If you are in denial that breast cancer could ever happen to you, join the club. This is a disease that often has no symptoms – no pain, no visual cues, and nothing that stands out to announce its presence in the early stages. The only way to detect it early is through regular screenings and being aware – knowing your body and noticing changes.
How prevalent is breast cancer? Very. One in every eight women in the United States, about 220,000 women per year, are diagnosed with this disease. (For men the incidence is about one in 1,000.) According to the Center for Disease Control (www.cdc.gov), breast cancer is the most common type of cancer in women regardless of race or ethnicity and it’s the second leading cause of death. However, there are 2.9 million women who have survived breast cancer living in the U.S. today, comprising the largest group of cancer survivors compared to any other type of cancer. Breast cancer deaths have been declining since 1990 because of increased awareness, better screening, early detection, knowledge about causes, and new treatment options.
Dr. Stephanie Jakim, a Family Practice physician for 30 years and currently based at Olmsted Medical Center in Preston, speaks candidly from her experience as a doctor and breast cancer survivor. She says, “…mammography has its limitations but it is the best test available. It detects early breast cancer. It allows us to treat women earlier. We think it decreases breast cancer deaths.” Dr. Jakim talks about risk factors for breast cancer. Family history is one factor but she warns, “Remember that 70% of women diagnosed with breast cancer have no family history, so it is not the only factor.” Some other factors are “early menarchy (the earlier you start your periods), late delivery of your first child, and dense breasts.”
Breasts are made up of three kinds of tissue: glandular, connective, and fatty. Glandular and connective tissue are more dense than fat. According to the Susan G. Komen Research Foundation, women with more breast density are four to five times more likely to develop breast cancer which makes density a significant risk factor. In spite of this risk, there are currently no recommendations or screening guidelines for women with dense breasts. So how do you know if your breasts are dense? Younger people and thinner people tend to have denser breast tissue, but not always. And dense breasts don’t feel any different, they just look different on a mammogram.
“One of the questions I get most often,” says Dr. Randi Berg, a physician in Family Medicine for 17 years, the past seven years with Gundersen Health in Harmony and Spring Grove, “is when to start and when to stop getting screened for breast cancer.” The answer is: it depends. Regular mammograms may start in your 40s, but possibly earlier or later depending on personal risk factors. The number one risk factor for breast cancer is simply being a woman. So the best thing for all women to do is pay attention to changes in your body and discuss any changes or concerns with your doctor. Things to watch for include lumps in breasts or underarms (90% of lumps you find when you are between the ages of 20-50 will be benign, but check them out in case of the 10% that indicate problems), discharge from the nipples, changes in nipple shape – inversion, puckering or dimpling (which may be very subtle), unexplainable swelling, itching, redness, or rash on breasts, under arms or on the collarbone, or thickening of breast skin.
There are many factors to consider when doctors say it’s ok to stop getting screened. Dr. Berg says, “We look at the current level of health and life expectancy. We try to maintain the person’s quality of life. Sometimes our goal is to treat rather than cure, so it doesn’t cause a lot of symptoms, pain or anything that’s difficult to manage.” Dr. Jakim concurs, “In general, medicine tries to take a hard look at the necessity of tests. The goal is to offer a longer life and a better quality of life. If it doesn’t have this result, why do it?”
Not only do attitudes and values change around breast cancer detection and treatment, medical technology is constantly changing. A new type of digital imaging, 3D mammography, also known as “DBT” or “tomosynthesis,” represents a big change in the way we screen for breast cancer. This technology provides more image clarity that results in earlier detection of abnormalities and fewer recalls for questionable spots. DBT is available at Gundersen’s Norma J. Vinger Center for Breast Care and at Olmsted’s Women’s Health Pavilion. “There is still compression of the breast,” says Sarah Kohn, Breast Care Coordinator at Olmsted’s Women’s Health Pavilion, “and it takes a few seconds longer because the mammogram machine moves in a 50 degree arc around you, taking pictures the entire time.” This enables the radiologist to see a sort of 3D movie of the inside of the breast with good clarity. Tomosynthesis has a good track record in detecting more invasive breast cancers. “The technology gets better and better,” says Dr. Jakim, “but it’s not perfect. There will still be false positives and false negatives. A new molecular screening test is in the study phase at Mayo.” Before scheduling 3D mammography you will want to check with your insurance company. The full cost may not be covered.
Breast cancer happens to a lot of people and sometimes there is no way to predict or prevent it but Dr. Jakim identifies several protective factors: if you are planning to have a baby, consider breast feeding. It offers protections. She also advises, “Your body is a system and if you keep the system healthy, any kind of cancer will have a harder time developing – eat a healthy diet, maintain a healthy weight, don’t smoke, exercise, and reduce your alcohol use. If you are diagnosed with breast cancer, the earlier you treat it the better.”
There has been a recent shift in thinking about cancer from organ-focused (the type of cancer) to gene focused (cancer genomics) which is changing the way doctors treat cancer. While most cancers happen by chance or through genetic damage that occurs as a result of aging or exposure to toxins, some cancers are the result of genetic mutations passed down in families. About 3% of breast cancers are caused by mutations in the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. Medical tests for these mutations can be performed for those who have family histories that indicate high risk. Everybody has BRCA1 and BRCA2 genes and when they work properly, they actually prevent cancers. When these genes don’t work properly, cancer risk can jump from the normal 12.5% up to 60-90%.
In 2015, actress Angelina Jolie, whose mother died from ovarian cancer at the age of 56, was found to have the BRCA1 mutation that put her at an 87% chance of getting breast cancer. One option for her would have been vigilant and frequent screening to catch any cancerous growth at an early stage. She opted for the more radical approach of a preventive double mastectomy and did so in a very open way. Her decision casts a light on cancer genomics, both the opportunities and the difficult decisions that need to be made when this type of information is available. The first step, prior to genetic testing, would be to collect your family medical history, especially as it relates to blood relatives who got breast or ovarian cancer, and discuss it with your doctor.
For those who do develop invasive breast cancer, mastectomies have changed. Reconstructive/plastic surgery often starts at the time of the initial operation. A new type of surgery called “Nipple Sparing Mastectomy” removes the glandular tissue but keeps the breast skin and nipple resulting in more natural looking breasts. When breast cancer is caught early, there is the option for less invasive surgeries that preserve muscle, reducing time in the hospital and minimizing the need for radiation.
While catching breast cancer early allows options and choices not available at later stages it is very easy to put off screenings. While traditional tests are easy and noninvasive, they do deliver false positives that cause unnecessary worry, and false negatives that delay treatment. Local women’s centers are aware of these factors and are now offering high tech options like tomosynthesis, MRI, and other services. Some are also changing to make it more pleasant to come in for screening. Olmsted’s Women’s Health Pavilion was remodeled in 2013 to offer a more spa-like atmosphere. The Breast Center there has a fireplace, low lighting, and a more private setting on the lower level. They provide private dressing rooms that lock with a key so you don’t worry about your possessions while being screened. Olmsted’s Women’s Health Pavilion is in Rochester, (507) 529-6605, and Gundersen’s Norma J. Vinger Center for Breast Care is in La Crosse, (608) 775-2385. A mobile mammography unit that comes to you is also available in Harmony and Spring Grove through Gundersen Clinics. So now that the holidays are over and life is probably settling down, perhaps it’s time to snap out of denial and talk to your doctor about being screened for breast cancer.