October is Breast cancer awareness month and although we have made many advancements in the diagnosis and treatment of breast cancer it still remains the most common form of cancer in women (excluding skin cancer) and is the second leading cause of cancer death in women following lung cancer. We have made many advancements and currently we have over 3 million breast cancer survivors in the United States. In 2019 it is estimated that close to 350,000 women will receive a diagnosis of breast cancer and over 40,000 will die from the same disease.
These numbers are staggering but it is encouraging that we have seen a decrease in breast cancer deaths since 1989. However the encouragement needs to be taken with all of the information. The improving death rate appears to be related mainly to white women, we are seeing death rates in women of color to be 40% higher in black women when compared to white women, and really shows a difference in black women under the age of 50. This cancer is a confusing one as we are seeing the incidence of breast cancer continue to rise but fortunately the death rate continue to decrease due to early identification and more effective treatments.
We take this month to increase awareness of the disease as well as to encourage women to make sure they are getting the appropriate and timely screening completed. The timing of beginning to screen for breast cancer can be a bit confusing as some societies call for screening to begin at age 40, while others recommend screening start at age 50. Which is right? It is unclear but women should have a discussion with their physician and an agreement should be reached. The interval for screening may be decided on to be annually or biennial, again this is after a discussion with your doctor. This discussion will take into consideration family history and risk factors as well as the patients desire.
So what are the risk factors for Breast Cancer
1.) Age- we know the risk increases as we age and that increase is noted up to the age of 70
2.) Genetics- we know that if a close relative has had breast cancer the risk is elevated for family members. This is often due to BRCA genes. Your physician may recommend genetic testing
3.) Estrogen exposure- women who started their periods at a young age or have delayed menopause have a higher exposure to estrogen which will increase their risk
4.) Breastfeeding actually appears to decrease the risk of breast cancer
5.) Obesity- women who are overweight and especially those who become overweight after menopause have a higher chance of breast cancer
6.) Alcohol consumption- a high rate of alcohol consumption appears to increase the chance of breast cancer
7.) Radiation exposure from treatment for other forms of cancer may increase the risk as well
8.) Birth control pills may slightly increase the risk of breast cancer as well as hormone replacement therapy
How do we diagnose breast cancer?
We all know that mammograms have been the staple for screening. There are more than one type of mammogram and it is important that women get the best screening they can. Women should be discussing with their doctor if they should be looking for facilities that do Digital Tomosynthesis. This is FDA approved and it is now considered to be the standard of care for screening. Tomo is essentially a 3 D X ray of the breast. To visualize the difference think of the difference between a circle and a ball. The standard mammogram would produce the circle the Tomo would present the ball image. For traditional mammogram 2 – 3 images are taken for the Tomo 11 images are taken and the images are sent to a computer where the images are assembled to picture a 3 D view looking for abnormalities. Not all facilities have this technology so discuss it with your physician.
Physicians may order follow up test which may include Ultrasound which helps distinguish a finding that may be a solid mass or maybe a fluid filled cyst, which is often benign.
MRI is now being used more often as well, sometimes as a follow up to a mammogram but also it is being used more often in women who are deemed to be at high risk.
The treatment for breast cancer continues to be multi focal it includes surgery, radiation, chemotherapy, hormone blocking treatment and newer medications including immunotherapy.
The outlook on breast cancer continues to be based on how early the cancer can be identified. Stage 1 breast cancer, where the cancer is small and has not spread, has a 5 year survival rate of close to 99%, however those individuals identified at Stage 4 where the cancer has spread beyond the breast to other organs in the body, have only a 27% Five year survival rate. As with most cancers early detection is the key to survival as well as the key to easier and less toxic treatment options.
Male breast Cancer
Although women have the vast majority of cases of breast cancer (Well over 99%), Men can still be found to have breast cancer. For men the risk of breast cancer is 1 in 833, this is in stark contrast to the risk in women of 1 in 8. Earlier this month it was shared with the world that Beyoncé’s father, Mathew Knowles has been diagnosed with Breast cancer. It appears his may have been caused by secondary exposure to radiation from a job he held for years.
Mr. Knowles has had surgery and is now becoming an awareness advocate for breast cancer. He was diagnosed after finding bloody discharge on his t shirt.
Breast Cancer vaccine- treat and prevent??
Last week Mayo clinic shared results from a new breast cancer vaccine that showed it helped remove cancer cells. The study is being done initially on early stage breast cancer patients, where the cancer has not spread. The vaccine is being tested now with the hopes it would be fully available in 8 years. The goal of the vaccine not only to stop the reoccurrence of breast cancer but also prevent the cancer from occurring in the first place. It is currently being tested on a few patients as they prepare for a much larger Phase 3 study. The vaccine as is true with other vaccines is to teach the immune system to look for, find and destroy any cancer cells. The few patients who have been allowed to use the vaccine have shown good results with minimal side effects.
If this continues in the direction it is going we may have a vaccine to not only treat breast cancer but to also prevent breast cancer by using the body’s own immune system.