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Think Pink Thursday, October 3, 2013

a guide to breast cancer awareness

a special supplement to the

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Thursday, October 3, 2013 Messenger-Inquirer

How you can lower your risk of breast cancer

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reast cancer is the second most common cancer among women, second only to lung cancer. One in eight women is expected to develop breast cancer in her lifetime, and a recent survey by the Society for Women’s Health Research found that 22 percent of women named breast cancer as the disease they fear most. The specter of breast cancer makes it no surprise that women are eager to seek various ways to reduce their risks of developing this potentially deadly disease. Though cancer treatments continue to evolve, there remains no cure for breast cancer or any other types of cancer. However, there are steps men and women can take to reduce their risks of developing breast cancer. In fact, the National Cancer Institute says avoiding breast cancer risk factors is the best path to prevention. • Avoid exposure to radiation. Repeated exposure to radiation therapy used to treat illnesses like Hodgkin’s disease can increase a person’s risk of breast cancer, particularly if treatments begin at an early age. • Keep a healthy weight. Obesity increases the risk of breast cancer, particularly in postmenopausal women. Healthy eating and exercise can help women control their weight while reducing their risks of developing breast cancer and a number of other diseases. Scientists at The Mayo Clinic believe there is a link between estrogen production in fatty breast tissue and breast cancer. • Get your exercise. Exercising four or more hours a week can lower breast cancer risk. Exercise need not be heavy lifting at the gym. Any moderate physical activity, from cycling to walking, can be effective. Exercise decreases hormone levels in the body that can impact breast cancer risk. Some studies indicate simply walking briskly for one to three hours per week can reduce a woman’s breast cancer risk by 18 percent. • Eat a low-fat diet. The Women’s Intervention Nutrition Study from the National Cancer Institute found that the highest rate of breast cancer reduction was among a group of women who

ate a low-fat diet. • Reduce alcohol consumption. Various studies have indicated that women who drink alcoholic beverages may develop cancer at a higher rate. Women who consume two to five drinks daily have a greater risk of developing breast cancer than those who abstain from alcohol.

• Weigh the risks of hormone replacement therapy. There are mixed reviews on hormone replacement therapy, or HRT, for postmenopausal women. There may be a link between long-term HRT and breast cancer, particularly when estrogen and progesterone are used in combination. Some doctors advise estrogenonly hormone therapy for women who have had a hysterectomy. • Use of SERMs and aromatase inhibitors. Selective estrogen receptor modulators, or SERMs, are drugs that act like estrogen on some bodily tissues but block the effect of estrogen on other tissues. Aromatase inhibitors decrease the amount of estrogen made by the body. Women with a high risk of breast cancer may benefit from taking a SERM or aromatase inhibitor. • Breastfeed your children. Lactation can suppress ovulation and the body’s production of estrogen, which has been linked to higher levels of breast cancer. Breastfeeding may drop a woman’s breast cancer risk by 4 percent. Although there is no cure for cancer, there are a number of different ways women can reduce their risks for breast cancer.


Thursday, October 3, 2013 Messenger-Inquirer

Educating young women about breast cancer

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t the age of 12 to 15, many young women are experiencing the body and life changes that accompany adolescence. It can be difficult to imagine that breasts that are just beginning to develop may contain cancer. But such is the reality for some girls. The majority of women who receive a breast cancer diagnosis are over the age of 40. Experts at Monroe Carell Jr. Hospital at Vanderbilt University note that only 5 percent of breast cancer cases are found in women under the age of 40. However, the hospital recently treated a 14-year-old girl who found a lump and learned she had a rare form of breast cancer called a phyllodes tumor. In 2009, a 13-year-old from Little Rock, Ark. found a quartersized lump in her right breast, while a 19-year-old student at the College of New Jersey was diagnosed with cancerous cells and underwent a bilateral mastectomy. Though such cases are rare, it behooves teenage and adolescent girls to familiarize themselves with the disease and be mindful of their breast health. Some organizations have increased breast cancer messages for young girls, and it is not uncommon to find

young women participating in runs and fundraisers for breast cancer research. Some organizations even conduct breast cancer workshops to educate young women about breast health. Dorothy Paterson of Texas, a former Girl Scout leader who was diagnosed with breast cancer herself, began conducting workshops for Girl Scouts in 2007. The idea isn’t to scare girls into believing they have the disease, but rather to increase their awareness of changes in their bodies that may or may not be normal. Some parents worry that educating children about breast cancer may cause them to worry unnecessarily, especially considering a young girl’s risk of developing breast cancer is so minimal. However, others see the importance in schooling girls early on about a disease that is so common. Advocates of teaching young girls about breast cancer often note that any effort to help save lives and promote health is worthwhile. Just as with older women, adolescents and teens should realize that eating healthy foods, exercising, avoiding alcohol and tobacco, and maintaining annual physical exams with a doctor are key ways to reduce the risk for cancer.

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Thursday, October 3, 2013 Messenger-Inquirer

Proper steps to W conducting a breast self-exam

omen recognize the importance of living a healthy lifestyle, which includes conducting self-exams to detect for breast cancer. Breast self-exams are vital to discovering abnormalities, including lumps or tenderness, in the breasts. Self-examination increases the chances of early detection of breast cancer. John Hopkins Medical Center states that 40 percent of diagnosed breast cancers are detected by women who feel a lump. Doctors urge women to conduct monthly self-exams to familiarize themselves with the look and feel of their breasts, which enables them to more readily recognize any abnormalities that may indicate illness. There are a number of ways to conduct a breast self-exam, and women are urged to find the method they feel is most comfortable for them. The National Breast Cancer Foundation, Inc., offers these tips for conducting a breast examination at home.

• Examine breasts in the shower. A breast examination can take place in the shower while you are washing. The shower is a convenient place to conduct an exam since you already have removed your clothes. NBCF says you should use the pads of your fingers and move around your entire breast in a circular pattern, moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month for any lumps, thickening or hardened knots. If you find a lump, visit your physician for an evaluation. • Conduct an examination in bed. The breast tissue will naturally distribute over your chest wall and ribs when you are lying down. NBCF advises you to place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit. Squeeze the nipple and check for discharge or lumps. Then repeat the process on the left breast. • Conduct a visual examination. Standing in front of the mirror, you can look at your breasts with your hands at your side and over your head. Look for any differences between breasts. Many women find that their breasts are not exactly the same shape or size, but unusual dimpling or taut or thick skin may be indicative of a problem.

Should any lumps or abnormalities be discovered during an examination, a woman should not panic but schedule an appointment with her doctor for a more thorough examination, which may include a mammogram or ultrasound to map out images of the breast that may be hidden to the naked eye. Breast self-examinations are an essential element of a healthy lifestyle for women. Early detection of breast cancer vastly improves survival rates, and self-examination is often the most effective way to detect breast cancer early on.


Oral contraceptives and breast cancer risk

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ral contraceptives have prevented pregnancies for decades. But some women take contraceptives to help regulate menstrual period symptoms and to treat other issues, including acne. Many women wonder if taking birth control pills affects their risk of developing breast cancer. Anumber of studies indicate that taking oral contraceptives appears to slightly increase the risk of developing cancer among younger women, according to the National Cancer Institute. However, discontinuing oral contraceptive use for 10 years or more returns risk levels to normal. The Mayo Clinic notes that it is difficult to weigh the effect of birth control pills on breast cancer risk. Although some studies have shown a link between the two, more recent studies do not show an increased risk for breast cancer while taking birth control bills. The variety of oral contraceptives available perhaps plays a role in why studies into the potential link between contraceptives and breast cancer risk may be flawed. Birth control pills may combine various levels of two female sex hormones, called estrogen and progesterone, and this combination works by preventing the release of eggs from the ovaries, changing the lining of the uterus to make it inhospitable for a fertilized egg, as well as changing the mucus at the cervix to prevent sperm from entering. A triphasic pill, in which the dose of hormones

is changed in three stages over the course of the woman’s monthly cycle, seems to be the biggest culprit in raising breast cancer risk. Women who started menstruating at an early age and subsequently began taking oral contraceptives in their teenage years also are at a slightly higher risk. Experts believe that birth control pills could affect cancer risk because the estrogen and progesterone have been known to influence the development of some cancers. It is believed the more estrogen a woman is exposed to during her lifetime, the greater her risk for breast cancer. It is not known if this is only the case with naturally occurring estrogen, man-made synthetic versions used in oral contraceptives or both. Women can weigh the pros and cons of taking birth control pills with their gynecologists. Some believe that taking oral contraceptives could decrease risk of other types of cancers, including ovarian and endometrial cancer. Women who take birth control pills to control severe premenstrual syndrome, known as premenstrual dysphoric disorder, may find that the benefits outweigh the slightly elevated risk of breast cancer.

There is no cut-and-dry answer as to whether or not oral contraceptives put women in danger of developing breast cancer.

Thursday, October 3, 2013 Messenger-Inquirer

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Thursday, October 3, 2013 Messenger-Inquirer

Breast cancer diagnosis often described in stages

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pon receiving a breast cancer diagnosis, many women instantly want to know their chances for survival. Such a reaction is understandable when receiving a diagnosis of any disease, and especially one as potentially deadly as breast cancer. A breast cancer patient’s prognosis is often linked to the stage of the disease. Stages are used to make breast cancer more understandable to patients and to give them a basis for comparison relative to other patients. As with many diseases, breast cancer is best treated the earlier it is detected, and the various stages of breast cancer can offer some insight into how far along the disease has progressed.

• Stage 0: During stage 0, cancerous cells have not broken out of the part of the breast in which they started or invaded neighboring tissue. The earliest stage of breast cancer, stage 0 breast cancer is considered noninvasive and is often successfully treated. • Stage I: Stage I breast cancer is divided into two subcategories and is an invasive cancer in which cancer cells have begun to invade normal surrounding breast tissue. Stage IA describes invasive breast cancer in which tumors measure up to two centimeters and the cancer has not spread outside the breast or to the lymph nodes. Stage IB is also invasive but does not necessarily feature a tumor in the breast. In such instances where there is no tumor in the breast, small groups of cancer cells no larger than two millimeters are found in the lymph nodes. When tumors are found in the breast, the tumors are no bigger than two centimeters and there are small groups of cancer cells in the lymph nodes.

• Stage II: Stage II breast cancers are divided into two subcategories depending on whether or not there is a tumor in the breast. Stage IIA can refer to invasive breast cancers in which no tumor is found in the breast but cancer has been found in one to three lymph nodes under the arm or in the lymph nodes near the breast. When there is a tumor in the breast during stage IIA, the tumor may be two centimeters or smaller and have already spread to the lymph nodes under the arm or the tumor may be between two to five centimeters but it has not spread to the lymph nodes under the arms. Stage IIB breast cancer may refer to an invasive breast cancer in which the tumor is between two and five centimeters and small groups of cancer cells have been found in the lymph nodes. This stage is also used to describe tumors between two and five centimeters that have spread to the lymph nodes under the arm or near the breastbone, or tumors larger than five centimeters that have not spread to the lymph nodes.

• Stage III: Stage III breast cancers are characterized by two categories, stage IIIA and stage IIIB. During stage IIIA, the tumor is between 2 and 5 centimeters in size and has spread to at least nine underarm lymph nodes. During stage IIIB, the tumor has spread beyond the breast to tissues nearby, such as the skin, chest wall, ribs, muscles, or lymph nodes in the chest wall. • Stage IV: Stage IV breast cancers describe invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other parts of the body. These organs can include the bones, brain, distant lymph nodes, lungs, liver, or skin. Stage IV breast cancers are often described as “advanced” and could be a recurrence of a previous breast cancer that has spread to other parts of the body.


Thursday, October 3, 2013 Messenger-Inquirer

Men not immune to breast cancer

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hough it’s significantly less common in men than women, breast cancer is not exclusive to women. That may surprise many men, who may not realize that they have breast tissue that can be susceptible to breast cancer just like their female counterparts. The likelihood of a man developing breast cancer remains quite slim, as the American Cancer Society noted that they expected roughly 2,200 new cases of invasive breast cancer diagnoses in men in 2013. But the relative rarity of male breast cancer cases does not mean it’s something men should take lightly, as a breast cancer diagnosis can be just as deadly for men as it can for women. Though male breast cancer prevention can be difficult because of the uncertainty surrounding the cause of the disease, men who understand the risk factors are in a better position to handle a diagnosis than those who don’t. • Age: Age plays a role in many cancer diagnoses, and male breast cancer is no exception. According to the ACS, the average age a male is diagnosed with

breast cancer is 68, and a man’s risk increases as he ages. • Alcohol and liver disease: Heavy alcohol consumption increases a man’s risk for breast cancer, and this can be connected to liver disease, which is another risk factor for male breast cancer. Heavy alcohol consumption can make men more likely to develop liver disease, including cirrhosis. Men with severe liver disease tend to have high estrogen levels because the liver finds it more difficult to control hormonal activity. Higher estrogen levels have been linked to breast cancer risk for men and women alike. • Family history: Just like age, family history can increase a man’s risk for various cancers, including breast cancer. The ACS notes that roughly 20 percent of men with breast cancer have close male and female blood relatives who also have or have had the disease. • Inherited gene mutations: Gene mutations greatly increase a woman’s risk of developing breast cancer, and they can be risky for men as well. Men with

a mutation in the BRCA2 gene have a lifetime risk of breast cancer of about 6 percent. A mutated BRCA1 gene also can increase a man’s risk of breast cancer but not as significantly as a mutated BRCA2 gene. Mutations in these genes are most often found in families with significant histories of breast and/or ovarian cancer. But even men with no such family history can have the gene mutations associated with breast cancer. Mutations in the CHEK2 and PTEN genes can also increase a man’s risk for breast cancer. • Klinefelter syndrome: A congenital condition affecting roughly one in 1,000 men, Klinefelter syndrome occurs when a man’s chromosome count is abnormal. A typical male body has cells with a single X chromosome and a single Y chromosome, but men with Klinefelter syndrome have cells with a Y chromosome and at least two and as many as four X chromosomes. Men with Klinefelter syndrome are often infertile, and, when compared to other men, they have more female hormones than male hormones. Though Klinefelter syn-

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drome is so rare that it’s hard to study, some studies have found that men with this condition are more likely to develop breast cancer than other men. • Obesity: Recent studies have begun to show that women who are obese have a greater risk of developing breast cancer, and researchers feel obesity poses a similar threat to men. That’s because fat cells in the body convert male hormones into female hormones, which means obese men will have higher estrogen levels than men who are not obese. • Radiation exposure: Men who have undergone radiation treatment in their chest area have a higher risk of developing breast cancer than those who have not. Lymphoma treatments may require radiation treatment to the chest, so men who have been diagnosed with lymphoma might be at a heightened risk of breast cancer. While the overwhelming majority of breast cancer patients are female, men should know they aren’t immune to this potentially deadly disease.


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Thursday, October 3, 2013 Messenger-Inquirer

Genetics put black women at higher risk for breast cancer New evidence suggests that black women have higher rates of breast cancer at younger ages due to a greater incidence of BRCA gene mutations. BRCA mutations, which made headlines recently when they were linked to actress Angelina Jolie’s decision to get a preventive mastectomy, raise the risk of breast cancer considerably. Research has shown that mutations in one of the BRCA1 or BRCA2 tumor-suppressing genes can raise a woman’s risk of breast cancer to 87 percent. BRCA mutations are a problem typically associated with women of Eastern European Jewish descent. But it appears black women are at significant risk as well. According to Dr. Jane Churpek, a cancer specialist and professor of medicine at the University of Chicago, past genetic studies regarding BRCA gene mutations have not included black women. But according to the American Society of Clinical Oncology, one-fifth of black women have BRCA mutations. Breast cancer is the leading cause of cancer death for black women aged 45-64, according to the Centers for Disease Control and Prevention. Black women are 60 percent more likely to die of breast cancer than white women, although the overall lifetime risk of breast cancer is lower for black women compared to white women. Because cancer may appear at a younger age and more aggressively

in black women, doctors urge this demographic to educate themselves about the disease. Some doctors advise that black females should be offered genetic counseling and should undergo more frequent breast cancer screenings. Doctors typically advise women get a mammogram once ever y year after age 40. There also are hormone-blocking pills available and other options for women with a high predisposed risk to breast and ovarian cancer. Black women should also understand that their breast tissue may be more dense than other women. This can make detecting lumps and other abnormalities in the breast more difficult. Knowing this can help patients seek more intensive screenings, such as digital mammograms, and be more diligent in their own self-examinations. It also is vital that women make themselves aware of other potential indicators of breast cancer, including: • thickening of the nipple or breast • swelling in the breast • discharge from the nipple other than milk • pain in the breast or nipple • skin irritation or dimpling Black women should understand that certain gene mutations may put them at a higher risk for breast and ovarian cancers than white women. Talking with your doctor about your options and educating yourself about this disease can increase your chances of sur viving a diagnosis.


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