Unless you are color blind and live under a rock you do not need your Chicago Cancer Examiner to remind you that October is Breast Cancer Awareness Month. Virtually no family has escaped the impact of breast cancer. More than a quarter million cases of invasive breast cancer are diagnosed in women annually, with an additional 58,000 cases of in situ breast cancer. Breast cancer kills approximately 40,000 women in American each year. Only lung cancer accounts for more cancer deaths in women.
With all of the information and publicity surrounding breast cancer this month, we will close out Breast Cancer Awareness Month by examining a couple of important groups that may only account for a small percentage of breast cancer patients, but nonetheless deserve more attention – young woman and men. It is important that they do not fall below the pink radar.
Young women often do not consider themselves to be at risk for breast cancer. It is true that less than 7% of all breast cancer cases are diagnosed in women under the age of 40. Yet breast cancer can strike at any age and the lower incidence of disease is of little comfort to the more than 250,000 living women in the United States who were diagnosed with breast cancer at age 40 or younger. Indeed, the 5-year relative survival rate is lower among women diagnosed with breast cancer before age 40 (84%) compared to women diagnosed at 40 years of age or older (90%). Tumors diagnosed at younger ages may be more aggressive or less responsive to treatment in some cases. Women who are diagnosed with breast cancer at a younger age actually are more likely to have a mutated BRCA1 or BRCA2 gene.
With all cancers, including breast cancers, we preach the importance of early detection. How many times have we heard this month about the importance of women getting mammograms and doing self-examinations? We have to ask ourselves whether young women are well served by the existing screening guidelines.
The American Cancer Society recommends annual screening mammograms for women starting at age 40. The U.S. Preventive Services Task Force does not even recommend routine screening for women in their 40s. For women between the ages of 50 and 74, the USPSTF says they should have screening mammograms every two years and none after age 74.
But why are regular mammorgams not recommended for women under age 40? There certainly is no magic to that age as many women under 40 get breast cancer and many over 40 do not. Many point out that, because breast tissue tends to be denser in young women, mammograms are less effective as a screening tool. But less effective does not mean completely ineffective or that other options should not be explored. Some point out that the low risk of developing breast cancer at a young age does not justify the radiation exposure or the cost of mammography. Notions of cost savings, minimal radiation exposure, and tissue density, however, are of little consolation to young women diagnosed with aggressive or advanced breast cancer.
“Clinical breast examinations” – examinations performed by the doctor – are recommended for women beginning at age 20 and “self examines” are considered “optional” for women under 40 by the American Cancer Society.
However, at best, these are guidelines and every woman under 40 is not well-served by strictly adhering to these guidelines. Whether a young woman should have a mammogram is a decision between the woman and her doctor. There are many instances where a mammogram is warranted in a woman under 40, such as for woman with a family history or other risk factors for breast cancer. There also are alternatives to traditional mammograms. Magnetic resonance imaging (MRI), which uses magnetic fields instead of x-rays to produce detailed, cross-sectional images of the body, for example, may be an option for women of various ages. A recent study suggests that ultrasounds may be superior to mammograms for women under 40.
The point is that young women should not assume that they will not get breast cancer and they should discuss screening options and tests with their physicians. Physicians that blindly adhere to guidelines are not always serving their patients well. Neither doctors nor their patients should mistake guidelines for gospel.
Pink is a pretty color and real men do wear pink. We all know that breast cancer is an important issue for men as well as women because a woman with breast cancer usually is some man’s mother, wife, sister, daughter, aunt, or friend. But it is also important to remember that men can and do get breast cancer. According to the American Cancer Society, in 2011 more than 2,100 cases of breast cancer were diagnosed and about 450 men in American died from breast cancer. Although men account for only about 1% of all breast cancers, men must realize that they are not immune from breast cancer.
Tonight on the Battling and Beating Cancer Radio Show will have a special program on breast cancer, young women, and fertility preservation. Dr. Ruta D. Rao, an oncologist at Rush University Medical Center, will discuss breast cancer in general and focus on young women with breast cancer in particular.
One of the many things breast cancer (and other cancers) – and cancer treatments can take from young women is the ability to have children. The program also will address the important subject of preserving the ability of cancer patients to become mothers. Mindy Berkson, a fertility consultant and founder of Chicago-based Lotus Blossom Consulting Lotus Blossom Consulting will discuss this topic along with Alice Crisci. Alice is a remarkably woman who took her experience with breast cancer and turned it into a blessing for many other woman by helping them become mothers through her non-profit organization Fertile Action. You can listen to the program live at 7 p.m. Central time tonight or on demand thereafter. Here is the link to the radio show.