Breast Cancer Survival Starts with Screening
Fatalities from breast cancer have been decreasing in the U.S. since 1990, thanks primarily to earlier detection and treatment advances. But it still ranks second – behind lung cancer – for the leading cancer deaths in women. According to breastcancer.org, 12 percent of American women, about one in eight, will develop invasive breast cancer over the course of their lives.
More than one in four cancers diagnosed in U.S. women (28 percent) are breast cancer, second only to skin cancer. Caucasian and African American women have a higher risk of developing and dying from breast cancer than women who are Asian, Hispanic or Native American. Caucasians are slightly more likely than African Americans to develop breast cancer, but they’re less likely to die from it, as tumors in African American women tend to be more aggressive.
Genetics do matter when it comes to breast cancer; a woman’s risk approximately doubles if she has a first-degree relative (mother, sister or daughter) who’s been diagnosed. 20 to 30 percent of women who’ve received a breast cancer diagnosis have a family history of it, however, those without a genetic link shouldn’t consider themselves “safe.”
The overwhelming majority of those who develop breast cancer (70 to 80 percent) don’t have any family history. The biggest risk factors for developing breast cancers are two things over which women have no control: their gender and age.
Now here’s some good news. As of 2010, there are more than 2.5 million breast cancer survivors in the United States. Medical researchers are working hard to ensure that number continues to go up, but women themselves play an important role in determining their fate given the critical importance of being diagnosed early.
Screening and Detection
Breast self-exam is something women can begin in their 20s and continue on a monthly basis throughout their lives. It’s important for each woman to become familiar with her anatomy, to be able to tell if something has changed from month to month. It’s very common to feel masses that are benign, such as cysts. While it’s a good idea to get any mass examined, cancer is usually the least likely outcome, occurring just five percent of the time.
It’s also a good idea to perform self-exams right after menstruating each month, as that’s when the breast is least lumpy. If something doesn’t feel right, most physicians would rather have you come in and let us tell you what’s going on, then wait until your annual physical or mammogram. If it’s nothing, that’s great, but if we suspect something’s awry, we may want you to get an ultrasound (if you’re under 30), get a mammogram or undergo a needle aspiration. If we’re in doubt about whether further action is necessitated, we’ll refer you to a specialist for further testing.
Mammograms are the best breast cancer diagnostic tool we have because they can detect tumors as small as one-half to one centimeter. It’s recommended that all women begin annual screening at age 40, and those at higher risk should start a decade sooner, using other diagnostic imaging if necessary.
Women at high risk include those with a strong family history of breast cancer (in a first-degree relative) as well as anyone who’s undergone genetic testing and learned she has a BRCA gene mutation. Women taking hormones, even at low doses, have also been found to have a significantly higher risk of breast cancer, and their tumors tend to be more aggressive.
While it’s not possible to change your age, gender or genetic makeup, there are things you can do to lessen your chance of getting breast cancer. For instance, eating a healthy, low-fat diet and exercising are recommended.
Treatment and Survival
Like all cancers, treatment for breast cancer at earlier stages is more likely to be successful; 88 to 90 percent of women diagnosed early will survive for 10 years or longer. Each course of treatment will be different and is dependent on factors like age, cancer grade, lymph node involvement and receptor (hormone) status.
Breast cancers diagnosed at stages 1 or 2, when the tumors are less than five centimeters, are typically treated by a lumpectomy (surgical removal of the tumor) followed with a course of radiation. Lymph nodes in the armpit are also tested to see if the cancer has spread, a procedure that used to be quite invasive but has become less so over the past five years.
What always must be kept in mind when dealing with breast cancer is that long-term survival is based on preventing the cancer from metastasizing to the bones, liver, brain or other organs. As a result, in women diagnosed with advanced breast cancer, as well as those who don’t want a lumpectomy and radiation or have previously had a lumpectomy, a mastectomy is typically recommended, followed by chemotherapy – typically for four to eight treatments, every two or three weeks – to treat any cancer cells that escaped from the original tumor.
Since a mastectomy can be emotionally devastating, it’s important for women to have a strong support structure that includes family and friends, as well as their medical team. We find some women desire a mastectomy due to the shock of a recent cancer diagnosis, so we offer counseling, education and support groups to eliminate irrational decisions and ensure they’re comfortable with their treatment choices.
Some women decide to have a mastectomy for precautionary reasons due to a history of questionable mammograms following a lumpectomy. In these cases, reconstructive surgery is always an option, although many older women choose not to pursue it.
In addition to focusing on regular screening, the medical community is working hard to test individual cancers so we can better pinpoint specific courses of treatment; for example, in certain cases it’s possible to test the tumor to help determine who is best suited for chemotherapy. Research is ongoing to maintain the downward trend in breast cancer fatalities.
By Robert Lanflisi, M.D. – Dr. Lanflisi is a board-certified surgeon who concentrates on cancer surgery. He’s affiliated with Sutter Solano Medical Center and is a member of Sutter Medical Group’s Community Provider Network.