OCTOBER 3, 2016
Cooler temperatures and shorter days are sure signs of fall – and so are pink ribbons, which seem to appear everywhere during the month of October. That’s because October is Breast Cancer Awareness Month, probably the highest-profile health observance in America, if not the world.
This high level of awareness is for good reason – other than skin cancers, breast cancer is the most common cancer affecting women; one in eight women is directly impacted by the disease. While breast cancer can affect men, it is uncommon.
Breast cancer is the leading cause of cancer deaths among Hispanic women and the second leading cause of cancer deaths among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women, behind only lung cancer. In 2013, more than 230,000 American women were diagnosed with breast cancer and slightly more than 40,000 died from the disease.
These are startling statistics, but there is plenty of good news in the treatment of breast cancer. Thanks to advances in treatment and screenings, as well as increased awareness of the importance of early detection, lives are being saved. While the overall incidence of breast cancer has remained stable, the rate of breast cancer-related deaths has declined consistently since the early 1990’s, according to data from the National Cancer Institute.
“If I could only tell my patients two things about breast cancer, it’s that this is a disease that can affect any woman or man and that early detection is the undisputed key to survival,” says Dr. D. Alan Johns, a gynecologist. “Breast cancer screenings save lives.”
Screening and Detection
The mammogram, an x-ray image of the breast, is the best way to detect breast cancer. Because treatment is most effective when the cancer is at an early stage, regular mammograms can reduce the risk of dying of breast cancer.
Breast cancer risk increases with age, so the American College of Obstetricians and Gynecologists (ACOG) recommends that women have a mammogram screening every year beginning at age 40. This is a general recommendation, and your physician will make specific recommendations for screenings based upon your medical history and any known risk factors.
A mammogram allows the physician to spot abnormalities, including cancer. In some cases, a mammogram may be inconclusive, in which case the physician may order an additional diagnostic exam, such as an ultrasound or MRI, in order to make a better assessment.
Your physician can order a mammogram for you as part of an annual well-woman exam, or as needed. There are also various community clinics and other resources that offer mammograms. The vast majority of insurance plans cover the full cost of mammograms with no co-pay or deductible for the patient.
Mammograms are not the only element of effective screening and early detection. For women ages 20-39, ACOG recommends a clinical breast exam every 1-3 years. This is a physical examination by the physician in the office, often conducted as part of a well-woman exam. During this exam, the physician examines the breasts for abnormalities.
Finally, a key component of early detection is what ACOG refers to as breast self-awareness. The goal of breast self-awareness is for a woman to be able to recognize any changes in the appearance or feel of her breasts. ACOG reports that a substantial percentage of breast cancers are initially detected this way – about half for women age 50 and older and more than 70 percent for women younger than 50.
Your physician may recommend you conduct a periodic breast self-exam (BSE) as part of breast self-awareness (see our October 2015 article, Breast Cancer Awareness: Risk Factors & Early Detection, for details on BSEs), but the overall goal of breast self-awareness is simply to be able to identify changes. Breast self-awareness is recommended for women of all ages.
It’s important to note that many women have lumps in their breasts which are unrelated to cancer. Cysts and fibrocystic breast condition are two common causes of non-cancerous lumps. What’s most important is that a woman is able to recognize a change in her breast, such as a lump that was not there before. If you notice a change in the appearance of feel of your breasts, see your physician right away.
The following may be signs of breast cancer:
- A new lump in the breast or armpit area
- Thickening or swelling of part of the breast
- Pain in any part of the breast
- Irritation or dimpling of breast skin
- Redness or flaky skin in the nipple area or the breast
- Pain in the nipple area
- Nipple discharge other than breast milk, including blood
- Any change in the breast’s size or shape
A woman may experience one or more of these symptoms and not have cancer, as there are other potential causes for these symptoms. Regardless, any of these symptoms is cause to see a doctor right away. It is also possible to have breast cancer and not experience any symptoms at all initially – that’s another reason regular screenings are so important.
Naturally, a lot of women wonder if there are things they can do to reduce their risk of breast cancer. Many of the risk factors associated with breast cancer are outside anyone’s control, such as age. The major risk factor is getting older, as the greatest incidence of breast cancer is in women over age 50. Some other risk factors associated with breast cancer include:
- Genetics: a family history of breast cancer increases risk.
- Early menstruation/late menopause: women whose periods began before age 12 or who begin menopause after age 55 are at a slightly higher risk of breast cancer. In both cases, the woman is exposed to estrogen hormones for a longer period of time.
- Late or no pregnancy: becoming pregnant for the first time after age 35 or never having a full-term pregnancy can increase risk.
- Dense breasts: women with denser breasts are at elevated risk.
- Combination hormone therapy: taking the hormones estrogen and progestin together for more than five years can increase risk.
- Oral contraceptives: certain types of birth control pills can contribute to breast cancer risk.
There are additional risk factors that can be reduced through lifestyle adjustments and healthy habits. Those include:
- Weight: women who are overweight or obese after menopause are at a greater risk.
- Physical activity: a sedentary lifestyle is a risk factor for breast cancer. Getting regular exercise helps lower risk.
- Alcohol consumption: the more alcohol consumed, the greater the risk for breast cancer. Consume alcohol in moderation.
- Smoking: smoking cigarettes is a known cause of many types of cancer, as well as heart disease.
Diagnosis & Treatment
If a mammogram indicates an abnormality that may be cancer, the patient will be referred to a breast specialist or surgeon. Additional imaging tests, such as the MRI or ultrasound may be conducted, and a biopsy may be performed to take a sample of tissue or fluid from the test to examine it for cancer.
Treatment for breast cancer varies based on how advanced the cancer is, the patient’s medical history and other factors. Treatment often involves a combination of surgery to remove the cancer, as well as chemotherapy or radiation therapy to shrink and kill remaining cancerous cells.
In the event that the treatment involves a mastectomy – the removal of the breast – breast reconstruction surgery is sometimes performed as part of the same surgery. In other cases, breast reconstruction may take place at a later time.
Help is a Click or Call Away
If you are over age 40 and have not had a mammogram or it’s been more than a year since your last one, make an appointment with your physician today. If you don’t have a physician, contact one of Texas Health Care’s Obstetricians & Gynecologists, Internal Medicine, Family Practice or Primary Care physicians.
A great Tarrant County resource is the Baylor All Saints Medical Center Andrews Women’s Hospital, which provides comprehensive health care services for women, including breast screenings and imaging. Texas Health Care physicians helped found Andrews and today, 25 Texas Health Care member physicians practice there.
“Early detection saves lives,” says Dr. Anita Chow, a breast oncology surgeon. “If you are due for a mammogram or a clinical exam, call a doctor and make an appointment today.”
This article contains information sourced from:
The U.S. Centers for Disease Control & Prevention
The American Congress of Obstetricians and Gynecologists
The National Cancer Institute, National Institutes of Health