It’s Pink Week! Around campus and in the media you may have noticed the pink ribbon, an international symbol of breast cancer awareness commonly displayed throughout October, National Breast Cancer Awareness Month. Here’s the rundown on the 10 things you absolutely need to know about breast cancer, for yours and others’ prevention, education and awareness:
- What is Cancer?
-
Cancer refers to a class of diseases characterized by abnormal cells that grow and invade healthy cells in the body. Breast cancer starts in the cells of the breast as a group of cancer cells that can then metastasize (spread) to other areas of the body. There are five stages of breast cancer, which indicate where the cancer is located, how much the cancer has grown, and if or where it has spread. Stages are determined through diagnostic tests; knowing the stage helps physicians determine a patient’s treatment plan and evaluate a patient’s prognosis.
- What Causes Breast Cancer?
-
Women have certain risk factors for developing breast cancer. Some of these risk factors are uncontrollable, such as family history of breast cancer; inherited genetic mutations (such as BRCA1 and BRCA2); age (risk increases with age, especially over 50); reproductive history (early menstrual periods before the age of 12 and late menopause after 55); having dense breasts and personal medical history of breast cancer, certain non-cancerous breast diseases and/or previous radiation treatment.
There are also controllable risk factors to consider when maintaining one’s lifestyle. These include not being physically active; being overweight or obese after menopause; a high-fat diet; taking hormones (including estrogen, progesterone, and other hormonal oral contraceptives); reproductive history (pregnancy before 30, not breastfeeding, not having a full-term pregnancy) and tobacco, drug and alcohol use.
- What are the Statistics?
-
1 in 8 women in the United States will develop breast cancer in her lifetime. That is quite a low statistic! 62% of breast cancer cases are diagnosed at a localized stage, for which the 5-year survival rate is 99%. This year, an estimated 41,760 women will die from breast cancer in the U.S. Although rare, men get breast cancer too. The lifetime risk for U.S. men is about 1 in 1,000. Breast cancer is the most common cancer in American women, except for skin cancers, and is the most common cancer among women worldwide.
- Breast Cancer in Young Women
-
Although breast cancer in young women is rare, about 11% of all new cases of breast cancer in the United States are found in women younger than 45 years of age. Of young individuals between 15-39 diagnosed with cancer, breast cancer is the most common cancer for women in this age group. Every year, more than 1,000 women under the age of 40 die from breast cancer. Compared to older women, young women generally face more aggressive cancers and lower survival rates, as cancer presents differently biologically between age groups. Race, too, plays an important role. African American women under age 35 have rates of breast cancer two times higher than Caucasian women under age 35 and die from breast cancer at rates three times higher than Caucasian women under 35. Access to and quality of healthcare contribute to these statistics. Sidenote: if you are not familiar with the history of racism in U.S. healthcare, I urge you to educate yourself on this topic, inform others and work against this persisting systemic issue starting by reading this article.
There is not yet an effective breast cancer screening tool for women under 40, most of whom have dense breast tissue that prevents routine mammograms from being a useful screening tool. Nearly 80% of young women diagnosed with breast cancer find their breast abnormality themselves.
Young women also have unique challenges, including the possibility of early menopause and sexual dysfunction brought on by cancer treatment, fertility issues, trying to raise a family, psychosocial issues, pregnancy after cancer treatment, concerns about body image after breast-cancer treatment, intimacy issues and challenges to financial stability.
- Breast Cancer Detection: Breast Examinations
-
It is important for women to begin conducting routine breast examinations on themselves through visual and physical examination at least once a month. Visually, begin by standing in front of a mirror with your hands by your sides. Face forward and look for puckering, dimpling or changes in size, shape or symmetry. Check to see if your nipples are inverted. Inspect your breasts with your hands pressed down on your hips. Inspect your breasts with your arms raised overhead and the palms of your hands pressed together. Lift your breasts to see if ridges along the bottom are symmetrical. If you have a visual impairment, find a trusted person to conduct this part of the exam for you.
Physically, two ways to examine your breasts are lying down or in the shower. Using the pads of your first few fingers with alternating levels of pressure an in a circular motion, cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you’ve reached the deep tissue, you should be able to feel down to your ribcage.
If you feel a lump, don’t panic. Make an appointment with your primary care provider, at your college’s health clinic or at a local health clinic—whichever avenue is best for you. Oftentimes lumps end up being benign, but it is a good idea to get changes and/or lumps in your breasts checked out immediately. It is also a good idea to have your breasts clinically examined by a physician once a year in addition to self-examinations.
- Breast Cancer Detection: Other Methods
-
Genetic mutations such as BRCA1 and BRCA2 increase the chance of developing breast cancer. An estimated 0.25% of the general population carries a mutated BRCA gene, or about one out of every 400 people. If you have a known family history of BRCA gene mutations or have other risk factors, this method can provide information about whether or not you carry this mutation. Speak to your primary care provider about getting a referral to genetic counseling.
You should start having annual mammograms after age 45, or earlier if you have known risk factors. Consult with your primary care provider if you are unsure when to begin and how frequently you should have them.
- Diagnostic Tests
-
If your physician suspects that you have breast cancer, they will order diagnostic tests, including a mammogram, ultrasound, MRI and/or biopsy to confirm a diagnosis. A mammogram is an x-ray of the breast; compared to screening mammograms, diagnostic mammograms provide a more detailed x-ray of the breast using specialized techniques. They are also used in special circumstances, such as for patients with breast implants. A breast ultrasound uses penetrating sound waves that are deflected by breast tissue; this produces an echo image of what’s going on inside the breast. During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves through the breast tissue. It scans the tissue, making detailed pictures of areas within the breast. These images help the medical team distinguish between normal and diseased tissue. Sometimes a breast biopsy is ordered. This tests tissue or fluid removed from the breast under a microscope to check for the presence of breast cancer. Finally, several lab tests such as the hormone receptor test and the HER2/neu test can provide insight into cancer treatment options. From these tests, your physician will be able to make a diagnosis.
- Types of Breast Cancer
-
A breast cancer diagnosis involves which type it is. The most common breast cancer type is ductal carcinoma in situ (DCIS), which is contained in the milk duct. There is also Invasive Ductal Carcinoma (IDC) which is in the duct and surrounding tissue; Triple Negative Breast Cancer, which means that the three most common types of receptors to fuel cancer growth are not present; Inflammatory Breast Cancer (IBC) in which cancer cells infiltrate the skin and lymph vessels of the breast, Metastatic Breast Cancer which is stage 4 breast cancer that has metastasized to other parts of the body; breast cancer during pregnancy and a few other types that are less common. A physician’s diagnosis further evaluates the stage of the type of cancer, which is the extent to which it has spread. From the diagnosis, the physician will determine the best treatment options.
- Treatment Options
-
In general, there are five treatment options, and most treatment plans include a combination of the following: surgery, radiation, hormone therapy, chemotherapy and targeted therapies. Some are local, targeting just the area around the tumor. Others are systemic, targeting the whole body with cancer-fighting agents.
- Living with Breast Cancer
-
If you or a loved one has been diagnosed with breast cancer, there are resources to help you better understand the disease, treatment options and how to manage practical concerns while maintaining a good quality of life. Breastcancer.org provides a helpful list for navigating one’s daily life after a diagnosis, including paying for care, employment, managing medical records, managing treatment, receiving support, managing fatigue, managing menopausal symptoms, intimacy and fertility issues.
Thank you for taking the time to read this. It is my hope that these resources will help inform you and others about breast cancer and related topics.
Go Irish, beat breast cancer!