Olivia Munn says early detection tool saved her—here's what you should know about breast cancer risk assessment
Hollywood actress Olivia Munn recently revealed that she underwent a double mastectomy after an online risk assessment tool identified her as high risk for breast cancer due to several factors.
Munn, who is 43, said in a social media post that she'd had a normal mammogram and a negative test for cancer genes in February 2023, before her OB-GYN, Dr. Thaïs Aliabadi—who also detected her own cancer using the same tool—calculated her breast cancer risk assessment score. She wrote that it looked at factors like her age, familial breast cancer history, and the fact that she had her first child after the age of 30. Scores above 20 percent indicate a higher risk. The test result indicated her lifetime risk was 37%.
"Because of that score, I was sent to get an MRI, which led to an ultrasound, which then led to a biopsy," she explained. "The biopsy showed I had Luminal B cancer in both breasts. Luminal B is an aggressive, fast-moving cancer." The actress underwent a double mastectomy 30 days after the biopsy.
Inspired by her own experience, Munn is committed to raising awareness about breast cancer risk among women. She credits her doctor's decision to calculate her lifetime cancer risk, saying it saved her life. "I feel grateful that I was given the opportunity to fight," she told People.
Online assessment tools such as the Gail Model and Tyrer-Cuzick Model are important breakthroughs for breast cancer treatment as they help check who is at risk.
Breast cancer is a significant health concern in the Philippines, with a high prevalence among Filipino women. Statistics show that 3 in every 100 Filipina women will be diagnosed with breast cancer in their lifetime. Additionally, the Philippines had the highest rate of breast cancer in Asia and ranked 9th globally in 2019.
According to Dr. Jaymie Lim M.D., a breast cancer consultant at Asian Cancer Institute at the Asian Hospital and Medical Center (AHMC), the disease often goes undiagnosed until advanced stages, contributing to its severity. “About 65% of breast cancer cases in the Philippines are diagnosed in advanced stages due to insufficient early detection and treatment. These figures highlight the urgent need for increased awareness, preventive screening programs, and improved access to healthcare services to address the prevalence of breast cancer in the Philippines.”
Check your risk
Breast cancer is a disease where cells in the breast grow uncontrollably, often forming tumors that can spread to other parts of the body. Dr. Lim says the common symptoms of breast cancer usually include a new lump in the breast or underarm, thickening or swelling of part of the breast, irritation or dimpling of breast skin, redness or flaky skin in the nipple area or breast, pulling in of the nipple, nipple discharge other than breast milk, changes in the size or shape of the breast, and pain in any area of the breast.
The risk factors for breast cancer include non-modifiable factors like genetics, age, and gender, as well as modifiable factors such as lifestyle choices. “Non-modifiable risk factors include gender, race, family history, personal health history, and certain genome changes like mutations in genes such as BRCA1 and BRCA2. Age is a factor as two out of three women with invasive cancer are diagnosed after the age of 55,” she says.
Dr. Lim adds that modifiable risk factors include lack of physical activity, poor diet, being overweight or obese (especially after menopause), drinking alcohol, radiation to the chest, and taking combined hormone replacement therapy. “As such, lifestyle changes like regular exercise, a healthy diet, limiting alcohol consumption, and maintaining a healthy weight can help reduce the risk of breast cancer.”
Detection tools
One of the first steps in detecting breast cancer is to calculate your risk of developing it. Dr. Lim talks about the two online tools that can help check for breast cancer risk. “The Gail Model predicts the risk of developing invasive breast cancer within five years based on factors like age, age at first menstrual period, age at first childbirth, family history of breast cancer, and more. The Tyrer-Cuzick Model (IBIS Tool), on the other hand, estimates the likelihood of a woman developing breast cancer in 10 years and over her lifetime based on personal and family history of cancers, including factors like breast density.”
She adds, “Take note that these risk assessment tools are designed to estimate an individual's likelihood of developing breast cancer. Your physician may use these tools as an adjunct along with a Physical Examination, and imaging as they play a crucial role in assessing individual risk factors and guiding healthcare providers in determining appropriate screening, monitoring, and preventive measures for breast cancer.”
These diagnostic tests may include physical examinations, mammograms, and an ultrasound. If a suspicious lump is seen either on mammogram or ultrasound, then a tissue biopsy is needed to confirm the diagnosis of cancer, she adds.
Early detection through screening and awareness of symptoms like breast lumps, skin changes, or nipple abnormalities is crucial for effective treatment and improved survival rates. That is why a breast self-exam is also important.
Dr. Alodee Zaragoza Mejia M.D., who is also a breast cancer consultant at AHMC’s Asian Cancer Institute, says women should do their monthly self-breast exam aside from their doctor’s checkup as screening only starts at 40 years of age. “Women are encouraged to do monthly self-breast as soon as they have breasts as it is the fastest way to find out if there are any lumps or issues in their breasts. Women are in the best position to tell if there is anything out of the ordinary in their breasts. They don’t have to wait for screening to start to be able to catch breast issues.”
Dr. Mejia shares that for women who still have their period, the best time to do their self-breast exam is one week after their menses. “Their breasts are less sore and tender, so they can be able to palpate better. Women who are menopausal may do their self-breast exam at any time of the month. This allows women to be more aware of their bodies, thereby being able to take charge of their own health,” she explains.
Tech to Screen
Mammograms are the standard test in breast cancer screening. They are able to visualize calcifications or subtle changes within the breast that are the earliest signs of breast cancer. This is often done together with a breast ultrasound.
Dr. Mejia explains, “Filipinas have dense breasts, which makes it difficult for mammograms to see the breast in its entirety. Breast ultrasounds can further characterize the breast and if there are any masses within. It can differentiate solid from fluid-filled ones.”
Screening is done annually, with mammograms and breast ultrasounds ideally done on the same visit. She adds that screening for women younger than 40 years old is only done if they are considered at high risk for developing breast cancer.
The latest technologies are being applied to make breast cancer screening more efficient and less invasive. At the Asian Hospital and Medical Center Breast Care Center and The Medical City's Breast Center, they have a breast tomosynthesis machine which is an advanced form of mammography using low-dose X-rays and computer reconstructions to create three-dimensional images of the breasts. They also have a Mammotome Revolve machine, which is a vacuum-assisted biopsy that allows for minimally invasive sampling of breast tissue under imaging guidance such as ultrasound.
The Medical City, meanwhile, has Ultrasonography, an ultrasound that uses sound waves to create detailed pictures of breast tissue. It's especially useful for women under 40 and pregnant women who can't have mammograms with radiation.
Dr. Mejia underscores the importance of breast cancer assessment and screening. “Catching breast cancer early is very important as this gives women a fighting chance at beating breast cancer. If detected at an early stage, there may be no need to undergo expensive and exhausting treatment like chemotherapy and radiotherapy. There is also no need to lose the entire breast and feel less feminine and disfigured. There is less likelihood of losing your loved one to breast cancer as an early stage nips it at the bud.”