What you need to know about breast cancer
By Stephanie Thurrott
Sisters Yolanda Jackson, Tressy Thomas and Tiffany Berrien can give you three good reasons to watch for signs of breast cancer—each other. Tiffany, the youngest, was diagnosed with breast cancer two years ago at age 34. The sisters were still reeling from that news when Yolanda, then just 35, was diagnosed with a different type of breast cancer three months later. Tressy, now 39, has avoided the disease, but she has mammograms twice a year to watch for potential problems.
The sisters can’t change their personal or family histories, which put them at high risk for the disease. Nor can they help aging or being female, other factors that increase their risk. (Men get breast cancer too, but it’s about 100 times more common in women.)
But there are things that they—and anyone—can do to minimize the odds of contracting the disease:
- Maintain a healthy weight.
- Exercise.
- Don’t smoke.
- Eat less fat, especially saturated fat.
- If you eat red meat, choose rare or medium instead of well-done.
There are also other factors within your control that can decrease your risk:
- Having your first child before age 30.
- Avoiding hormone replacement therapy.
- Breastfeeding for one and a half to two years.
- Limiting alcohol to no more than one drink a day.
For some high-risk women, more drastic preventive strategies might be the best choice. Tamoxifen, a drug previously prescribed to treat breast cancer, is now approved for its preventive benefits. In fact, the drug’s benefits were so apparent that the research study testing it ended early so women taking the placebo could choose tamoxifen instead.
And other drugs similar to tamoxifen may be on the horizon. “We’re looking at a medication used to treat breast cancer patients to see if it’s also effective in preventing breast cancer. It may be more effective than tamoxifen—we’re doing this study to find out for sure,” says UAB surgical oncologist Helen Krontiras, M.D.
Some women with exceptionally high risk choose to have their breasts surgically removed rather than risking breast cancer. And, in some cases, doctors recommend removing the ovaries, to reduce levels of estrogen, which feeds some tumors.
Watch for Warnings
Despite your best efforts, you can’t protect yourself against the disease completely. That’s why the American Cancer Society says it’s important to watch for signs of the disease so it can be caught and treated early, before it’s had a chance to spread. Women on average have a one in eight lifetime risk of breast cancer. But the death rate from breast cancer is dropping, partly because women and their doctors are spotting cancer sooner. Breast cancer that hasn’t spread to other parts of the body and is identified in the earliest stages has close to a 100 percent five-year survival rate.
Following the recommendations for early detection is key, and one of those recommendations is monthly breast selfexams. “It’s important for women to be aware of their breast health and to do regular self-exams,” Dr. Krontiras says. That’s how Tiffany discovered a lump, which she brought to her doctor’s attention.
Your doctor should perform a clinical breast exam as well, every three years for women up to age 40 and yearly after that (more frequently for women at higher-than-average risk). This is how Yolanda’s mass was discovered.
And women should start annual mammograms at age 40, unless your doctor recommends starting at an earlier age. Because of her sisters’ diagnoses, Tressy started mammograms sooner and has them more frequently than other women.
You may have heard recently about digital mammograms. While the procedure for undergoing the mammogram is the same whether the format is film or digital, with digital mammograms a technician can adjust the image to better view the suspect area. Dr. Krontiras says that so far, studies have not found that digital techniques detect cancer earlier in the general population. But digital mammograms may decrease the need for women to come back for additional views.
Taking a Closer Look
Women who have suspect areas on mammograms also may have a breast ultrasound to evaluate the abnormality. And doctors are increasingly recommending breast MRI for screening certain women. “MRI looks at the breast in a different way,” Dr. Krontiras says. “It’s a screening tool we use for younger women with dense breasts who are at a high risk for genetic mutation for breast cancer.”
New detection techniques are on the horizon too. UAB researchers are studying whether early cellular changes in milk ducts are linked to later breast cancer, for example.
If you have a suspicious mass, your doctor will likely recommend a biopsy— taking a sample from the lump to check for signs of cancer. Depending on the location and size of the lump, your doctor might choose from several options:
- Fine-needle aspiration biopsy uses a very thin needle to draw fluid from the lump. Your doctor may guide the needle to the lump via ultrasound.
- Stereotactic or ultrasound-guided core needle biopsy uses a larger needle and removes samples from several locations within the lump.
- Surgical biopsy removes some or all of the lump, and sometimes some surrounding tissue as well.
Techniques for Treatment
If your biopsy reveals cancer, doctors will stage it to determine how invasive it is and how likely it is to have spread. You’ll work with your doctor to develop a treatment plan, which might include chemotherapy before and/or after surgery, radiation therapy, surgical removal of the lump, or surgical removal of some or all of the breast.
Studies are always evaluating which treatment methods are most effective. UAB is now studying partial breast irradiation, a technique where the radiation targets the exact tumor site and causes less damage to nearby healthy tissue.
Both Yolanda and Tiffany opted for preventive mastectomies in their noncancerous breasts and both thus far have seen no additional signs of cancer. Tressy is currently weighing her options, considering either mastectomy or starting a tamoxifen regimen to help thwart cancer.
For information on the UAB Breast Health Center at The Kirklin Clinic®, log on to uabhealth.org/breasthealthcenter or to schedule an appointment, call UAB Cancer Answers at (205) 975-8222 or 1-800-822-0933.