 2024 was the U.S. Preventive Services Task Force’s recommendation that women start getting mammograms—long the gold standard for breast cancer detection—at 40 rather than 50. (The organization is an independent panel of experts in primary care and prevention that systematically reviews and recommends clinical preventive services.)
Although the median age for a breast cancer diagnosis is 62, “the screening guidelines starting at 40 puts women in the best position to capture breast cancer early,” Sebastian says. “It also helps the radiologist to have some history on each person and know what normal looks like on their mammograms, so they can be better detectives and detect subtle changes.”
New technologies are also bolstering early detection. The 3D mammograms that are now standard capture more images and angles than earlier 2D scans, Sebastian adds.
At the two-year-old Inova Saville Screening and Prevention Center at the Inova Schar Cancer Institute in Falls Church, researchers are conducting a study of Mirai, an artificial intelligence tool that can assess imagery from a normal mammogram and predict a patient’s risk of developing breast cancer in the next five years, says Rebecca Kaltman, a hematologist oncologist and the center’s director.
“It’s actually been shown in validated studies to predict not only the risk of breast cancer developing, but if it does develop, what quadrant of the breast it’s going to develop in,” Kaltman says. “Wouldn’t it be amazing if we could just look at the mammogram alone, be able to risk stratify everyone in a population and make sure that those at highest risk are actually getting the resources they need?”
Many physicians currently use the Tyrer-Cuzick Risk Assessment Calculator, which factors in a patient’s age, height, weight, pregnancy and birth history, breast density, family history, and other metrics to assess that person’s 10-year and lifetime risk of developing breast cancer. A chance of at least 20% is considered high risk.
The tool is helpful but imperfect, Kaltman says. “We have to ask the patients, either on questionnaires or during the visit, all about their risk factors, and then it spits out a number,” she says. Conversely, “Mirai can look at the mammogram in and of itself and tell us what somebody’s risk is.”
In addition to clinical advancements, medical providers are redesigning the physical landscape of cancer assessment and prevention, setting up one-stop shops that put almost all the services patients need in one place.
In late October, Virginia Cancer Specialists, which has locations throughout the DMV, reorganized its High-Risk Breast Clinics into Comprehensive Breast Centers that treat both women and men with a high risk for developing breast cancer. The centers give patients access to medical oncologists, radiation oncologists, breast surgeons, genetic counselors, palliative care physicians, dieticians, social workers, financial counselors and nurse navigators, depending on their needs.
David Weintritt, a breast surgeon with Virginia Cancer Specialists, describes this new, centralized approach as “more patient-centered and proactive vs. reactive.”
“It’s really…trying to gather together elements of care that we have been providing in existing locations,” and consolidating them in one place, he says.
Last year, VHC Health opened the Charlotte Stump Benjamin Center for Women’s Health on the fifth floor of the hospital’s Outpatient Pavilion in Arlington. The Center offers services related to breast health as well as obstetrics and gynecology, maternal-fetal medicine, general health and wellness through menopause, genetics and other medical services.
“It’s an entire floor filled with, as it happens, all female physicians,” Sebastian says. “Having a modern facility where all the services can be coordinated and co-located has just been incredibly helpful for the practice of each one of the providers on this floor.”
Inova’s Schar Institute takes a similar centralized approach, Kaltman says. As part of its breast cancer risk management, Schar provides genetic counseling, body scans (to determine fat and muscle mass percentages) and info sessions with dietitians and behavioral health specialists.
When it comes to determining a patient’s risk, “It’s not just about one thing,” Kaltman explains. “It’s not [just] about genetic testing. It’s not just about looking at your mammogram and deciding if you need an ultrasound because of your breast density. It’s really taking in the whole picture.”
The Saville Screening and Prevention Center carries that mantra even further, she says, by bringing multiple disciplines—lung, prostate, skin, pancreatic and thyroid cancer screening—into one place.
“Having everything clear and accessible from a prevention standpoint is key,” Kaltman says.
Once patients know their breast cancer risk, the protocols are similar among all of the health care providers interviewed for this story. Preventive measures may include lifestyle changes such as increased exercise or smoking cessation. For higher risk patients, the recommendations may also include more frequent mammograms, additional screening technologies such as breast MRIs, and risk-reducing medications such as Tamoxifen. In extreme cases, prophylactic mastectomy may be a preemptive option.
“If we could be all-powerful and all-knowing and make anything we wanted happen, we would have super targeted therapies for every kind of cancer that would kill the unhealthy cells and leave the healthy cells alone and have no side effects, and we would cure cancer,” says Sebastian at VHC Health.
Absent that, “We are fortunate to have more of those tools available to us with respect to our breast cancer patients—almost more than any other area of malignancy and cancer management.”