October is Breast Cancer Awareness Month, one of the highest-profile health observances of the year. The pink ribbons that have become synonymous with breast cancer awareness can be found everywhere in October, one indication that our society increasingly understands and embraces the need to raise awareness about a disease that affects more than 12 percent of all women. Apart from skin cancers, breast cancer is the most common type of cancer to affect women. Breast cancer is possible – but extremely rare – in men.
Breast cancer is most frequently diagnosed in women ages 55-64, with a median diagnosis age of 62. The National Cancer Institute, a division of the National Institutes of Health, estimates that more than 266,000 new cases of breast cancer will be diagnosed in 2018, representing slightly more than 15 percent of all new cancer cases and 30 percent of all cancer diagnoses in women. It also projects that nearly 41,000 women will die from the disease this year, accounting for 6.7 percent of all cancer-related deaths.
“The fact breast cancer represents 15 percent of all cancer diagnoses but less than 7 percent of cancer-related deaths is proof that many women can beat breast cancer through early detection and treatment,” says Dr. Douglas Decker, an obstetrician and gynecologist. “The five-year survival rate for breast cancer is nearly 90 percent, a significant increase from 1975, when it was only 75 percent. In other words, nine out of ten women diagnosed with breast cancer today will live at least five years after their diagnosis and many will live much longer.”
“The key to beating breast cancer is early detection through awareness and screenings,” explains Dr. Lindsay Breedlove Tate, an obstetrician and gynecologist. “Treatment for breast cancer has also improved, helping more women overcome this disease.”
Awareness, Screening and Detection
Changes or abnormalities in the breast can be detected in a variety of ways: through a mammogram or other imaging test, a clinical breast exam and through “breast self-awareness.”
The mammogram, which is an x-ray image of the breast, is usually the most effective way to screen for breast cancer. Because treatment is most effective when the cancer is at an early stage, periodic mammograms increase the odds of successful treatment.
The American College of Obstetricians and Gynecologists (ACOG) updated its guidelines for breast cancer screenings in 2017:
All women age 40 and over should be offered mammography screenings beginning at age 40 and women who have a normal risk of breast cancer should consider having a mammogram screening every year or every other year beginning between the ages of 40-49.
All women age 50 and older should have a mammogram every one or two years.
These are general recommendations, and your physician will make specific recommendations for screenings based upon your medical history and risk factors.
“Mammograms have saved countless lives,” says obstetrician and gynecologist, Dr. Joseph Kilianski. “Every woman is different and instead of relying on a one-size-fits-all approach to screening, your physician will consult with you so you can make the best decision on when to begin mammograms 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 imaging exam, such as a 3-D mammogram, an ultrasound or an MRI to make a better assessment.
Your physician can order a mammogram for you as part of a 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.
Clinical Breast Exams
For women with normal risk who are too young for mammograms, your physician may suggest a clinical breast exam as part of a regular check-up or well-woman exam. This is a physical examination at the doctor’s office in which the physician examines the breasts for any abnormalities.
ACOG’s guidance on clinical breast exams is:
They may be offered for women with normal risk at ages 25-39, every 1-3 years.
They may be offered annually for women age 40 and older.
Finally, a key component of early detection is what is known 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. 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 can recognize a change in her breast, such as a lump that was not there before. If you notice a change in the appearance or feel of your breasts, see your physician right away.
Many of the risk factors associated with breast cancer are outside anyone’s control. 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:
Family history of breast cancer: a woman who has a history of breast cancer in her family, especially a first-degree relative such as a mother, sister or daughter who has had the disease, is at elevated risk.
Genetic mutations: Inherited gene mutations, such as BCRA1 and BCRA2, known as the breast cancer genes, increase 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, increasing risk.
Late pregnancy or never having been pregnant: 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 – those with more connective tissue than fatty tissue – are at elevated risk.
“While some risk factors are outside anyone’s control, there are other known contributing factors to breast cancer that can be managed, mitigated or eliminated through lifestyle changes and working in partnership with your health care provider,” explains Dr. Emily Maas, an obstetrician and gynecologist. These risk factors include:
Hormone replacement therapy: Taking hormones to replace estrogen and progesterone during menopause may increase breast cancer risk. Your physician can help advise you on the best course of action when considering hormone replacement therapy.
Oral contraceptives: Some, but not all, types of birth control pills may contribute to breast cancer risk. Again, this is something to ask your health care provider about.
Weight: Women who are overweight or obese after menopause are at a greater risk. Maintaining a healthy weight helps to reduce risk.
Alcohol consumption: The more alcohol consumed, the greater the risk for breast cancer. Consume alcohol in moderation, if at all.
Smoking: Smoking cigarettes is a known cause of many types of cancer, as well as heart disease.
Sleep: Inadequate nighttime sleep can increase the risk of breast cancer. Get a good night’s sleep each night, and if you are having trouble sleeping, see a doctor.
Breastfeed your babies, as breastfeeding has been shown to reduce the risk of breast cancer.
Breast cancer often produces no noticeable symptoms initially, which is the key reason that following recommended screening schedules is so important. The following may be symptoms 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
Having one or more of these symptoms does not necessarily mean cancer is present, but is reason to see a doctor right away.
Diagnosis & Treatment
If a mammogram indicates an abnormality that may be cancerous, the patient will be referred to a breast specialist or surgeon. Additional imaging tests, such as an MRI or ultrasound may be conducted, and a biopsy may be performed to take a sample of tissue or fluid from the breast to examine it for cancer.
“A breast cancer diagnosis is understandably frightening for the patient and her family. This is an issue that has touched me personally, since my mother fought advanced stage breast cancer and has now been cancer free for 16 years,” says Dr. Rachel Lusby, an obstetrician and gynecologist. “Your physician and your health care team will be with you every step of the way in your fight. We want you to know you’re not alone in this battle. Your health care providers are here to help you navigate this journey with the right medical treatment and the emotional support needed.”
“Treatment for breast cancer varies based on how advanced the cancer is, the patient’s medical history and other factors,” explains Dr. Joseph Heyne, a breast oncology surgeon. “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.”
The scope of surgery to treat breast cancer varies from patient to patient and will depend in part on how advanced the cancer is, as well as if and how much it has spread. In breast-conserving surgery, the cancerous tumor and surrounding tissue are removed from the breast. In other cases, the entire breast must be removed, a procedure known as a total mastectomy. Finally, in a modified radical mastectomy, the breast is removed, as well as some of the lymph nodes under the arm and lining of the chest muscles. Chemotherapy may be employed before surgery to first shrink the cancerous tumor.
Additional treatments include hormonal therapy, which blocks the cancer cells from getting the hormones they need to grow and spread, as well as biological therapy, which helps the body’s immune system fight cancer cells and/or cope with side effects from chemotherapy and radiation treatment.
In the event the treatment involves a mastectomy, breast reconstruction surgery is sometimes performed as part of the same surgery. In other cases, breast reconstruction may take place at a later time.
Make an Appointment Today
If you are over age 40 and have not visited with a doctor about the right time to begin mammograms, make an appointment with your physician today. If you don’t have a physician, contact one of Privia Medical Group North Texas’ obstetricians & gynecologists, internal medicine, family practice or primary care physicians.
A respected North Texas resource is the Andrews Women's Hospital at Baylor All Saints Medical Center in Fort Worth, a facility that provides comprehensive health care services for women, including breast screenings and imaging. Privia Medical Group North Texas physicians helped found Andrews Women’s Hospital and continue to practice there today.
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