Breast-cancer awareness helps save livesPublished 5:48pm Saturday, October 5, 2013
October is Breast Cancer Awareness Month. Our police department will have pink on its cars. Many people will be wearing black-and-pink Paint the Town Pink T-shirts Tuesday at Beaufort County Community College for the Pink Power luncheon, where experts will speak about breast cancer. Even though the official color of fall is orange, our world will be pink for a month. All the celebration aside, the most important message is that breast-cancer screening with clinical breast exams (breast exam by a medical professional) and mammograms save lives.
In medicine, we prove or disprove everything with clinical trials. Such trials show that when women with an average risk for breast cancer (one in eight), are between the ages of 40 and 74, and have yearly mammograms, there is a 15 percent to 20 percent reduction in death due to breast cancer. What does one do if they are over 75 years of age? One has to factor in other medical conditions and how serious they are and estimate one’s life expectancy. If the conditions are minor, and a person has generally good health at this age, then it is reasonable to screen with a mammogram.
What does one do if they are younger than 40? Here we assess individual risk of breast cancer based on a number of factors. Is there a family history of breast cancer? Have there been prior benign breast biopsies for suspicious lumps? Has there been a previous biopsy showing a condition called atypical ductal hyperplasia? There is a questionnaire that your doctor can tell you more about called the Breast Cancer Risk Assessment by the Gail Model. If a woman has a risk of 1.7 or greater then they can talk to their doctor about using a pill to cut their risk of ever getting breast cancer by 50%. Two pills are approved for this: tamoxifen and raloxifen. As we all know, there is not a pill made that is not without side effects, and tamoxifen can very rarely cause blood clots and very, very, very rarely cause endometrial cancer (which is usually easily curable in this situation). Raloxifen can also cause blood clots, but not endometrial cancer.
What if a woman’s risk of getting breast cancer is calculated to be 20 percent or more, or if a woman in her 40s or younger has a suspicious lump? Here is where MRIs are useful as they find smaller lumps. This doesn’t mean that MRI should be done for all women or that MRI is better than a mammogram because MRIs also lead to more negative breast biopsies. This means that with MRIs, more women have biopsies that are not cancerous.
There is so much confusion surrounding many types of cancer screenings that for someone who does not do this everyday it is difficult to know what to do or believe. That is where we at Vidant Beaufort Hospital and the Marion L. Shepard Cancer Center come in to answer these questions. We hope that all women will take advantage of the upcoming breast cancer awareness activities.
John Inzerillo, MD, is an oncologist with the Marion L. Shepard Cancer Center in Washington.