Over the years, the face of breast cancer has appeared in various forms throughout this medical odyssey, of which I have been allowed to experience firsthand. My earliest exposure occurred in medical school at the University of Iowa on my surgery rotation. A woman in her 60’s, probably a farmer’s wife, although memory fades me at this point, presented to the surgeon with one of the most horrific looking cancers I had ever seen. Her left breast did not even resemble a breast anymore. It was hard for me to differentiate the breast from her chest wall because the cancer had eaten way so much of her tissue. What was glaring before my eyes was just a large clump of macerated exposed flesh.
Forgive me for my gruesome description, but that is the harsh reality of a parasitic condition that is allowed to progress to such a degree. Having seen that at an early stage of my career, helped shaped my fervent passion for educating women on the importance of early detection and prevention. In honor of Breast Cancer Awareness Month, I dedicate this column to all of the families who have been affected by breast cancer including my own.
Cancer that begins in the tissue of the breast is breast cancer. The most common type, ductal carcinoma, begins in the lining of the tubes that carry milk from the lobules to the nipple. Lobular carcinoma originates in the milk glands. Breast cancer can occur in both male and females, but is rarely found in men. For women in the United States, breast cancer is the second most common cause of cancer. In 2011, over 220,000 women were diagnosed with breast cancer and over 40,000 of those women died.
The consensus from most health organizations except the USPSTF, the United States Preventive Service Task Force, is to begin yearly mammograms in women starting at age 40. The USPSTF recommends breast cancer screening starting at age 50. Mammograms are x-rays of the breast tissue and can detect very tiny abnormalities. Contrary to common belief, mammograms are well-tolerated as compared to other types of exams and involve some minor compression of the breast. The technician performing the x-ray tries to compress the breast tissue enough so that masses are easily visible.
Prior to my first mammogram, female patients in my practice had convinced me that the pain from a mammogram was like having your breast slammed in between steel beams. However, I found that description to be far from the truth. The entire procedure takes less than 10 minutes and compared to the pain of metastatic breast cancer, I would choose the mammogram any day.
Though mammography has been the standard of care for some time, many women continue to delay their routine screenings. In 2010, only a third of women over the age of 40 had a mammogram in the last two years. The rates of mammography were even poorer if the woman lacked health insurance, with only 32 percent of uninsured women receiving a mammogram in that same year. Several barriers to screening mammograms exist, such as low income, lack of access to care, lack of a primary care physician, lack of a provider-driven recommendation, lack of awareness regarding breast cancer risks and screening techniques, and cultural/language differences. These barriers may help explain why disparities in breast cancer exist for African American women. The incidence of breast cancer is lower in African American women but the death rate is higher. Research has also shown that African American women are more likely to present with more advanced breast cancer and are often delayed in receiving the type of care that is needed once the cancer is diagnosed.
But what about prevention? Is it possible to prevent breast cancer? Maintaining a healthy weight, regular exercise, eating a diet full of fruits and vegetables and not smoking are all ways to improve the likelihood of not having breast cancer. And it is not too late to start these life-saving habits. In addition, be proactive. Don’t delay yearly mammograms. Throughout the year, several of the local hospitals provide mammography vans across the city. There are even programs that will assist you financially and emotionally if you are diagnosed with breast cancer.
October is Breast Cancer Awareness Month and it symbolizes more than just walks and wearing pink ribbons and t-shirts. This month represents survival and unbridled energy toward improving the statistics of breast cancer. It is about saving lives!
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
