June- in regard to reduced breast cancer rates in older BF moms,
unfortunately I am not at the office right now and don't have my file on
this.  I will warn you that there is some controversy in the literature as
these studies are always problematic in design (lots of other factors that
are hard to control for when doing retrospective analysis).  However, I do
remember reading more than one study that looked at moms' age during
lactation and found it NOT to be a factor in the decreased breast cancer
risk.  I did just do a quick online search and found this article (note the
statement made regarding mothers' age at lactation in the last sentence):

        R. Millikan et al.  International Journal of Epidemiology 1999; 28:396-402.
This study compared rates of breast cancer between 751 mothers who had
breastfed at least once and 743 mothers who had not.  Breastfeeding reduced
the risk of breast cancer by 20% in women age 20 to 49 years and by 30% in
women ages 50 to 74 years. Moreover, breastfeeding seemed to protect against
breast cancer regardless of the number of children breastfed, mother's  age
at first and last lactation, and menstrual history.

As far as her options for screening- sonograms have not been shown to be an
effective screening tool (though they are often helpful when an abnormality
is detected on mammogram or physical exam).  In my practice, I have been
starting to use screening MRI's of the breast on women at very high risk of
breast cancer (usually these women who carry a genetic mutation making them
at extremely high risk of developing breast cancer.)  MRI should be safe.  I
don't know how lactation would affect the interpretation of the MRI,
however.  It very well may be that, like a mammogram, the sensitivity (the
ability to find an abnormality) may be reduced in a lactating breast - I
don't know.  Cost can also be prohibitive if insurance won't cover it.  I
would be very surprised if the hospital actually has a "no mammo on
lactating breast" policy.  What would they do if a lactating mom found a
palpable breast lump?  When my breastfeeding patients meet resistance to
obtaining a mammogram (usually from the techs performing a mammogram), the
matter is usually easily solved by a conversation between the radiologist
and one of the docs at the breast center where I work.  In my personal
experience, moms nursing toddlers don't always have the same dense tissue
that interferes with reading a mammogram in a mom early on in lactation when
milk production is high.

Good luck to you and your friend!  She is lucky to have you around . . .

Jayne Charlamb, MD, LLLL

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