By Terry Rogers
In honor of Breast Cancer Awareness Month, Milford Public Library sponsored “Fight Like a Girl,” a breast cancer awareness program presented by Bayhealth. Information was presented regarding early detection, breast health and risk factors that may lead someone to develop the disease. Paula Hess, MSN, RNDLN, the Cancer Nurse Navigator with Bayhealth, provided the educational information, which began with an explanation of the structure of the breast before discussing what she called the “triad” method to keeping breasts healthy.
“The triad approach to breast health includes breast self-awareness, clinical exams and mammography,” Ms. Hess explained. “We used to call it self-breast exams, but doctors found that when women found lumps, which were mostly non-cancerous, it caused significant stress. In addition, they realized that there was more to breast health than simply examining the breast each month. We learned that women need to be aware of changes at all times, and not just when they examine their breasts.”
Risk factors that increase a woman’s chance of breast cancer include gender, age, obesity, high fat diets, use of alcohol, and family history. African American women have a higher incidence of breast cancer than other races, although Hispanic and Latino women have a higher mortality rate, often because their cancers are not detected early. Women who have a mother, aunt or sister diagnosed with the disease also have a higher risk for getting breast cancer.
“One reason researchers believe that obesity and a high fat diet increase the risk of breast cancer is that fat cells contain estrogen, and higher estrogen levels can lead to breast cancer,” Ms. Hess explained. “Another issue with family history is that, in some cultures, it is felt that it is improper to discuss a family member’s illness. It is possible that if a great-grandmother died of breast cancer, the family may not share what caused or death, or may not know what caused her to die. This is why talking about family medical history is critical.”
Women who began menstruating before the age of 12 or began menopause after age 55 also have a higher risk of breast cancer, as do women who had no children or had their first child after the age of 30. Birth control and hormone replacement therapy also raise breast cancer risk. However, Ms. Hess explained that there are ways to reduce risk, even for those who may be in a high-risk group.
“The best prevention is to eat a healthy diet and increase physical activity,” Ms. Hess said. “Minimize alcohol intake and follow the American Cancer Society screening guidelines, which include a yearly mammogram at 40 years old, unless there is a family history of the disease. For example, if a close family member was diagnosed at age 42, we would perform a mammogram on relatives beginning at age 32.” Clinical exams for women aged 20 to 30 should be performed every three years, and after 40, every year.
Ms. Hess also explained some common breast diseases that are normally benign, such as calcifications and fibrocystic disease. Calcifications are calcium salts that develop in the breast and can only be found by mammograms. Although calcifications are normally benign, doctors may choose to investigate them further to be sure there are no cancer cells included. Experts believe that fibrocystic disease develops due to hormone fluctuations, and Ms. Hess said that caffeine can increase the lumpiness that occurs when someone has fibrocystic disease. To be sure that the lumps are not cancerous, an ultrasound may also be required in addition to a mammogram. Fibroadenomas occur in women in their late teens and early 20s, and present as a lump. These are often solid collections of cells and require biopsy to be sure they are not cancerous.
Breast implants do not cause breast cancer, but they reduce the ability to detect cancers in some cases. Because the radiology technician is unable to view the breast all the way to the chest wall, they sometimes miss small cancers that the implant may hide. Ms. Hess said that women with breast implants have a higher mortality rate than other women when they are diagnosed with breast cancer.
“Many women say that they cannot afford a mammogram or clinical exam, and even if they can get assistance with those tests, they worry that if cancer is found, they cannot afford treatment,” Ms. Hess explained. “In Delaware, we have the Delaware Cancer Treatment Program. Anyone who is within 650 percent of the poverty level qualifies for two years of cancer treatment if they have no health insurance and are a Delaware resident.” In addition, the Screening for Life program provides assistance for screenings for breast, cervical, colon and prostate cancers, along with other medical conditions, for those whose income is between 100 and 250 percent of the poverty level.
“Survival rates in Delaware are improving despite the fact that the word cancer is so frightening that some are afraid to go to the doctor when something is wrong,” Ms. Hess said. “You know your body better than your doctor does and it is important to understand that fear can kill you.”