October is Breast Cancer Awareness month. I think it is fitting to take some time to discuss a disease that affects so many families in this country; more than 250,000 women and at least 2,000 men are expected to be diagnosed with breast cancer annually in the United States. Further, it accounts for one-third of all cancer diagnoses in American women. We are however reaping the dividends of the significant investment that has been put into breast cancer research and a breast cancer diagnosis today does not have the same implications that such a diagnosis would have had in the past. Breast cancer mortality declined by 37% between 1990 and 2013. The medical community is harvesting valuable research findings to improve our approach and to refine our response to this disease. What has changed over the years?
New Response to Diagnoses. To start, medical professionals now employ improved screening techniques and are more knowledgeable about cancer spread patterns and what cancers to look for. If atypical tissue is found the response may not be the same as it would have been ten years ago. Research has shown that not all lesions in the breast evolve into cancer. A stage 0 cancer diagnosis may ultimately not turn out to be cancer. Doctors are therefore delaying – and even sometimes forgoing – treatments that might have been recommended in the past.
This new approach is a response to increasing emerging evidence suggesting that certain surgeries, chemotherapy and radiation may incite negative side effects that worsen a patient’s overall health. Patients sometimes find it difficult to accept a ‘do nothing’ approach however the use of sophisticated tools such as 3-D mammography, MRIs and genetic tumor tests to monitor the behavior of the disease allows patients to be more open to this ‘management’ versus ‘treatment’ strategy.
Revised School of Thought on Screening. It is generally agreed that early detection and early treatment increases the chances of survival. It has therefore been common practice for women to undergo mammograms annually from the age of forty onwards, with some women starting even earlier.
Some public health groups are now suggesting that mammograms are not necessary until a woman is fifty years old. To better understand this, Dr. Laura Esserman (a breast cancer expert at the University of California in San Francisco), is leading the WISDOM study which intends to target about 100,000 women across the United States. Each woman will be randomly assigned to either a personalized screening regimen—meaning they choose when to get a mammogram—or an annual mammogram regimen. One of the goals of the study is to generate sufficient data to better understand optimal timing for testing in order to reduce the cost and deleterious health effects of unnecessary testing.
Increased Prevention Awareness. Cancer is a complex disease. It is difficult to pin down specific triggers. One may be genetically predisposed or external factors such as exercise and lack of sleep may influence the likelihood of developing cancerous cells. Research has however provided some insight into risk reduction opportunities.
The American Cancer Society recently stated that “75% to 80% of breast cancers may be tied to lifestyle choices and environmental exposures.” Maintaining a healthy diet, exercising regularly and reducing alcohol intake have been identified as crucial steps in lowering the chances of developing cancer. In fact, specific dietary practices such as substituting animal fats with healthy fats (such as like olive oil) have been shown to possibly reduce breast cancer by as much as 60%. Habits of daily living weigh more heavily on cancer prevention than previously thought and substantial measures have been taken to educate our society on how to leverage this powerful tool.
We have made tremendous headway in combatting breast cancer (in both men and women) in recent years. There is still more to be done. I am currently in the final stages of training for my second New York City Marathon and I am once again running with Team Continuum. Our group provides resources to assist with the non-medical expenses faced by cancer patients and their families. We assist with all cancers but in honor of Breast Cancer Awareness month I wanted to do my part to increase awareness so we can fight back together.