October is Breast Cancer Awareness Month and there are pink ribbons everywhere. I believe it is important during this time to reflect on why breast cancer has become a nationally recognized cause. Whenever I tell someone that I am a breast surgeon, it seems they always have had a personal experience with this disease. Sometimes it is the story of a family member, a friend, a neighbor, a coworker, or sometimes it is their own story.
According to the 2010 American Cancer Society data
, breast cancer remains the number one cancer diagnosis in women with an estimated 207,090 cases predicted for this year. In Texas, an estimated 12,920 women will be diagnosed with breast cancer this year, and 2,780 women will die from the disease.
Stacey Lopez, Jessica McCall, Gena Slayton, Claudia Vela, Dalael Wille, Jennifer Railsback, Mary Lauriano, Elizabeth Paniagua, and Stella Turrubiate.
Breast cancer does not discriminate. It strikes women of all races, although not always equally or fairly. It is most common in Caucasian women, followed by African-American women, then Hispanic and Latino women, and then women of Asian descent. And we should not forget that for every 100 women diagnosed with breast cancer, one man will also be diagnosed with the disease. For reasons not yet clearly understood, while more Caucasian women will be diagnosed with breast cancer, more African-American women will die of this disease. And a woman’s risk continues to go up with age. You are never too old to get breast cancer.
The good news is that the number of women being diagnosed with breast cancer has been decreasing. This decrease occurred after we stopped routinely recommending hormone replacement therapy for menopause. Another positive statistic is that fewer women with breast cancer are dying. This benefit is believed to be related to early diagnosis and improved treatments.
When a woman learns she has breast cancer, one of the first questions she usually asks me is, “What is my stage?” The stage describes the extent of the cancer in the body. It is based on whether the cancer is invasive or non-invasive, the size of the tumor and whether it has spread to the lymph nodes under the arm or to other parts of the body. The stage of a cancer is one of the most important factors in determining prognosis. Breast cancers found at early stages have better survival rates than those found at later stages.
So if finding breast cancer at earlier stages when the tumor is small means fewer women will die, how do we reconcile the current controversy regarding mammograms?
Most of us have heard or read that the U.S. Preventive Services Task Force (USPSTF)
, which is a group of health experts convened by the U.S. Department of Health and Human Services, made significant changes in their recommendations for women receiving mammograms. Their recommendations were based on computer statistical models of numbers of breast cancers found by screening compared to the number of biopsies done in which no cancer is found.
The USPSTF recommends the following:
- Routine screening of average-risk women should begin at age 50, instead of age 40.
- Routine screening should end at age 74.
It’s important to note that the new USPSTF guidelines are just about routine screening mammograms. They're not about getting a mammogram when you have a lump or other suspicious finding or if you're at high risk of breast cancer. Any woman, of any age, should get a suspicious lump or other breast change checked out.
The American Cancer Society
and other national organizations involved in the care and treatment of women with breast cancer continue to recommend annual screening mammograms for all healthy women beginning at age 40.
The American Cancer Society recommends the following:
- Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health
- Clinical breast exams about every three years for women in their 20s and 30s, and every year for women 40 and over
- Breast self-exam starting in their 20s
So besides getting our mammograms on a regular basis, are there any other things we can do to proactively take control of our health and reduce our chances of getting breast cancer?
- Maintain a healthy weight. Obesity, especially weight gain after menopause, has been associated with increased risk of breast cancer.
- Stay physically active. Women who exercise regularly decrease their risk of developing breast cancer. Set a goal of 45-60 minutes of intentional exercise five or more days a week.
- Limit the amount of alcohol you drink. Alcohol use has been linked to increased risk of breast cancer and the greater the intake the greater the increase in risk. The American Cancer Society recommends limiting alcohol to one drink or less per day.
- Avoid hormone replacement therapy when possible. And if you and your doctor decide to use hormone therapy for symptoms of menopause, it is usually best to use it at the lowest dose that works to control the symptoms and for as short a time as possible.
During October, as you see the pink ribbons all around, take a few minutes and ask, “Is it time for my mammogram? Am I doing everything I can to stay healthy and decrease my risk of breast cancer?”