“I’m sorry to tell you that you have breast cancer”. While these words have never been spoken to me, the possibility brings about anxiety. I have a history on both sides of my family of breast cancer. While it hasn’t been in my immediate family, it has affected my family nonetheless. Given the degree to which we fear this disease it seems odd to think that it’s possible breast cancer has been over treated or that screenings aren’t useful. This possibility is causing some in the medical and research community to rethink their approach to treating this cancer that claims the lives of 40% more black women than white women.
The Biology Of Cancer
Let’s take a step back with a bit of a biology lesson. Cancer cells are actually always present in our bodies. Our immune system is designed to seek them out on a regular basis and do away with them. Some will kill themselves (apoptosis). When the growth of cancer cells goes unchecked (angiogenesis) that’s what we call “having cancer”. This is the point where patients will undergo radiation and/or chemotherapy to kill the cancer cells. The problem is chemotherapy is poison and it also kills good cells. There is a saying that people don’t die from cancer they die from chemotherapy. This is the primary reason Steve Jobs refused traditional western treatment initially for his pancreatic cancer, instead opting for dietary and other alternative medicine methods. Many believe that most, if not all, cancers can be treated by starving it to death. The number one fuel source for cancer is sugar. The theory is if you remove sugar from your diet the cancer cells will starve. There is some research to support this theory, however it may not apply to all cancers. The implication is that through diet we can help our immune system rid the body of cancer cells on a regular basis as to prevent overgrowth.
When talking about breast cancer there does appear to be a genetic predisposition. You may be aware or have heard of the BRCA 1 and BRCA 2 genes. These are breast cancer genes. Everyone has these genes but those who carry a mutation are more likely to develop breast cancer. In fact, you can get screened for these mutations. Unfortunately health insurance doesn’t always cover the cost of this screening. But if you have immediate family (mother, sister, aunt) who developed or died from breast cancer, you may qualify for the screening. At the very least you qualify for early mammography for family history reasons. Generally speaking most Americans of black, white and Hispanic descent have a 1 in 400 to 1 in 800 chance of carrying the mutation. Ashkenazi Jewish men and women have a 1 in 40 chance of carrying the mutation. Ashkenazi Jews are those of Europen descent versus Middle Eastern descent or Sephardic. I happen to be of Ashkenazi Jewish descent on my father’s side (so I’m told).
Think you’re too young to have breast cancer? While it still primarily strikes older women, 11% of those diagnosed with breast cancer are under the age of 45. Of those women under age 45 who develop breast cancer, it is more likely to be driven by hereditary factors. So if your mother, sister or aunt had it there is no need to wait until the 40-year mark to start mammograms. In fact, your doctor should have already raised the issue with you. Obesity, sedentary lifestyle, inflammation and smoking also contribute to the development of breast cancer and cancer in general. All of these things inhibit your body’s natural immune response. Also, breast cancer in younger women tends to be found later and at a much more aggressive stage.
We are bombarded with messages to get a mammogram and check our breasts. I do it on this site and via social media. I’ve even posted photos of me getting a mammogram.
— Nile, Chief Chick (@NewBlackChick) June 4, 2015
However medical professionals may want us to ease up on the screenings and self-checks. According to an April, 2014 article published in JAMA, mammography contributes $8B dollars to healthcare costs in the United States. The article also points out that we are the only country that recommends annual screenings starting at age 40 whereas most other countries start at age 50 and are every two to three years. Not only that, preventative screening accounts for a small number of breast cancer diagnosis. This assumes that most breast cancer caught is symptomatic or incidental. There is also an ongoing debate over 3D and traditional mammography. 3D mammography adds to the cost of screening. Under the Affordable Care Act (aka Obamacare) screening starting at age 40 is covered by insurance. There is a raging debate if preventative screening works or if it causes more problems. If something is found during mammography there is anxiety and additional procedures to determine what’s on the image. Any woman whose life is saved by this process will not complain about the inconvenience of getting additional procedures. The debate is it worth the cost of doing preventative screening when the diagnosis rate from them are considered low? A study published in the British Medical Journal reported that death rates among women who get mammograms and those that don’t are roughly the same. This is based on a 25-year study of 90,000 Canadian women.
What about self exams? The answer is yes, but some medical professionals recommend not doing them every month, rather every two to three months. Why? Because much like mammograms researchers found there is not much difference in the death rates. When you do them you should do them at the exact same time every month so that you can more accurately compare. Breast tissue feels different as hormone levels fluctuate throughout the month. Sometimes they may feel more “lumpy” than other times.
Broadly speaking there are two types of breast cancer, noninvasive (in situ) breast cancer and invasive (infiltrating) breast cancer. In plain english in situ means the cancer cells remain in the breast tissue while infiltrating spreads to other parts of the body. The cancer type is further broken down into where the disease started, for example in a milk duct or lobuls. Then within that there are many more classifications. The most common type of breast cancer diagnosed in the US is Ductal Carcinoma In Situ (DCIS) at more than 60,000 cases annually. This type of cancer is typically treated with lumpectomy (removing the tumor) and radiation. A mastectomy (removing the breast) may also be an option.
Some research suggests that there may not be a need to treat every case of DCIS aggressively. Oncologists are looking at the general health and well being of the individual to determine the best course of action, and that may mean foregoing radiation all together. If the cancer cells are growing at a slower rate there may be an option for hormone based medicines versus radiation. Research published in JAMA Oncology discussed that surgery on women diagnosed with low grade DCIS had no impact on mortality, meaning their risk of death was not improved, especially for African American women. However women with high grade DCIS did show better mortality rates with surgery. In light of the numbers watchful waiting is encouraged. When breast cancer is the invasive type a more aggressive approach is typically required given that it is spreading throughout the body.
So what does this mean? Something that we need to understand about medicine is that it isn’t an exact science. We exalt doctors in our society and often do what they say without question. There is a reason it’s called practicing medicine, because they are doing just that…practicing. There was once a time doctors didn’t know about spreading germs and mocked a surgeon who suggested that physicians sterilize instruments and wash their hands between patients. Now there is a sterile field in the operating room. What this all means is that as researchers and medical professionals learn more about breast cancer they are discovering there are other options besides immediately going to the most aggressive choice. Always opt for a second opinion and understand the treatment landscape for your particular type of breast cancer.
There Is Hope
It seems somewhat bleak when it comes to breast cancer. If the mortality rate isn’t different between those screened and not screened what is the point? By the way, the survival rates have dramatically improved over the last forty years. In my humble opinion it seems like the first step would be test women early for the BRCA 1 and BRCA 2 genes based on family history, then develop a course of action from there. This test should be covered by insurance for everyone. Those who test positive have the option to undergo a preventative double-mastectomy or get screened regularly. If it’s caught early, breast cancer is highly treatable. For those who test negative for the genes they should follow a different screening regimen taking life style into account. We know someone who is obese, sedentary and smokes is more likely to develop any type of cancer.
Even though black women are 40% more likely to die from breast cancer it’s primarily due to lack of access to health care leading to the disease being caught in the later stages. Doctors are also finding that defaulting to the most aggressive treatment isn’t always the best. If the cancer hasn’t spread to other parts of the body yet there are more treatment options depending on age and general health status. The treatment can be as hard as the disease itself. The best way to protect yourself is to know your body and be a partner with your healthcare provider. It’s good news that oncologists are starting to vary their approach based on the patient’s case. Hopefully that will extend to black women as most treatment options and medications are geared toward and primarily tested for efficacy in the white population. Heaven forbid you should be diagnosed, but understand your treatment options. Survival rates are good and increasing, especially stages 0 to II with 93%-100%, stage III with 72%.
The most at-risk are those with the least amount of access to healthcare. They are less likely to be examined by a physician or even seek medical attention until it’s late in the disease progression. They may ignore the signs or may not know them.
The C word is scary, but it doesn’t have to be. If we first arm ourselves with good general health and partner with a healthcare provider we trust we can both reduce our chances of developing breast cancer and catching it early. Stage 0-I have a 100% survival rate and through regular self exams and screenings breast cancer can be beat. We’ll leave the medical debate to the medical professional and healthcare providers on whether the high cost of preventative screenings makes a difference. For now, you just follow the guidelines because as black women we are less likely to be diagnosed in the early stages and more likely to die. Comment below and share this post with someone you love and in your social media communities.
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