So, after all we’ve discussed this week, this is what it comes down to: the one in eight lifetime risk has landed at your doorstep. What happens next is very important. The ability to recognize and obtain early treatment for breast cancer (or not) will determine the length and quality of the rest of your life. Remember, most women survive breast cancer; there are approximately 3 million breast cancer survivors in the U.S. That said, also remember that there are about 40,000 annual deaths from breast cancer. The combination of breast self-exams and widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Unfortunately, many others go undetected because of the limitations or failure to engage those two modalities.
I really want you to become familiar with your bodies (in this instance, your breasts). The most common symptom of breast cancer is a new lump, but you should be in tune with any new change or irregularity, including pain, swelling, redness, irritation, nipple inversion or other irregularity. Remember, breast tissue extends into the armpit (axilla), and you may find swollen and tender lymph nodes in the axilla or near the collarbone (clavicle). My bottom line: you be responsible for diligently assessing any abnormalities, and your healthcare team will determine the cause and if it’s cancer.
One more pitch for early detection: if breast cancer is detected prior to spread to the lymph nodes, the 5-year survival rate (with appropriate treatment) is as high as 98%. If it’s reached the lymph nodes, that drops to approximately 84%, and if it has spread to other body parts (e.g. the lungs, liver and bone – this is called metastatic cancer or carcinoma), the average 5-year survival rate drops to 23%.
This represents a drop in mortality rates by about 25% since 1990. Unfortunately, survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself. That said, recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences and 50% of new cancers in the opposite breast occur after 5 years.
Many of you have asked about tumor ‘predictors’. I’ll end this post with a look at three considerations, although there are many others:
1. Breast cancer cells may contain binding sites for hormones (estrogen and progesterone). When that’s the case, these cells are called hormone receptor-positive; if not, they’re called hormone receptor negative. When cancer cells are hormone receptor positive, they are responsive to certain medications (such as tamoxifen and others). This improves prognosis. These types of cells also happen to grow more slowly, which also helps. On the other hand, hormone receptor-negative cells only respond to chemotherapy.
2. Tumor markers are proteins released from cancer cells that are able to be identified during the disease. They are notable for demonstrating (or predicting) how aggressive one’s cancer may be. The one I will mention (yes, there are others) is the HER2 marker, which is especially quick-growing and aggressive. The American Cancer Society recommends all newly diagnosed women be tested for this. Fortunately, only 20% women with invasive breast cancer are positive for HER2.
3. Curiously, tumor location within the breast has proven to be an important predictor. Tumors in the middle of the breast are most serious than those toward the outside.
I wish all of you breast cancer survivors or those with family members affected all the best with this. I hope these posts have again pointed out the importance of lowering your risk profile and early detection and treatment. This is another illustration of the shortcomings of our typical approach to health care; relying on medical care is not the same as comprehensive healthcare. The time to engage the fight against breast cancer is not in the midst of advanced disease.
I welcome your comments or questions.
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