Breast cancer awareness: knowledge is half the battle
Years ago, breast cancer was in the same category of health issues as menopause and prostate cancer: it wasn't discussed freely except among medical professionals, and it certainly wasn't the subject of a global campaign with pink ribbons, fund-raising telethons and media attention. But thankfully for everyone's sake, attitudes have changed.
As research expands our knowledge of breast cancer and breast health, we can become stronger advocates for our own well-being. However, this research also brings some controversy, especially about mammograms. First, let's review the basics.
What is breast cancer?
Cancer is the word we use for diseases in which abnormal cells divide uncontrollably and are able to spread to other tissues. Breast cancer forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
In the United States in 2011 as an example, it's estimated that 230,480 new cases of female breast cancer were diagnosed and 39,520 women are expected to have died from breast cancer. Overall, about 12% of American women will develop breast cancer in their lifetime... and for about a quarter of these, it will be fatal.
When breast cancer starts, it is too small to feel and does not cause signs and symptoms. Mammograms help doctors look for early signs of breast cancer. If breast cancer is found early, it may be possible to treat it before it spreads. In 2008, more than 75% of women over 40 reported having a mammogram in the past two years.
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Mammograms: which type, how often?
In recent years, some studies have questioned the benefit of mammograms (x-ray pictures of the breast) and how often they should be taken, and raised red flags about potential harms. It's important to know that this issue is about screening mammograms (performed to check for breast cancer when there are no signs or symptoms of the disease), and not diagnostic mammograms, which check for the disease after a lump or other symptom has been found.
Randomized clinical trials and other studies have shown that screening mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74. However, screening mammograms can also have false-negative (which may create a false sense of security and postpone or dissuade from further evaluating breast symptoms) and false-positive results, can lead to overdiagnosis and overtreatment, and do, of course, involve discomfort, distress and exposure to radiation damage. (Digital mammography often requires fewer images and, thus, less radiation exposure than conventional or film mammography.)
How often should women have screening mammograms? That's a very individual question, and can only be answered by a woman and her informed healthcare professional.
The National Cancer Institute (NCI, the major U.S. health agency for cancer research) recommends that women age 40 and older should have screening mammograms every 1 to 2 years -- depending on their risk factors. No benefit has been found from regular screening or baseline screening mammograms for women under age 40.
The NCI also says that women at higher risk of breast cancer need to talk with their healthcare professionals about whether to have mammograms before age 40, and how often to have them. There are several risk factors that can increase chances of developing the disease, including having had breast cancer before, having a family history of the disease, and having inherited changes in certain genes.
There is also controversy about the value of self-exams, or BSEs (breast self-exams). While many women have been taught to self-examine their breasts, this is not a substitute for having a doctor perform a clinical breast exam, or for getting a screening mammography. Because lumpy and uneven feelings are often normal -- and aging, hormones and other benign factors cause changes to occur -- BSEs alone have not been found to help decrease the number of deaths from breast cancer.
Healthy basics are key
For post-breast cancer patients, regular doctor appointments, exams and tests help protect against a recurrence and help detect a recurrence in its earliest stages. As with so many wellness issues, women recovering from breast cancer are encouraged to follow healthy guidelines in nutrition and exercise.
Obesity and weight gain can increase the risk of breast cancer recurrence (and they're also both risk factors for developing the disease in the first place). Research indicates that a diet low in fat and high in fruits, vegetables and whole grains may help protect against cancer.
Regular exercise provides real benefits to breast cancer survivors. A study in the Journal of Pain and Symptom Management showed that women with breast cancer that has spread beyond the breast may benefit from participating in a tailored yoga program that includes gentle yoga postures, breathing exercises and meditation.
In addition to helping maintain a healthy weight, physical activity can rebuild strength and energy while reducing stress. Exercise can also reduce symptoms of fatigue, nausea and pain.
For breast cancer survivors in particular, as with the general population, a healthy lifestyle can make a real difference in the quality of everyday life. As we learn more about breast cancer over the next 25 years, perhaps the pink ribbons will no longer be needed.