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Breast cancer: women fighting back

City of Hope provides advice and answers

Merdies Hayes | 10/4/2013, midnight
Breast Cancer Awareness Month got underway nationwide this week as tens of thousands of women of all ages, all colors ...

Breast Cancer Awareness Month got underway nationwide this week as tens of thousands of women of all ages, all colors and stations in life learned what important, sometimes life-saving, measures they need to take for themselves and loved ones in order to defeat a scourge that will reportedly claim 40,000 lives this year.

The American Cancer Society estimates that there will be about 227,000 new cases of breast cancer diagnosed nationally each year; and the disease continues to be a leading cause of cancer-death for women. But there are improved measures of detection available today, and facilities such as the City of Hope in Lancaster and the Antelope Valley Cancer Center are urging locals to get screened for breast cancer and learn about the positive, actionable steps to help fight the disease.

The discovery of a lump on your breast, or the physician’s dreaded words “we found a problem,” is often an unexpected shock for the woman diagnosed with a cancerous tumor. Often, the stressful wait for test results and the resulting brush with mortality may upturn the ordinary life and even leave psychological scars.

That’s why early screening is vital. It often saves lives. But when should you have a mammogram? The American Cancer Society maintains its recommendation that yearly mammograms should begin at age 40, but the U.S. Preventive Services Task Force has recommended that women receive mammograms yearly from ages 50 to 74, and after that every two years. This latter recommendation was based on data showing that yearly mammograms could do more harm than good, leading to many false-positive findings that may result in additional expense, unnecessary anxiety and needless follow-up procedures.

Dr. Jane Mortimer, director of the women’s cancers program at City of Hope, said last month that recent, varied studies of breast cancer in women do not support so-called “across-the-board” screening for every woman beginning at age 40. Her colleagues found that earlier, regular mammograms may not be suitable for every woman, noting that it is not a “one-size-fits-all” decision.

Early screening is recommended for women with a family history of cancer, those who have already had a bout with cancer (i.e. lukeumia) or people who suffer from diseases such as HIV/AIDS, Hodkins, Sickle Cell etc.)

“Some organizations have left the screening at age 40 [in place] because it is such a contentious issue. It’s more about emotion than data,” Mortimer said. “Risk assessment is really very critical. We harp on individualized healthcare, and that means understanding each woman’s risk.” Mortimer further explained that, women at low risk of breast cancer, should not be exposed unnecessarily to radiation in mammograms. Women at high risk, though, should definitely have a mammogram and may need an MRI (magnetic resonance imaging), she said.

Who is more at risk?

Those more at risk for developing or dying from cancer include poor Black women; poor women; those with a history of cancer in the family; women who smoke or drink heavily.

Studies have found that younger women who develop breast cancer tend to have a more aggressive form of the disease—one of the arguments against early routine mammograms. Mortimer said such cancers progress much faster—sometimes in less than a year.

Because the tumor may be small or obscured a mammogram may not detect it and, possibly, create a false sense of security. High-risk patients usually get a screening every six months, alternating between an MRI and a mammogram. Older women who may be at risk include persons who have been exposed to chest radiation, or who have had a prior cancer. Women who have tested negative for one of the known cancer mutations (such as oncogenes and tumor supressor genes), but have a family history of breast cancer, could be at high risk. There are women whose family histories are incredibly strong, but have yet to get screened, Mortimer continued. “Those women should be aggressively screened as well.”

Being a woman is considered the main risk factor for developing breast cancer, although men do contract the disease but in much fewer numbers. The National Breast Cancer Foundation says about five to 10 percent of breast cancer cases are thought to be hereditary. That is, they result directly from gene defects (mutations) inherited from a parent. The most common cause of hereditary breast cancer are found in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, the foundation believes you have a high chance of contracting breast cancer during your lifetime. In some families, it can be as high as 80 percent, but on average the risk factor is in the range of 55 to 65 percent.

Notwithstanding the factors leading to discovery of cancer percentage and numbers may be of little solace to the woman who, at minimum, must undergo surgery when any mistake on the operating table can be life-threatening. Sometimes a mastectomy and reconstructive surgery may be called for and, with good fortune, the cancer may be removed entirely. Recurrent breast cancer means the disease has returned after being treated. It may come back in the breast, chest wall or in other parts of the body. The advanced-stage cancer is often a terminal diagnosis in which medical help is futile.

According to the Los Angeles County Department of Health Services, early detection of breast cancer is imperative for reducing mortality rates, sometimes by as much as 15 to 25 percent depending on the mass of the tumor. They recommend that women ages 40 to 49 speak with their healthcare provider about when to have a mammogram.

Consider factors, officials stress, about your risk level and your personal beliefs about the potential benefits and pitfalls of screening. County officials believe women ages 50 to 74 should have a mammogram every two years. If you’re over 75 years, they suggest you consult your doctor because radiation from the mammography can sometimes leave a senior much weaker and more fragile compared to the effect on a 20- or 30-year-old.

Mortimer said that mammograms are, indeed, a “valuable” diagnostic tool, but like all cancer screening tools, must be used appropriately. She added that the most beneficial approach is one that takes into account a woman’s individual risk factors and needs. “Getting an annual mammogram does deliver radiation,” Mortimer explained. “If you don’t need to get it, why expose yourself?”

The most common form of breast cancer is ductal carcinoma which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Cancer that begins in the lopes or lobules (milk glands) is called lobular carcinoma and is more often found in both breasts than are other types of cancer.

Invasive breast cancer is a malignancy that has spread from where it began in the breast ducts or lobules to surrounding normal tissue.

Inflammatory breast cancer is a fast-spreading form of the disease and cannot always be detected by a self examination because no hard mass or lump may be easily detected; in this case, a clinical (manual) examination performed by a doctor is the best identifier.

Because cancer detection and resultant care is improving, the City of Hope encourages family members of women to take on a vital role as caregivers.

The City of Hope is conducting an on-going study analyzing the difference that supportive services can make for cancer patients. They believe such services have the potential to improve physical, psychological, social and spiritual well-being.

“For 99 percent of the time, cancer care is provided at home by the family,” said Betty Ferrell, Ph.D, and director of Nursing Research and Education at City of Hope. “Patients are in the clinic for a few hours. People are hospitalized less and less often. It’s really the family providing care, and they’re doing it 24 hours a day.”

City of Hope announced in August that an MRI of the breast is generally better than mammography at detecting cancerous lesions . . . but there are downsides. First, an MRI costs about 10 times more than a mammogram (the latter priced roughly at $250 for the screening, the radiologist reading and the computer-aided detection), and, the research organization reports, there is a “higher likelihood” of a “false positive” which can lead to unnecessary tests and treatments. Also, researchers found that women who had a breast MRI are more likely to undergo invasive mastectomies, which can come with their own complications.

The National Institute of Health reported in 2011 that wounds on the chest wall may persist long-term, leading to skin loss or infection. A build-up of blood at the surgical site can form hard scar tissue (hematoma) that could lead to bleeding into the area where the breast was removed.

Also, the Mayo Clinic in 2008 found that 20 to 60 percent of women will experience chronic pain after a mastectomy with symptoms including pain in the chest wall, pain or itching in the shoulder or armpit, pain around the surgical scar and tingling down the arm. After evaluating relevant data, City of Hope researchers found that women 65 years and older who underwent a breast MRI were 20 percent more likely to opt for a mastectomy rather than breast-conserving surgery.

Yet another City of Hope survey found that online tools can improve patient outlook. Here, researchers within the department of Medical Oncology and Therapeutics Research said that online intervention tools can help boost a patient’s mood, making them feel less depressed. They had patients create a personal website and found that women who expressed their feelings about their health enabled them to better communicate with loved ones, resulting in a more positive outlook. Also, patients didn’t have to constantly repeat to their distant family and circle of friends information about their treatment. “This is a way they can mobilize support through their computer and website,” said Annette Stanton, Ph.D, lead author of the study.

Women can take action now to help prevent the chance of breast cancer. First, limit alcohol intake, exercise regularly, maintain a healthy weight, eat a balanced diet, and definitely either stop or don’t start smoking.

The signs and common symptoms of potential breast cancer include:

  • A change in how the breast or nipple feels;
  • A change in how the breast or nipple looks;
  • A change in the size or shape of the breast;
  • A lump or thickening in the size or shape of the breast;
  • Nipple tenderness;
  • Nipple discharge/discoloraton;
  • A nipple turned inward into the breast;
  • The skin of the breast, areola, or nipple may be scaly, red or swollen. It may have ridges or pitting resembling the rind of an orange.

Treatment for breast cancers is an individualized choice based on the severity of the cancer diagnosis. Traditionally, chemotherapy and surgery are treatments and in some cases holistic healing for cancer.

However, the Food and Drug Administration recently approved the drug Perjeta for women who have a form of early-stage breast cancer. It is said to be the first medicine approved to treat breast cancer before surgery, and is designed for women who may have a high risk of having the cancer spread to other parts of the body. Because surgery to remove tumors is usually the first step in treating forms of cancer, the new drug could help shrink tumors thereby making them easier to remove. In some cases, according a report by the Associated Press, this medicine could allow women to keep their breasts, rather than having a full mastectomy.

This month, City of Hope will conduct seminars/events designed to promote breast cancer awareness. On Oct. 10 at 6:30 p.m., Antelope Valley Hospital will host Dr. Lily Lai who will give a free educational lecture on breast cancer survivorship. The following week on Oct. 19, the City of Hope will sponsor the Antelope Valley Making Strides Against Breast Cancer Walk at 7 a.m. at Palmdale Amphitheater, benefiting the American Cancer Society’s breast cancer programs. So far, 44 teams have been organized (173 participants) collecting $7,768 in donations.

National Breast Cancer Awareness Month is a collaboration of national public service organizations, professional medical associations, and government agencies working together to promote breast cancer awareness, share information on the disease and provide greater access to services.

Founded in 1985 as a partnership between the American Cancer Society and pharmaceutical giant AstraZeneca, National Breast Cancer Awareness Month has promoted mammography as its most effective weapon in the cancer fight. The month involves a variety of events nationally and around the world, including the popular Avon walks and runs, “Race for the Cure” by the Susan G. Koman Foundation and even players in Major League Baseball will wear pink caps and National Football League players will wear pink cleats.

There have been critics of National Breast Cancer Awareness Month who have said the festivities may point to a conflict of interest between corporations sponsoring breast cancer awareness while profiting from diagnosis and treatment. The breast cancer advocacy organization, Breast Cancer Action, has said that the month of October has become more of a public relations campaign that avoids discussion of the causes and prevention of breast cancer, and instead focuses on “awareness” as a way to encourage women to get mammograms.

Among the collaborating organizations working this month to put a spotlight on breast cancer are the American Society of Clinical Oncology, the American Medical Women’s Association, CancerCare, the National Medical Association, the National Cancer Institute and Prevent Cancer Foundation.