Too Much Breast Cancer Awareness?

October is Breast Cancer Awareness month, and we can brace ourselves for a deluge of pink. There will be countless promotional products from companies trying to demonstrate their commitment to fighting breast cancer. Some will profit from their association with the cause and end up contributing a miniscule amount to breast cancer research.
We can also expect a barrage of articles about how we're making progress understanding and treating this disease, but women today will get many of the same treatments their mothers did. And we still have no idea what causes this disease.
The unfortunate result of all this awareness is a pervasive and unrealistic fear of breast cancer. Heart disease is the leading killer of women -- and lung cancer is the leading cause of death from cancer in women. Yet, most women believe their greatest threat is breast cancer.
The average woman faces a 1 in 8 risk of getting breast cancer at some point during her lifetime. This number sounds alarming, but it is important to note that risk increases with age, and at any particular age, a woman's risk of getting breast cancer is actually lower than 1 in 8. According to the American Cancer Society, the risk of getting breast cancer for a woman between the ages of 40 and 50 is 1 in 70 while the risk for a woman between 60 and 70 is 1 in 28. The risk for a woman in her 20's is 1 in 1,837, and though breast cancer is extremely rare in anyone under 20, concerns about it are not.
Breast cancer specialist and author Marisa Weiss recently published a book about breast cancer for teens and young girls because she sees growing fears about the disease in this age group. It's bad enough that grown women overestimate their risk for getting breast cancer, but when there is so much focus on this disease that young girls start worrying about breast cancer, it is clear there's too much awareness.
One effect of this misperception about breast cancer risk is that women are choosing mastectomy over less drastic treatment even when it is not known to provide any advantage for survival. Women with a gene that increases susceptibility to breast cancer are choosing to have both breasts removed even though there is uncertainty as to who would benefit from it. The number of women being diagnosed with these genes is increasing because the company that does genetic testing has started the questionable practice of advertising directly to consumers. Again, too much awareness.
Some women with early stage breast cancer are opting to have both breasts removed instead of facing a small risk that they will have a recurrence. There is no known survival advantage for those who have both breasts removed. By the time a cancer is diagnosed, it may have already started spreading to distant organs, and it is these metastases that lead to cancer deaths. But most women who are diagnosed at an early stage do not have the cancer spread outside the breast and will never have a recurrence.
It is not enough to wear pink ribbons, buy pink products, and spend a month becoming more aware of breast cancer -- and more fearful. We need to push Congress to support cancer research instead of hindering it as they have this year. They reduced the budget for the National Cancer Institute and blocked legislation to fund research on environmental causes of breast cancer. We also need to press for more research on breast cancer prevention instead of having so much of the research budget devoted to searching for that elusive cure.

Prophylactic Mastectomy: A Cautionary Tale

Hearing you're high risk for breast cancer is frightening. There is uncertainty as to what you should do about it -- and you desperately want to do something. But taking the most drastic step of having both breasts removed is not the right choice for many women. It wasn't for me.
I had no family history of breast cancer and would never have thought I was at risk until a routine mammogram showed a suspicious spot. A biopsy revealed that I had a precancerous condition that put me at high risk for getting breast cancer.
I thought my days were numbered. Adding to my concern was confusion about what this condition was and how it should be treated. Lobular carcinoma in situ (LCIS) is a cancer "in place" that has no potential for spreading outside the breast unless it undergoes a transformation. It is classified as a "Stage 0" breast cancer but is not a true cancer because it lacks the potential to metastasize, or spread.
Now there is more certainty about what women with LCIS should do, but when I was diagnosed almost twenty years ago, the medical community was evenly divided on what to recommend. Around half the doctors surveyed for a study at the time said they would carefully monitor women with LCIS with regular check-ups and mammograms. The other half said they would advise LCIS patients to have both breasts removed.
A double mastectomy for a precancerous condition seemed extreme -- since the treatment for a more threatening invasive cancer would have been a lumpectomy or a single mastectomy. LCIS indicates a potential for developing breast cancer in either breast, so to fully reduce the likelihood of breast cancer, both breasts have to be removed. But even with a double mastectomy, there is no guarantee you won't get breast cancer.
I considered the bilateral mastectomy, but followed the recommendation of my wise and progressive breast surgeon to have careful follow-up. Now most doctors favor this approach, and the women most likely to be grappling with the issue of having prophylactic bilateral mastectomy are those who have been diagnosed with a gene that causes susceptibility to breast cancer. Some are taking the initiative in deciding to have this surgery -- and in many cases, they are ignoring the recommendation of their doctors.
And why shouldn't they, you might ask. They are told their risk for getting breast cancer can be as high as 85%, and they are living with the uncertainty that breast cancer could strike at any time. Many have watched mothers or sisters struggle through surgery, radiation, and chemotherapy. They understandably want no part of that.
But there are reasons they should not rush into having this surgery.

• Some women with the gene will never get breast cancer. The risk of a woman with a susceptibility gene getting breast cancer at some point during her lifetime is 36% to 85%, as compared to a risk of 12.7% in the general population. The risk for women with the gene is often described as being "up to" 85%, but that number represents the worst case scenario.
• These estimates of risk are not etched in stone. They are likely to change as scientists learn more about how these genes lead to breast cancer, just as ideas about LCIS changed. One group has already reported that the risk may be lower than currently believed.
• Scientists are trying to learn why some women with the gene do not get breast cancer, and at some point, they may be able to predict who is at greatest risk and should consider prophylactic mastectomy.
• Women who get bilateral mastectomy can still get breast cancer. The surgery reduces risk by 90%, but does not eliminate it. Breast tissue is spread out in the chest, and some remains after mastectomy.
• There are less drastic ways to reduce breast cancer risk. Tamoxifen and Evista reduce breast cancer risk by around 50%. Some women can reduce their risk with a healthy lifestyle.
• The risk of getting breast cancer increases with age, even in women with a susceptibility gene unless they have close relatives who got breast cancer when young. For women whose mother or sister didn't get breast cancer until close to menopause, though, having breasts removed in their 30's -- as some women are doing -- may be premature.
• No surgery is free of risk, and further surgery may be necessary. Women having mastectomies can develop infections or have bad reactions to drugs, just as with any surgery. Implants need to be replaced periodically.

Of course, bilateral mastectomy may be the wisest choice for some women who have the gene, but it is too drastic a step for many others.

Improving Your Odds

It may seem inconceivable that a healthy lifestyle could protect anyone from breast cancer, but scientists have done hundreds of studies that tell us that some women can. They don't know which of us can hope to stop this dreaded disease, but we don't need to wait for all the answers before we use what they've learned about reducing breast cancer risk and recurrence:

• Eat wisely. Base your diet on vegetables, fruits and whole grains. Limit fats, sugar and anything made with white flour.
• Get moving! Moderate physical activity is enough to reduce breast cancer risk and recurrence. It can be as simple as brisk fifteen-minute walks twice a day, but any amount of exercise helps.
• Keep your weight under control. Eat moderate portions of healthy foods and exercise regularly to keep weight down.
• Limit alcohol consumption to one drink per day -- less is better.
• Breastfeed for six months or more, if possible.
• Avoid hormone replacement therapy. The hormones in these pills are known to fuel the growth of some types of breast tumors.
• Guard your environment. Avoid exposure to chemicals like pesticides and some ingredients in cosmetics and toiletries that might play a role in increasing breast cancer risk.
• Control stress. It dampens your immune system, and there's nothing like stress to make you eat and drink more than you should.
• Don't smoke. And avoid second-hand smoke.
• Get regular mammograms and breast exams. Treatment is more likely to be successful when breast cancer is caught early.

Of course, there are some women who do everything on this list and still get breast cancer. But there are some who can hope to stop this disease. Isn't it worth a try?

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