Breast-cancer awareness: it’s a wonderful thingPublished 5:45pm Saturday, October 5, 2013
Awareness is a wonderful thing. It allows us to recognize patterns from the past, improve our decision-making in the present, and carve out a better path for ourselves and our loved ones in the future. In the best of all possible worlds, we can share our insights with others by establishing some guideposts to provide direction to those following behind as they proceed on their own journey.
The American Cancer Society has recently released its annual report entitled “Cancer Statistics”. The report demonstrates the excellent progress we have made over the last few decades, and illuminates how we can make further progress. The good news is that the death rate from cancer peaked in 1991. This year, we celebrate a phenomenal milestone in the fight against this dreaded disease: in less than two decades, the overall death rate from cancer has decreased by 20 percent. That means that there are literally millions of survivors celebrating tens of millions of birthdays with loved ones — each celebration an opportunity to reflect and improve.
The greatest improvements are where there are effective methods of early detection, such as breast, prostate and colon cancer. The goal of early detection, as one might imagine, is to catch the disease early. It has been repeated so often that it has become cliché, but the impact is profound. In breast cancer for instance, the five-year relative survival among patients whose cancers are caught in the earliest stage is 100 percent; whereas, the same survival rate in patients in the more advanced stages is less than 50 percent.
Guidepost 1: Early detection saves lives. Get annual mammograms and perform regular self-exams. Although the death rate has fallen by 30 percent for breast cancer overall, not all groups have benefitted equally. Statistics increasingly demonstrate that socio-economic factors play a significant role. Those of us who are committed to the crusade against cancer must redouble our efforts to effectively communicate the importance of, and improve access to, early detection and early diagnosis among the less fortunate members of our society.
Guidepost 2: Cancer does discriminate. The economically and educationally disadvantaged die of cancer at a significantly higher rate. One of the greatest potential areas of further improvement is to spread the word, and improve access to annual mammograms to those individuals.
Everyone knows that there is a genetic component to breast cancer. This has recently been thrust into the public consciousness by the recent revelation that Angelina Jolie has undergone bilateral mastectomies because she discovered that she is a carrier of a specific genetic mutation that increases the risk of breast and other types of cancer. She has been hailed as a hero, and criticized as a coward. It is important to understand that true carriers of a specific mutation represent only a tiny fraction of the overall population. In fact, the proportion of BRCA1 and BRCA2 genetic mutation carriers in the general population is 0.11 percent and 0.12 percent respectively. Together, they affect about two out of 1,000. So, the decision by Jolie may be right for her, but is not necessarily appropriate for the other 99.8 percent of the population.
Guidepost 3: Double mastectomy is not necessarily appropriate for the vast majority of women with breast cancer. Far more common than the true genetic mutations are women whose risk of breast cancer is increased by virtue of a familial disposition, such as a mother or sister or first-degree relative that has been diagnosed with breast cancer. It is estimated that familial disposition accounts for approximately 5 percent to 10 percent of all breast cancers. For all of the attention that has been paid to the role of genetics, the role of obesity and lack of physical exercise have a much greater impact. Between 25 percent and 30 percent of breast cancers are related to obesity and sedentary lifestyle. In other words, the impact of the things that we can control is three times greater than the total effect of the things that we cannot control.
Guidepost 4: The risk attributed to obesity and lack of exercise dwarfs the risk associated with genetic make-up and family history. As we constantly strive for greater awareness, in hopes of improving our own lives and the lives of those around us, it is important to occasionally step back, take a moment to reflect and regenerate, so we can better prepare ourselves to move boldly forth along the path of right action. In the fight against breast cancer, the newest evidence not only underscores what we already know — that early detection saves lives — but it also reveals that not all segments of our society have benefitted equally. This knowledge provides a clear path for further improvement.
Although technology has advanced dramatically, such as identifying specific genetic mutations that increase an individual’s risk of breast cancer, the newest data demonstrate that simple lifestyle changes can potentially provide the greatest benefit. Many women can do far more to protect themselves and their loved ones from devastating effects of breast cancer by simply making some healthy lifestyle changes.
Robert McLaurin, MD, is a radiation oncologist at the Marion L. Shepard Cancer Center, a department of Vidant Beaufort Hospital.