By Dr. Janet Matthews
We’re approaching the close of National Breast Cancer Awareness month, and I hope all of you have pledged anew to take the right steps to help defeat this disease: monthly self-exams, annual clinical exams, and annual mammograms for those past 40.
I have spoke to many women this month about breast cancer, and encountered the same questions multiple times. I also keep running into many of the same misconceptions about breast cancer which I’ve heard in the past.
I’d like to use this last column of October to try and correct a few of those popular misconceptions, and along the way possibly answer some of the recurrent questions.
One question I’ve heard from several women concerns the age at which mammograms are no longer needed, and my reply always is that there is no such age. The risk for breast cancer rises with age, and so the need for early detection becomes even more important as we age.
For some women who are elderly and have other medical problems, questions surrounding breast cancer detection concern how aggressive treatment would be if cancer was found. For a woman with multiple medical problems who would be unable or unwilling to tolerate breast cancer treatment, the usefulness of mammograms might be questionable. For other women, though, age alone should not be a barrier to annual mammograms.
There also seems to be confusion among women about the importance of family breast cancer history. Yes, if you have a first-degree relative with a history of breast cancer you do have an increased risk. The vast majority of breast cancers, however, are diagnosed in women who have no family history.
All women should consider themselves at risk and follow the same guidelines for early detection I outlined in the first paragraph.
While considering yourself at risk, however, I want to correct the idea that breast cancer is an incurable and dreaded killer. It is true many women die of breast cancer, but it is far from the most common cause of death among women.
The most common killer of women is heart disease, outranking the deaths from all cancers combined. Among cancers, lung cancer kills almost twice as many women as does breast cancer. One common thread there is smoking.
It’s also not true that breast cancer is inevitably a death sentence. The number of women (and men) who have survived breast cancer is far larger than the number of those who have died. The five year survival rate for women diagnosed with breast cancer is 88.7 percent. In other words, almost nine out of every 10 women diagnosed will still be kicking five years later.
Finally, I always get questions from women about the relationship between breast cancer and hormones — either birth-control pills or post-menopausal hormone replacement. These questions are a bit trickier.
As far as birth-control pills are concerned, there is no research which clearly shows an increased risk of breast cancer from previous use of oral contraceptives. Some older research studies did show a possible link, but these studies were done at a time when the hormone dosages in the pill were much higher. Later studies show no increased risk at all.
For post-menopausal hormone replacement, the evidence is not so clear. The Women’s Health Initiative, the massive study done several years ago which changed some of our views on hormone replacement, had mixed results on breast cancer risk.
The initiative looked at large groups of women who were taking two different forms of hormones: one group took only an oral form of estrogen, while another group took a pill containing both estrogen and another hormone called a progestin. For women who still have an intact uterus, the progestin is necessary to protect against endometrial cancer.
What this study found was that women taking the combined estrogen and progestin did have a slightly increased risk of breast cancer, equal to an additional eight cases a year for each 10,000 women. These additional cancers tended to be less aggressive types-more sensitive to hormonal types of treatment.
The women in the study who had previous hysterectomies and therefore could take estrogen alone did not have an increased risk of breast cancer. There was a small and statistically insignificant decrease in their risk for breast cancer.
It’s important to talk to your doctor about your own individual history and risk factors.
Send questions, comments or suggestions for future columns to janet.matthews @capellahealth.com.
