We\’re going to talk about breast cancer this month. Given that in recent years, such a good job has been done in general to make all of us aware of this disease, you may be wondering what I can possibly say in this column that you haven\’t already heard. That\’s the point – we simply cannot hear too much about it. If not for ourselves, then for our friends, for the younger generations–our daughters and nieces–and for the older generations–our mothers and aunts. We need to remind them (and ourselves) that prevention and early detection are the keys to staying healthy, and that we know a lot more about this disease than we used to.
What do we now know about breast cancer? We know that it\’s the most common cancer in women over the age of fifty, that statistics show that each of us has a 1 in 8 chance of developing it, and a 1 in 33 chance of dying from it over our lifetime, and that the American Cancer Society predicts that approximately 175,000 new cases will have been diagnosed in 2007, and that nearly 40,500 women will have died from it in 2007.
We also know which of us has a greater chance of getting breast cancer because many factors that place us at risk have been defined. Although it seems that every Monday and Thursday a new study is coming out telling us about something else that can cause it, there actually are some definites in this regard. As with the risk factors for heart disease, we can change some of these risk factors, and can do nothing about others. Also, as with heart disease, the more risk factors that one has, the greater are one\’s chances of developing the disease.
Those risk factors we cannot change are age (the older we become, the greater the risk), race (see below), family history (see below), the density of our breasts (the denser, or the more glandular tissue rather than fatty tissue, the greater the risk), a past history of having breast cancer, our menstrual and reproductive history (this includes our history of taking hormones), our past exposures to environmental toxins and radiation and DES, and of course, our genetic makeup.
One thing to remember: even though we cannot change the above factors, simply our knowing about them and thus, knowing that we are risk, allows us to practice the measures that can lead to early detection of a cancer and the possibility of a cure, or at least, a much better outcome. So if you have one or more of the above risk factors, don\’t despair – be proactive for your own good health. How to do that follows in a moment.
A further word about a couple of the above risk factors. Although Caucasian women have the highest risk of getting breast cancer, African American women have a higher risk of death from the disease. This is thought to be partially due to the fact that the disease is caught later in these women. Hispanic, Asian American, and Native American women have a lower risk than either of the above two groups. As for family history, if you have one or two first degree relatives (mother, daughter, sister) with breast cancer, your risk goes up dramatically, so you may want to be examined more frequently than is normally recommended if this is the case.
Those factors that put us at risk for breast cancer that we can change are being overweight or obese, having a sedentary lifestyle, and drinking too much alcohol. Currently being intensively studied, among other factors, is the role certain foods and nutrients play in the development of breast cancer.
What can you do to prevent this disease, or at the very least, to have the best outcome if you do get it? You can be proactive in the following two broad categories: establishing a routine for screening your breasts (and a team approach with your care providers) and establishing a healthy lifestyle. If you are fifty or over, you should be getting an annual mammogram; if you are still in your 40\’s, it\’s recommended that you get one every two years unless you have one or more of risk factors, or your clinician recommends them more frequently. Remember that mammograms are not always 100% accurate; they can miss tumors. If your breasts are dense you should ask your clinician whether you should have a digital mammogram or a MRI of your breasts. In addition, you should be having at least one annual breast exam by a professional, such as your gynecologist or internist; it makes the most sense to schedule your Gyn exam or your regular internal medicine check up six months away from your mammogram, so that you will have a professional breast check at least twice a year.
You should also be doing a self examination on your own breasts monthly. Don\’t forget to examine your nipples and under your arms. If you\’re uncomfortable in general with what you\’re feeling when you examine yourself, here\’s an idea: right after your Gyn or your internist has done a breast exam, go home and do one yourself that very day. That way, you\’ll know what\’s normal for you. Also, many clinicians have a realistic model of a breast – with and without lumps – on which you can practice the exam; ask about this. But, regardless, if you find something in your breast, even if you think you\’re not good at examining yourself, see your clinician – it could save your life.
What about a healthy lifestyle? Being at a reasonable body weight is very important in prevention, as is regular exercise (30 minutes per day of walking for 5-7 days/week at least). You should limit your intake of alcohol to less than three drinks/day. A nutritious diet of many colorful fruits and vegetables, healthy proteins (fish and chicken) and “good fats and carbs” is essential, as are calcium and Vitamin D supplements. And add onto all of the above a positive outlook!
Discussing this one topic could fill an entire book (and, in fact, does); I have tried to hit on the highlights here. For further information, go to www.nci.nih.gov/cancerinfo/types/breast and www.nbcam.com/