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October is Breast Cancer Awareness Month, which has gained widespread attention and support over the last decade. Through all of the fundraising efforts and creative initiatives that have coincided with the campaign, it may be easy to forget a key component to helping fight the disease – getting screened.

Dr. Susan HarveySusan Harvey, director of the Johns Hopkins Breast Imaging section, leads the breast imaging enterprise at Johns Hopkins including the Johns Hopkins imaging sites located at Green Spring Station and White Marsh, the Johns Hopkins Outpatient Center, and the Bayview Medical Center Breast Center. In today’s Ask the Expert, Harvey answers some commonly asked questions about the screening process and explains why getting screened is so vital.

If you have any questions about breast cancer screening, Bonmyong Lee, Assistant Professor of Radiology and Radiological Science will be available throughout the day to answer your questions in the comment section.

What are the current guidelines for getting a screening mammogram?

The guidelines for screening mammography have not changed, but they are inconsistent here in the United States. They vary from beginning annual screening at age 40 without a defined age end point to beginning at age 50 and continuing every other year until age 65. The unfortunate result of the lack of clarity is confusion for both patients and primary care providers. In breast imaging at the Johns Hopkins Department of Radiology and Radiological Science, we follow the American College of Radiology guidelines suggesting annual screening from age 40 onward, which matches several other society recommendations.

What are some of the high-risk factors of breast cancer?

Risk factors for breast cancer can be divided into factors women can change and factors women cannot change.

Factors that cannot be changed include:

Being a woman: Women are 99 times more likely than men to have breast cancer

Aging: The risk of breast cancer increases with age in a linear fashion.

Family and genetics: Only about 10 percent of breast cancers are related to inherited genetic mutations. The most common are BRCA 1 and BRCA2. However, it is important to recall that most cancers arise from spontaneous not inherited mutations.

Breast tissue density

Age of menarche: The age at which women begin their periods is a risk factor. Women are at higher risk when they get their period at a younger age.

Radiation to the chest for malignancy: This is unusual, but treatment of other malignancies with chest radiation elevates the risk of breast cancer.

Previous personal history of breast cancer: This makes breast cancer more likely.

Factors that women can change include:

Weight: Obesity is a breast cancer risk factor

Smoking: This increases lung and breast cancer risk.

Exercise: Women who exercise regularly have a lower cancer risk.

Alcohol intake: Heavy drinking is related to an increase in cancer risk.

Hormone replacement: Long-term hormone use is considered a risk factor.

Child birth: Having no children or being an older age at child bearing is a risk factor.

What can mammogram results tell a woman?

Mammography results can inform women of their breast tissue density and also about vascular calcifications, which in some instances can be reflective of other vascular disease. There is compelling evidence that breast density is a risk factor for breast cancer, either on its own or in combination with other risk factors. A higher breast density may signal the need for supplemental screening examinations, such as a breast ultrasound or breast magnetic resonance imaging.

Can those results indicate other issues?

There are other findings on mammography that can be clues to or are signs of disease. For example, enlarged lymph nodes can be a sign of lymphoma, autoimmune diseases, inflammation or infection. There are times when edema, or swelling, in the skin, can be seen with cardiac dysfunction or infection. Calcifications in lymph nodes can be seen with previous fungal infections and sometimes with previous radiation treatment.

Are there any new technologies being applied to the breast screening process?

Three-dimensional mammography is a new technology that is an advanced digital mammogram. This technique allows several low-dose images to be reconstructed into 1 millimeter slices through the breast. This is similar to computed tomography, or CT, used in other parts of the body. Three-dimensional mammography mitigates the impact of overlap and summation of tissues, which can both obscure and mimic cancers. This allows an increase in invasive cancer detection and a decrease in the number of women recalled for further evaluation. Three-dimensional mammography is a more accurate screening test, as shown by several large trials in the U.S. and Europe.

What does it mean when someone is called back for additional imaging?

Being called back means that a possible abnormality has been seen on screening mammography and requires further evaluation to assess if there is a significant finding that could be suggestive of breast cancer. The majority of women asked to return are found to have normal breast imaging or a benign, non-cancerous, finding at the time of further evaluation. Only about 2 percent of women require biopsy after this further imaging is performed.

What is the difference between a screening mammogram and a diagnostic mammogram?

Screening mammography is a four-view imaging exam performed in women who have no clinical symptoms or signs of cancer. This exam has been proven to decrease mortality from breast cancer from 30 to 40 percent.

Diagnostic mammography is performed for women who have symptoms such as a palpable lump or nipple discharge. In addition, diagnostic mammography is performed for women who have had breast cancer treated in the past or who have been identified to have an abnormality on their screening mammogram that requires further evaluation. Breast pain can be an indication for diagnostic mammography but only when previously assessed by a woman’s primary care provider.

What can women do to help avoid breast cancer or detect breast cancer early?

Annual screening mammography was proven to decrease mortality by 20 to 40 percent in large European and American trials. Annual screening mammography is one of the most significant actions women can take to allow earlier detection of breast cancer.

As mentioned above, there are also some behaviors and life style choices that can impact breast cancer risk.


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A Woman’s Journey, the informative and interactive conference featuring 32 seminars on present-day women’s health issues, will be held Saturday, Nov. 1. Johns Hopkins experts will each give a one-hour presentation on some of today’s most talked about topics at this 20th-year event.

Take a look at the five most popular seminars based on current registrations and share which is the most interesting to you, or visit the A Woman’s Journey page for the full list of seminars and leave us a comment about other presentations that you would like to see.

Be sure to register for the event to choose four of the 32 seminars you wish to attend. Don't forget, Johns Hopkins employees receive 10% off!

Which "A Woman's Journey" Seminar Would Most Interest You

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Strategies to Prevent Bone Loss and Osteoporosis
Women begin to lose bone strength as young as 30. Endocrinologist Kendall Moseley identifies risk factors that make women susceptible to bone loss, strategies for optimizing bone density, including common drugs—some now considered controversial—and emerging therapies to treat osteoporosis and prevent fracture.

New Recommendations About Multivitamins and Medications
Internist April Fitzgerald addresses significant changes in the management of elevated cholesterol and high blood pressure that were announced this year. She also talks about new results of research that impact the use of multivitamins and other supplements, as well as annual mammograms.

A Trip Down Memory Lane
As baby boomers age, it is estimated that the number of people in the U.S. with Alzheimer's disease will almost triple by 2050. Psychiatrist Dr. Constantine Lyketsos outlines the differences between normal changes in memory and those that are signs of dementias, including Alzheimer’s disease, new research and medically-based strategies to help preserve good memory.

Sage Advice for Aging Gracefully
Geriatrician  Ariel Green discloses what successful aging really means and explores the importance of social and cognitive engagement and physical activity. She also discusses the importance of primary care, medication management and screening tests to live the healthiest and most productive life as we age.

Top 15 Power Foods
Enhance your shopping list with foods that can help you age well by decreasing your risks of cardiovascular, bone mineral and circulatory diseases; macular degeneration; and even wrinkles. Dietician Lynda McIntyre offers a menu that includes nutrients from lutein to omega-3 fatty acids that combat these diseases and improve your health.

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Beginning the career journey as a teen can be overwhelming. Deciding on a college, deciding if college is the right option, picking a job or trade of interest - all of these forks in the road can be a tough call for people who are barely old enough to drive a car.

What advice you would give (or have already given) to the youth of today as they prep for life in the workforce or in college?

Johns Hopkins is a member of the Maryland Business Roundtable for Education, which is hosting two programs designed to help inspire teens to pursue and achieve their goals through classroom interactions with professionals like you. The programs each include a training session.

If interested in volunteering, see the Inside Hopkins announcement. You can learn more about these opportunities or register for a program by visiting

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StampsThe child-like wonder of your youth may have influenced you to collect a number of different things while you were growing up. Or maybe you had a grand collection of just one thing. In fact, the hobby of collecting might still carry on with you today.

From baseball cards to dolls to stamps to insects, tell us what types of things you collected as a child in today’s Throwback Thursday!



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As people age, memory loss can suddenly become a concerning issue. While some people expect that distant memories will natually become foggy, it doesn't have to be a foregone conclusion. In fact, there are a number of ways to help keep your memory sharp as you get older.  Dr. Constantine G. Lyketsos, MD, Director of the Memory and Alzheimer's Treatment Center, provides some tips for healthy mental aging.

For more on memory preservation and the difference between normal memory changes and signs of dementias, register for the 2014  A Woman's Journey conference where Dr. Lyketsos will host one of 32 featured seminars, "A Trip Down Memory Lane." A Woman's Journey conference takes place Saturday, Nov. 1. For more information visit,

  • Track your activity, sleep, steps and weight
  • Avoid unnecessary medication use. Don’t take pills you absolutely don’t need.
  • Be wary of what is being sold in alternative health care. Make sure that you are getting what you pay for and understand any potential risks.
  • Don’t fully retire unless you must. If you do retire, keep as active as possible
  • Stay healthy: manage your weight, blood pressure, blood sugar and other health conditions. Stay engaged with a good primary care doctor.
  • Sleep well – at least seven hours a night. Make sure that you are getting enough rest!
  • Limit the effects of stress on your body (try meditation!)
  • Keep physically active. Emphasize variety, combine different forms of physical activity over time. Formal exercise is only one form of physical activity. Change your regimen once a year.
  • Keep mentally active. Learn new things: a language or musical instrument, for example. Take a course in a field that is outside of your past experience and comfort zone.
  • Keep socially active. Stay engaged with family, social organizations, religious activities, etc.
  • Follow a Mediterranean diet. Eat lots of fruits vegetables, fish and olive oil.
  • Consume antioxidants. Examples of these include blueberries, red wine or dark chocolate.

For more information on memory loss and related conditions, visit the Memory and Alzheimer's Treatment Center

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The Johns Hopkins University recently welcomed the class of 2018. As they embark on the next chapter in their education, take a look at some facts and figures on this year’s incoming class:

Number of students in first-year class: 120 - 118 new plus 2 returning students

Of this year’s new students:

69 are female and 49 are male

109 are regular MD students and 9 are combined MD-PhD students

20 are underrepresented in medicine (17% of entering class)

Average age: 23

Age range: 20-35

Percent with advanced degrees:  9%

Number of students applied:

AMCAS (American Medical College Application Service) applications – 6,429

Average MCAT (Medical College Admissions Test): 35.3

  • Verbal reasoning – 10.9
  • Physical science – 12.1
  • Biological science – 12.3
  • Overall average – 11.7

Average GPA:  3.87

Number of non-U.S./non-PR students:  3 (the Bahamas, Brazil, Iran)

Number of States represented in this year’s class:  31

Number of undergraduate schools represented in this year’s class:  65


17% of this year’s class had a major other than science;

10% received an advanced degree (includes 4 with Ph.D.’s)

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The Johns Hopkins Strategic Plan is a five-year strategy that focuses on six core priorities that will help carry on the success and sustainability of the institution for years to come. Your commitment to these priorities helps maintain Johns Hopkins’ legacy as a leader in the healthcare industry.

Vote on which of the six priorities connect with your role at Johns Hopkins? Do you help with cost saving and operational efficiency? If so, you would fit into the "Performance" priority. Let us know where you connect by selecting as many that apply!

Which Strategic Plan Priorities Do You Connect With Most in Your Role at Johns Hopkins?

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One of the Johns Hopkins Medicine Strategic Plan priorities is performance, which involves saving money and making operations more efficient. Everyone can play a role in reducing costs at the office.

Let us know your ideas and initiatives to help your department to be more efficient in today’s Hopkins Happenings’ Question of the Week.


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Classic_CarYou may have dreamed about driving the latest sports car or a classic ride from the past before you turned 16. Then, reality probably set in when you received your very first vehicle, which was likely not your dream car. But that car will always be remembered—it was your first and may have taken you on some fun adventures

Leave a comment below and tell us about your very first automobile and why it was special to you.

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