By: Dr. Phyllis Bivins-Hudson
October is Breast Cancer Awareness Month. So, while you are planning your next to-do list, include making sure to educate yourself about the disease.
We all know something about breast cancer, however, there is so much more advanced information for us to know. Just a little bit of knowledge might save your life or someone else's life.
I hope reading this month's article will help. Let me know.
There was a time when I knew no one who ever had breast cancer. Now, I am sorry to say that I know too many people who have had that awful disease.
However, as awful as it may be, the years of research and discovery have been good for us as a society in general. To those who have lost their lives or to those who are left behind to mourn their loved ones, I recognize that my words don't mean very much.
Still, great strides have been made in trying to combat this disease. Probably the best advice, though, is still in the words, "If breast cancer is found early, when it's small and has not spread, it is easier to treat successfully". This means getting regular screening tests for early detection.
These tests have proven to be among the most reliable ways to find breast cancer early.
That said, education is still the best teacher. We must educate ourselves and our loved ones so that we can all be as protected against this disease as we can be.
And even though we might be doing the right things, it is no secret that for some of us, breast cancer is inevitable, but it doesn't always have to be a death sentence.
The evidence of this rests in the many breast cancer survivors and their stories of bravery.
I know women who religiously have breast cancer screenings, and I am one of them. However, I also have heard women ask how often they should be screened or need a mammogram.
To this, I yield to the professionals who say, "Yearly mammograms for women aged 40 and older. However, the specific frequency may vary based on your risk factors and the guidance of your health care team". (Atlantic Health System).
Fortunately, breast cancer screenings are generally covered by insurance, and this is especially true for women who have reached the recommended screening age of 40 or older. But when I have been in discussion with women who ask how often or if they need a prescription from a physician, I am always curious as to whether their ask is because they don't know how often they should have this procedure performed or if it's something else.
Once I received a response to the latter, I inquired. When I learned that money was the concern, I went on my quest to see how this important procedure could be done if funds were not available.
What I learned is that, for the most part, if you are a member of the recommended screening age of 40 and older class of women, a prescription is not required to schedule a routine screening.
Of course, if there is a prescription, it is better because your results can be shared with your physician, who knows you better and, if nothing else, provides a second set of eyes on the results.
Hence, if a physician's prescription is not required for the particular class of women mentioned, then perhaps those women might consider making an appointment for a free or low-cost mammogram through programs like the National Breast and Cervical Cancer Early Detection Program, local health departments, or certain non-profit organizations like the Susan G. Komen Foundation," according to https://www.breastcancer.org/screening-testing/mammograms/where-to-get-mammogram#
As women, in particular, we have to be diligent about getting our regular screenings for breast cancer because it is crucial to our health.
With so much new research and promise around this disease, we must be proactive. The life we save may be ours, a loved one's, or a friend's.
Here are 5 reasons why you should have regular breast cancer screenings, according to City of Hope:
- Breast cancer is a leading health concern for women. Breast cancer is the second most frequently diagnosed cancer in U.S. women, behind only skin cancer. Following your recommended screening schedule can make all the difference, in combination with self-exams and regular well-woman visits.
- Self-exams cannot find everything. The most common symptom of breast cancer is a lump, but the disease can develop without outward signs or symptoms. If you discover an unusual mass or a troubling change in the breast, notify your physician without delay.
- Early detection saves lives. Finding breast cancer early gives you and your physician the most options and is a key factor in successful treatment. The five-year overall survival rate for breast cancer that has not spread beyond the breast is 99%.
- Risk increases with age. As we get older, the risk of breast cancer rises. A woman of average risk should have an annual clinical breast exam starting at age 20 and an annual mammogram starting at age 40. If your breast cancer risk is higher than average, your physician may recommend starting screenings earlier or more frequently.
- Screening is an opportunity to understand your overall breast cancer risk. When you talk to your doctor about breast cancer screening, ask about positive lifestyle changes that can help prevent cancer, such as maintaining a healthy weight, quitting smoking, and being physically active. If you have a family history of breast cancer, your physician may recommend genetic testing to determine if your genes carry an inherited change commonly associated with breast cancer.
Then there's genetics. We have to consider that we are all from somewhere and someone. That said, we have to look at the genetic code and what it says about us individually and collectively. Genetic testing is a valuable scientific tool that we can employ to help guide our decisions when we consider our cancer risks.
According to Dr. Wade Smith, M.D., medical oncologist and breast cancer specialist at City of Hope, New Beach, July 21, 2021, "Your cancer risk can be increased by genetic mutations passed down through your family tree; think of the BRCA1 or BRCA2 mutations associated with breast cancers and ovarian cancers.
You inherit one copy of your genes from your mother and the other from your father. If there are cancer-causing mutations on either side, there's a chance the mutation has been passed down to you. Simply put, when you have a more accurate picture of your genetics, you have a more accurate picture of your cancer risk."
This is an excellent reason why we should consider genetic testing as well as discuss these matters with family members. In some families, illnesses are kept a secret, but a part of the education process I mentioned earlier includes knowing your family history.
When we have this important information, and we learn that there is a family history of cancer, especially through multiple generations and first-degree relatives, or particular types of cancer that have occurred on one side of our families (for example, your mom, her sister and their aunt all had colon cancer), we position ourselves in a place where a genetic counselor can help us determine if genetic testing is right for us.
If you suspect you are genetically predisposed to breast cancer or any other cancers, take some time to curate a family health history with known relatives who had cancer and the age they were when they were diagnosed.
The results may return positive, which may mean you have a genetic mutation and may have an increase in cancer; however, it does not mean you have cancer or will have cancer in the future. It does offer an opportunity to speak with your doctor and perhaps make some changes in your life, which could save your life as you get older.
If you are concerned, have an in-depth conversation with your physician, especially since there could also be nonhereditary factors to consider. In fact, according to Dr. Smith, "This information allows you to be proactive. If you have a BRCA1 mutation, for instance, you can talk with your physician about pursuing a screening strategy that accommodates your higher risk. You may also decide to adopt lifestyle changes that prevent other risk factors, whether that's maintaining a healthy weight through diet and exercise or quitting cigarettes."
Women aren't the only ones who have to be concerned with breast cancer. While men are not usually the unfortunate benefactors of this dreaded disease, they can get breast cancer, too. Would you believe that about 1 out of every 100 breast cancers diagnosed in America is found in men? (Men's Health, Alexa Tucker, October 25, 2017).
It's true. And while that number is small by comparison, it is also true that breast cancer is about 100 times less common in men than women, according to the American Cancer Society (ACS). The ACS has said further, "For the average man, the risk is about one in 1,000.
That equates to about 2,470 new cases of invasive breast cancer diagnosed in men in 2017." I'm sure that number has increased over the years, although I hope that isn't the case.
Here are: 6 Facts About Male Breast Cancer Every Man Needs to Know
- Male Breast Cancer Fact: The first sign is almost always a lump in the chest Feeling a lump—or a breast mass—in your chest is almost always the first sign of breast cancer in males, says Sharon Hermes Giordano, M.D., professor of breast medical oncology at the University of Texas MD Anderson Cancer Center and Breast Cancer Research Foundation investigator. Most often, it's found directly behind the nipple, but it can be anywhere within the breast. You may also be able to feel an enlarged lymph node in your armpit, adds Dr. Boolbol. Another sign is a change in your nipple, although this will usually be associated with a mass you can feel, says Dr. Boolbol. The shape may change, or the nipple may retract inwards, she says. "I've had a few patients that have developed bleeding from the nipple, which can be another worrisome sign," adds Dr. Giordano.
- Male Breast Cancer Fact: Family history, male or female, can put men more at risk. A family history of breast cancer—male or female—puts you at a higher risk than the average male. According to the American Cancer Society, about one in five men with breast cancer have a close relative who has also had breast cancer. In many cases, that's due to inheriting a BRCA1 or BRCA2 gene mutation spoken of earlier in this paper. While not all breast cancer in men is caused by BRCA gene mutations, it does put men at a significantly higher risk. If a man has the BRCA2 gene mutation, his lifetime risk of developing breast cancer jumps to about six in 100. According to the ACS, if he has a BRCA1 mutation, the risk is about one in 100. BRCA mutations also increase the risk for other cancers, including prostate cancer and pancreatic cancer. So if one of a man's direct relatives has the gene mutation—parents have about a 50 percent chance of passing it onto children—or he has a strong family history of breast cancer, genetic testing may be a wise decision to understand the risk so he can watch for any possible cancer-signaling breast changes, says Dr. Giordano.
- Male Breast Cancer Fact: Certain health conditions may also increase the odds While family history is the bigger concern, says Dr. Boolbol, certain conditions increase a male's risk, too—namely, ones that increase estrogen. "Men [with breast cancer] are much more likely to have tumors that are driven by hormones, estrogen in particular," says Dr. Giordano. This is opposed to other types of breast cancer that are seen mostly in women, like triple-negative breast cancer. While most causes of male breast cancer are unknown, according to the American Cancer Society, hormone levels are thought to play a role because breast cells grow and divide in response to female hormones like estrogen. The more dividing that happens, the bigger the chance there is for error in the DNA-copying process. And that can lead to the growth and spreading of cancer cells. One estrogen-related risk factor is liver disease, like cirrhosis or severe liver scarring that's often a result of chronic heavy drinking. According to the American Cancer Society, men with severe liver disease often have lower levels of androgens—male sex hormones, like testosterone—and higher levels of estrogen. Obesity also puts both men and women at a higher risk because fat cells convert androgens into estrogens. It's worth noting that obesity also raises the risk for many other cancers, too, says Dr. Boolbol. Men who've had radiation to their chest wall, often as a treatment for another cancer called lymphoma, are also at higher risk.
- Male Breast Cancer Fact: Breast lumps can often be confused for man boobs Those conditions linked with higher estrogen can also cause gynecomastia, which is simply the development of breast tissue in men—you might think of them as man boobs. This can often be confused with breast lumps. "One of the most common reasons why breast surgeons see men is because they've developed a mass," says Dr. Boolbol. "It more often turns out to be gynecomastia, rather than breast cancer." Gynecomastia itself doesn't increase your risk for breast cancer, but since it's also linked to higher estrogen levels, it's important to make sure it's just gynecomastia, says Dr. Boolbol. Even if it's not a breast mass, a physician can evaluate what's causing it.
- Male Breast Cancer Fact: There is treatment for male breast cancer While every patient is different, the protocol for screening for and treating breast cancer in men and women is pretty much the same. "When a man comes in with a breast mass, we frequently will do the same thing as we do with women: Get a mammogram and an ultrasound," says Dr. Boolbol. This will alert your doctor as to whether or not a biopsy is needed to check for cancer cells. If there is a breast cancer diagnosis, the next step is typically surgery. "Most men undergo a mastectomy, even if they have very little breast tissue," says Dr. Giordano. The surgeon will then do a biopsy of the lymph nodes in the underarm to make sure no cancer has spread, she says. This is often followed by chemotherapy and radiation if needed.
- Male Breast Cancer Fact: Delays in diagnosis can be deadly When men and women are diagnosed at the same stage, the survival rate is the same. "If they both present at stage one, the overall prognosis is the same. Stage two, it's the same, [and so on,]" explains Dr. Boolbol. However, many men do tend to wait longer to get checked out, and early detection is key for boosting your chances of beating it. "Sometimes if a guy feels a lump, a lot of men don't even think that it's a possibility that they could get breast cancer, so they might not go to their doctor and get it checked out in a timely fashion," says Dr. Giordano. "They do tend to present with bigger tumors, and they're more likely to have lymph node involvement because we're [also] not picking anybody up by screening [with mammograms]." This means it's up to you to watch for lumps and other changes—and get them checked out as soon as possible. That said, it's also easier for men to notice lumps in their breasts because they have less breast tissue. "Although men tend to wait longer, overall men with a breast mass do get evaluated because it's unusual," says Dr. Boolbol.
Even though a man's chance of developing male breast cancer is slim, it can be deadly—about 460 men will die from male breast cancer each year.
Whether you are a male or female, take charge of your health by being informed about breast cancer and the steps you can take to reduce your risk. And the next time you see those pink ribbons, don't only associate them with women with breast cancer because men get breast cancer too.
A common notion is that men cannot get breast cancer because they don't have breasts. However, Dr. Susan K. Boolbol, chief of breast surgery at Mount Sinai Beth Israel, says, "…of course they do. Men are born with small amounts of breast tissue, and while they don't develop like women's, it means there's still a potential for cancer to develop there."
Protect yourselves and help your loved ones protect themselves. Get regular screenings and know the signs of breast cancer as well as any other cancers.
Until next time, keep flying on your own wings.