Pink is everywhere in October, and at this point, everyone knows what that means: It’s Breast Cancer Awareness Month. With one in eight women diagnosed with breast cancer in their lifetime, it seems everyone knows someone who has been touched by it, either personally or through a friend or relative. Today, women are aware and have become more vigilant about breast self-exams and mammograms, and modern medical technology continues to advance early detection as well. And the sooner the diagnosis, the better the outcome after treatment.
understanding breast cancer risk
Modern treatments and surgeries are providing promising results for breast cancer patients, but doctors are equally encouraged about another important development: genetic testing to learn about a patient’s breast cancer risk before tumors appear. Early detection is always an advantage, so this is yet another way doctors can help a patient improve her breast health outlook, they say.
Suzanne Mahon, DNSc, RN, an advanced practice nurse who counsels families about cancer risk at Saint Louis University Cancer Center, says a patient generally should discuss DNA testing with her doctor when she has a family history of breast cancer under age 50. “The lower the age at which cancer has appeared, the more concerned we are,” Mahon notes. “Some providers say you should be worried about breast cancer history under age 45; others say 50. In any case, if there’s a history and you’re concerned, it’s better to ask about it than not. We don’t want to miss breast cancer risk that might be there.”
Mahon says patients often assume it’s sufficient to test for genetic risk only on the maternal side since breast cancer mostly affects women. But it is seen in men as well, and risk actually comes from both sides of the family, she notes. “Many people don’t even ask about paternal family history,” she says. “But dad’s DNA can transmit genetic risk for female breast cancer as well. Obviously men don’t express it, but they can pass it along as easily as mom can. Patients have said to me, ‘I’m not concerned because the breast cancer is all on my father’s side of the family,’ but that’s not how it works. Unfortunately, a lot of myths and false information are out there.”
Before testing, it’s important to have frank discussions with family members and gather as much information as you can about cancer history on both sides, says Erin Linnenbringer, Ph.D., instructor in surgery at Washington University’s Siteman Cancer Center. Other gynecologic diseases such as ovarian, fallopian tube and endometrial cancers can be an indicator of breast cancer risk too, she notes, so they should be mentioned in conversations with your doctor. “These conditions can be difficult for families to talk about, so you might not know about a great aunt’s or grandmother’s cancer unless you ask,” Linnenbringer says. Testing also can be an advantage in cases where the patient is adopted and doesn’t have access to family health history, she notes.
Whatever the circumstances, it’s smart to collect as much background information as possible to help doctors assess your breast cancer risk, whether it’s through DNA testing or other means, Linnenbringer advises. “Keep the lines of communication open with your family and care providers, and look at other ways you can potentially reduce risk through good diet and exercise,” she says.
types of breast cancer
Cancers of the breast generally fall into two categories—those that are confined to the milk ducts and haven’t spread to other parts of the body, and those that have, says Dr. Cara Hahs, a Mercy oncologist and surgeon. “‘In situ’ cancers are those in which the cancer cells have not broken out and moved to the axillary lymph nodes under the arms,” Hahs says. “But sometimes the ‘pipe’ springs a leak and those cells move outside the duct structure. Then we say the cancer is invasive, or infiltrating. Once it becomes invasive, it can spread.”
Hahs says when doctors suspect metastasis, or spreading of the cancer, they first look at those axillary lymph nodes. “We call them ‘sentinel’ nodes because the patient’s lymphatic system drains to them first. If we don’t find cancer cells there, then we know we aren’t likely to find them elsewhere in the body.”
When a growth is found in the breast, it may be treated surgically via lumpectomy to remove the tumor; or the patient may need a mastectomy, which involves removal of one or both breasts. Reconstructive surgery can be done using artificial implants or tissue from another area of the body, such as the lower abdomen or back, Hahs says. In those cases, a plastic surgeon is involved.
Dr. Geoffrey Hamill, a breast radiologist at Missouri Baptist Medical Center, says invasive breast cancers can spread into the neck, chest and other areas of the body. “A third, rare type we see is inflammatory breast cancer, which can become locally advanced and cause swelling, redness, discharge, pain and sometimes enlarged lymph nodes,” he says. “The patient may notice two or three symptoms, but she may not realize it’s cancer because it presents much like an infection. A biopsy can tell whether tumor cells are present.”
a life with breast cancer
A clean bill of health is the goal of breast cancer treatment, so it’s also important to plan for what happens afterward, doctors say. Surviving the disease comes with necessary lifestyle changes that can help maintain long-term health.
Dr. John Finnie, a medical oncologist with Mercy, says one of the keys to successful ‘survivorship’ is avoiding extremes in diet and physical activity. “For a period of time after breast surgery, you generally want to avoid brisk activity, at your surgeon’s discretion, to allow the body to heal,” he says. He also recommends eating a balanced diet that is low in calories and fat, and avoiding some foods like grapefruit that can affect the metabolism of prescription drugs.
Dr. Theresa Schwartz, a SLUCare breast surgeon, advises maximizing most other fruits and vegetables, minimizing bad fats and exercising 30 minutes a day for at least five days a week. “Even brisk walking can help maintain your heart health and keep fat levels low,” she says. “You want to increase lean body mass and maintain muscle. This will help preserve overall health and help the body recover faster from chemotherapy.” Finnie adds that after radiation therapy, some patients may experience bone and joint pain, but supplements like vitamin D may help with those symptoms.
Schwartz says while patients may tend to focus on healing the breast area after surgery, it’s important not to ignore the rest of the body. “Continue to get screening tests like colonoscopies when you’re supposed to, and think about your bone and heart health as well,” she advises. “This may be difficult because you’ve been focusing on breast cancer treatment for so long, but it’s all very important for your overall health and healing.” Once the patient has recovered from treatment and surgery, she can work with a personal trainer to regain full physical function, Schwartz says. “Surgery can mean changes in upper body strength, and there may be hand and foot pain from nerve damage that chemotherapy can cause,” she explains. “All these things take time and effort to heal.”
Finnie adds that it’s important for the patient to explore any persistent post-treatment symptoms with her doctor, and ask any questions she has about how she is feeling. “Guidelines from the National Comprehensive Cancer Network state that breast cancer patients should have follow-up doctor visits every three months for the first two years after treatment, and schedule them on a case-by-case basis after that,” he says. “And if there are questions or problems in between, the patient should always feel comfortable speaking up.”
To keep mentally and emotionally healthy after breast cancer, it’s important to allow family members and support groups to help, Finnie advises. “There’s no such thing as a bad or wrong question when you’re taking care of your health,” he notes.
3-D mammography
Hamill notes that 3-D mammography is making strides in earlier detection of breast cancers because it gives doctors a much clearer picture of changes in the patient’s breast tissue. “Rather than looking at one two-dimensional, static image of the breast, we now can scroll through 30 to 50 views of it. That’s because the 3-D technology takes multiple, thin, overlapping images, top to bottom. It allows us to uncover smaller tumors, which is especially helpful in women with dense breast tissue.”
Hamill says the new technology lets doctors see subtle image distortions that may indicate cancer much earlier than with traditional mammography. If they find something suspicious, they can follow up with other tests like breast ultrasounds and biopsies, he says. “With 3-D mammography, we are locating tumors as small as 4 millimeters,” he notes. “These are cancers we might not have seen or felt otherwise. In five to 10 years, as 3-D becomes the standard, doctors everywhere will find cancers earlier and give better prognoses. It’s very encouraging.”