Battling breast cancer
Doctor addresses disease during Breast Cancer Awareness Month
MARQUETTE — October is Breast Cancer Awareness Month, although most people probably are aware of the disease 365 days a year.
“Breast cancer is quite mainstream, and it’s all over the media,” said Dr. Sheetal Acharya, who specializes in cancer care at UP Health System-Marquette. “There’s a lot that people still don’t know about it.”
Breast screening was the featured topic of Wednesday’s “Meet the Physicians” presentation at the Peter White Public Library in Marquette.
“In the U.S., it’s the most common female cancer,” said Acharya, who pointed out the lifetime probability of getting it is about one in six to eight overall — an approximate 11 to 12 percent lifetime risk.
That is a higher probability than in 1970.
“This is probably due to a longer life expectancy,” Acharya said. “So, the longer you live, the longer your body is exposed to estrogen, which is the main fueling feature of breast cancer.”
However, mortality rates have declined since 1975 due to increased use of screening mammography and greater use of adjuvant therapy, which she explained is any type of therapy given after surgery to kill any unseen microscopic cells.
That kind of therapy is used to decrease recurrence of the disease, she said.
Acharya discussed various risk factors for breast cancer, which include:
• age and gender, which in this case in older women.
• race, specifically Caucasian.
• benign breast disease that can increase risk.
• personal history of breast cancer.
• family history and genetics.
• lifestyle and dietary factors.
• reproductive and hormonal factors.
• exposure to radiation.
• environmental factors.
Acharya elaborated on some of these factors.
“There’s some thought that density is associated with increased risk, and it’s mostly if the density seems to be increasing over time,” Acharya said. “The average woman’s breast density decreases as they get older and it’s replaced more with fat.”
If ovarian cancer exists in a family history, Acharya suggested people think about a genetic syndrome that links the risk of ovarian and breast cancers, particularly if there’s a BRCA1 or BRCA2 mutation.
According to WebMD, BRCA1 and BRCA2 tests can help people know of their chance of getting breast and ovarian cancer, although the gene test doesn’t test for cancer itself.
“All women with the BRCA1 and 2 mutations are counseled about removing both breasts and removing both ovaries to maximally reduce their risks of breast cancer and ovarian cancer,” Acharya said.
Exercise can play a part too, she said.
“It doesn’t matter how strenuous it is,” Acharya said. “Regular activity may reduce your risk, especially in postmenopausal women.”
Longer exposure to estrogen is a risk factor too for women who began their menstrual periods before 11 years old or hadn’t gone through menopause until after age 55, she said.
Also, the more pregnancies a woman has, the lower the risk of breast cancer.
There are, Acharya noted, some old wives’ tales.
Underwire bras, deodorants, working the night shift — these are examples of breast cancer myths, she said. There even is no known connection between the use of tobacco and breast cancer.
As with many diseases, though, preventive actions can be taken, and Acharya addressed those associated with breast cancer.
The U.S. Preventive Task Force, she said, recommends against the routine use of menopausal hormones, or at least the lowest effective dose for the shortest possible time.
Acharya also said it has been found that the drugs Tamoxifen and Raloxifene, if given for five years to women with the risk of breast cancer, decreased that risk by up 50 percent.
“This doesn’t guarantee that you’ll live longer, but rather, perhaps, may have a lower chance of getting breast cancer,” Acharya said.
Other drugs block blood vessels from forming around a tumor so it doesn’t get the nourishment it needs to grow, she said.
Mastectomies, of course, were part of the Wednesday discussion.
“Removing both breasts reduces the risk about 97 percent,” Acharya said. “It’s not 100 percent because no matter how good the surgeon is, there’s still a little bit of that breast tissue there. We recommend this in high-risk women, like the BRCA mutation carriers.”
There are modified mastectomies and lumpectomies, also known as partial mastectomies, as well.
Screening mammography, she noted, is for women with no signs of breast cancer and involves X-rays of both breasts. A diagnostic mammogram, which takes longer and involves more X-rays, is undertaken when an abnormality is found.
A hallmark event in the history of breast cancer awareness in the United States came when former First Lady Betty Ford went public with her struggle in the 1970s.
Acharya said that in 1974, she was diagnosed with invasive breast cancer after undergoing a routine mammogram.
“Weeks after becoming First Lady, she underwent a mastectomy and a lymph node dissection, and she spoke about it in public, which no one ever did,” Acharya said.
This had a good result for breast cancer awareness.
“News coverage brought the words ‘breast cancer’ out of the shadows and into the public discourse,” Acharya said. “So, her lesson for other women was straightforward: Get a mammogram, which many think she had not done and wouldn’t have done if her doctor not found a lump.”
Ford died in 2011 at age 93.
When should a mammogram be performed?
“Right now, I would initiate the conversation at age 40,” Acharya said. “Get a mammogram. Definitely by age 45, every year.”
Quality of life, she stressed, is “not to be undermined.”
That includes thinking about short-term and long-term side effects of breast cancer treatment, including psychological distress, hormonal symptoms, weight gain, fatigue and “chemo brain,” which deals with cognitive issues.
“I spend a lot of time talking to my patients about these, but there’s really not a great, ‘OK, this is what we need to do,'” Acharya said.
Awareness of the disease, though, is big.
Acharya said: “Breast cancer awareness is so out there, and it gets more and more every year, that any woman now is going to seek medical attention when they have a problem.”
The next “Meet the Physicians” is set for noon Nov. 15 at the Peter White Public Library’s Shiras Room, with Dr. Gina Sternschuss talking about “Advancements in Women’s Health.” There is no admission charge.
Christie Bleck can be reached at 906-228-2500, ext. 250. Her email address is firstname.lastname@example.org.