4 Things To Know About Breast Cancer
Image Credits: Unsplash Images
5 min read
As a practice dedicated to the health and wellbeing of women, gender minorities, and marginalized individuals, we applaud the awareness about breast cancer that October brings and the increased rates of mammograms during this month! But we also haven’t forgotten that every statistic and every rate and number that we mention represents a person who is teetering on the edge of the all-too-familiar and uncomfortable line for cancer patients of caution, optimism, fear and persistence to live life even in the face of the unknown. But in 2021, there is so much that we do know about treating and preventing breast cancer and a lot of it comes from knowing one’s risk as early as possible.
Breast Exams
Monthly breast exams (also known as BSEs or breast self exams) are recommended for women with higher than average risk of breast cancer (i.e. past history of chest radiation, family history of breast cancer, genetic mutations that increase likelihood of breast cancer, etc.). But you may be surprised to know that the American Cancer Society reports no clear/direct evidence of breast cancer prevention for average-risk women performing BSEs. So what does that mean for you?
The regularity of your self breast exams may depend on your age, risk for breast cancer, and personal comfort with conducting one yourself. The important thing is that individuals keep track of how their breasts look and feel and report any deviations to their health care providers (noting that changes of breasts during pregnancy, right before and after a menstrual cycle, and during menopause are typical). If monthly breast exams are the most comfortable and easiest way for individuals to do this, then by all means do so. But clinical breast exams normally performed at annual appointments and mammograms have been proven to be the most effective and sensitive breast cancer screening methods.
Mammograms
Mammograms are X-rays of breast tissue that can detect microcalcifications and smaller nodules not detectable by self breast exams. Mammograms have been shown to increase screening of breast cancer in women 40 or above and most effective for ages 44-54. Mammograms are not perfect screening tools; like other tools, they have a false positivity rate that may catch masses and nodes that clinical breast exams wouldn’t have and might cause higher fear and anxiety than if the mammogram would have never been performed. On the flipside, mammograms have a false negative rate of about 20% especially among those who are younger and/or have dense breasts. However, they’re currently one of the best tools we have; and catching breast cancer early can reduce risk of death from the disease by 25-30%.
Genetic Risks
Cancer can have a variety of origins including hereditary and genetic, environmental causes (which often interact with our genes), and lifestyle causes. The BRCA1 and BRCA2 genes (specifically mutations in these genes) have gotten a lot of press over the years for their role in breast cancer as they are estimated to contribute to 10% of all breast cancers (and can increase risk of breast cancer in both males and females). And while these genes have a high penetrance (mutations in these genes are highly associated with breast cancer), they are by no means the only genes that lead to breast cancer. Other genes with high risk (mutations in these may have greater than 50% chance of developing breast cancer) include PTEN, TP53, and PALB2. This is by no means an exhaustive list and many genetic tests can screen for common and known gene variants related to breast and gynecological cancer.
Breast Cancer & Hormones
There has been much debate and controversy over whether estrogen, progesterone, and/or hormone replacement therapy (HRT) can influence risk of developing breast cancer and so it can be difficult to deliver simple one-size-fits-all guidelines. But here’s what we do know. HRT and estrogen therapies are often used to manage perimenopausal symptoms like hot flashes and night sweats, symptoms which can significantly reduce quality of life. Estrogen has a lot of benefits - including being able to manage these symptoms for many people and protecting bone health and cardiovascular health to name a few. But estrogen can only increase our risk of cardiovascular issues and blood clots along with increasing the risk for breast cancer in certain individuals.
For those under the age of 60 or within 10 years of menopause, the benefits of taking HRT could outweigh the potential risks and deserves a conversation with a Certified Menopause Practitioner. Those with a past history of breast cancer are often encouraged to avoid taking HRT. For those without a personal history of an estrogen receptor positive breast cancer, it is important to note the differences in risk based on age, history, type of estrogen, whether or not progesterone will also need to be used, length of time since menopause, dose, and method of administration of the hormone. Managing this risk for breast cancer and symptom relief is an individual choice and one that should be discussed with a provider as a variety of options are available. For example, for those experiencing vaginal dryness or urinary concerns due to lack of estrogen, there is no excess risk with use of vaginal estrogens.
Part of the reason cancer, in particular breast cancer, is so terrifying is because there are so many unknowns. Will my mammogram detect a mass this year? How worried should I be about my __% risk? What stage of cancer may I have? What are my options for treatment? How do I know what lumps or bumps are normal? And due to the unfortunate way women are so often defined by their bodies, even the question "What will my partner think if my breast looks different after surgery or needs to be removed?" And our brains inevitably turn these unknown into fear. But there is so much we do know about breast cancer now thanks to self and clinical breast exams, breast self awareness, mammograms, genetic testing, and newer and more targeted therapies. Let these tools help and guide you to make the best choices possible about your breast health.
Written By Akansha Das, Women’s Health Collective Pre Med Student Volunteer
Edited by Nisha McKenzie, PA-C, CSC, NCMP, IF