October is Breast Cancer Awareness Month, one of the most important health observances of the year. It’s important because breast cancer affects one out of eight women in America and is the most common cancer to impact women, other than skin cancers. In rare cases, breast cancer can also affect men.
The National Institutes of Health (NIH) estimates more than 250,000 new cases of breast cancer will be diagnosed in 2017, representing 15 percent of all cancer cases. In addition, NIH projects there will be slightly more than 40,000 breast cancer-related deaths in 2017, representing 6.8 percent of all cancer deaths. Taken together, those numbers demonstrate that the percentage of breast cancer-related deaths are significantly lower than the percentage of new breast cancer cases, indicating that improved detection and treatment continue to make a positive impact on the ability to survive breast cancer. The current five-year survival rate for breast cancer is nearly 90 percent.
“While the incidence of breast cancer has remained stable, we have seen a steady decline in the number and percentage of breast-cancer related deaths over the last 25 years,” says Dr. Catherine Bevan, an obstetrician and gynecologist (OB/Gyn). “There are two primary reasons for that – first, increased awareness has led to more women being screened and detecting the cancer early, and secondly, treatment has continued to evolve and is increasingly effective.”
Screening and Detection
The mammogram, an x-ray image of the breast, is usually the most effective way to detect breast cancer. Because treatment is most effective when the cancer is at an early stage, regular mammograms can increase the odds of successful treatment.
The American College of Obstetricians and Gynecologists (ACOG) updated its guidelines for breast cancer screenings in July 2017. ACOG suggests women who have a normal risk of breast cancer consider having a mammogram screening every year or every other year beginning between the ages of 40-49 and recommends that all women age 50 and older have a mammogram every year 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 can save lives,” says Dr. Taylor Bradley, an OB/Gyn. “Every woman is different and 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 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 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. In addition, your physician may recommend 3-D mammography, an enhanced screening option that will be covered by insurance plans in Texas beginning in 2018.
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 has also recently revised its recommendations with respect to clinical breast exams:
Screening clinical breast examination may be offered to asymptomatic, average-risk women in the context of an informed, shared decision-making approach that recognizes the uncertainty of additional benefits and the possibility of adverse consequences of clinical breast examination beyond screening mammography. If performed for screening, intervals of every 1–3 years for women aged 25–39 years and annually for women 40 years and older are reasonable. The clinical breast examination continues to be a recommended part of evaluation of high-risk women and women with symptoms.
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 of 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:
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 mitigated through lifestyle adjustments and healthy habits. Those include:
Weight: women who are overweight or obese after menopause are at a greater risk. Maintaining a healthy weight helps to reduce 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.
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, if possible. Not breastfeeding may increase risk.
“As with so many diseases, a healthy lifestyle centered around a balanced diet, regular exercise, alcohol in moderation, avoiding tobacco and getting enough sleep can reduce your risk of breast cancer,” says OB/Gyn Dr. Kathleen Cammack.
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 of 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 reason 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.
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.
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 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.
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 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. Andrea Palmer, an OB/Gyn. “If you are due for a mammogram or a clinical exam, call a doctor and make an appointment today.”
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