Why Early Detection Is Critical When It Comes to Breast Cancer
October 18, 2017
We’re very willing to bet that anyone and everyone reading this has been affected by breast cancer in some way. Whether it’s a friend, family member, or you that’s been diagnosed, the odds are unfortunately not in our favor. About one in eight women will develop breast cancer, and according to the Center for Disease Control and Prevention, about 11 percent of new breast cancers are found in women under 45. But it’s not all bad news: Early detection has shown to increase survival rates, and, along with advances in various types of genetic testing and personalized screening protocol, there are lots of new, positive developments. Here’s what you need to know.
Early detection saves lives
“Early detection and screening is one critical step for improving outcomes for women with breast cancer. Today, women diagnosed with Stage 0 or Stage 1 breast cancer have more than a 99 percent rate of five-year survival. Women with Stage 2 breast cancer have a 93 percent rate of five-year survival,” says Dr. Marc Hurlbert, Chief Mission Officer at the Breast Cancer Research Foundation. This makes early detection a key area of current research, with the BCRF committing more than $12 million to spend on early detection and prevention this year alone. Talk about money well spent.
Catching it early often means less aggressive treatment
Of course, survival rates are the prominent topic at hand, but the less aggressive the cancer is when it’s detected, the less aggressive you may need to be with treatment, points out Elizabeth Morris, MD, FACR, Chief of Breast Imaging Service at Memorial Sloan Kettering Center. “This is one of the big benefits of early detection that often goes unmentioned. Early detection can not only increase your chances of survival, but also increases the possibility of less toxic treatments. Less surgery may be needed. Less chemo. And even potentially less radiation therapy,” she explains.
There are also new treatments available for early stage breast cancer, such as Nerlynx, which was approved by the FDA this summer. “About 20 percent of early breast cancers are an aggressive type that have extra amounts of HER2 protein, which allows these tumors to grow faster and spread to other parts of the body sooner,” explains Frankie Holmes, MD, a breast cancer expert with Texas Oncology, an affiliate of The US Oncology Network. Nerlynx is a ‘chaser’ treatment, used after standard antiHER2 treatment for early stage breast cancer. “It gives patients with HER2 positive tumors another highly effective oral treatment that can reduce the risk of their cancer returning,” says Holmes.
To that point, regular screening is essential
The current guidelines recommend an annual mammography starting at age 40, but that’s not a hard and fast rule. If you have a first-degree relative (parent or sibling) who was diagnosed with breast cancer, you should start screening with mammography ten years earlier than the age she was when she was diagnosed, notes Morris. (So, if your mom was diagnosed at 45, you should get a mammo at 35.) Annual MRIs are now recommended for known genetic carriers—more on that to come—usually starting at age 30, according to Morris. But all the medical testing aside, don’t underestimate the importance of regular self-exams; according to Johns Hopkins Medical Center, 40 percent of diagnosed breast cancers are detected by women who feel a lump.
Consider this a friendly reminder to feel yourself up
All joking aside, it’s essential that a breast self-exam be a regular monthly occurrence. Set a reminder on your phone, write a note on your calendar, just make sure it happens. Check yourself at the same time each month, since hormonal changes and where you are in your cycle can affect how your breasts feel. Do so in the shower while standing up, but repeat the process again later in the day, laying down. Establishing this regular routine will help you get to know how your breasts feel, so that you’ll detect any changes right away. Feel something strange or different? Call your doc. (And an FYI to girls with dense breasts: Be extra vigilant, as it’s more challenging to detect cancer in dense breasts and they’re also correlated with a slightly increased risk, notes Morris.)
Be your own advocate
Don’t be afraid to be pushy if your gut tells you something is wrong. Breast cancer survivor and author of Pretty Sick, Caitlin Kiernan, attributes her persistence to saving her life: “I felt a pea-sized lump by accident, but because I have small, dense breasts, it didn’t show up on two mammograms. The day of the second one, I refused to leave the hospital until my insurance sent over an emergency approval for a sonogram. I waited four hours, but within five minutes of the test being underway, they discovered two lumps. One was malignant. It goes to show how important it is to be your own advocate. Being the squeaky wheel that day literally saved my life.”
Family history plays a role, but not always
According to the American Cancer Society, the risk of breast cancer is about two times higher for women with one affected first-degree female relative, and about three to four times higher for women with more than one affected first-degree relative. Still, most women who develop breast cancer do not have a family history of the disease. Take Alexa Gould, who was only 30 years old at the time of her diagnosis. “I was too young to begin screenings, I have very little family history, and I had just been to the gyno six months prior. No red flags. But I found the lump myself and knew something wasn’t right,” she says. And it wasn’t—Alexa was diagnosed with stage two breast cancer, underwent a lumpectomy and chemo, and is set to begin radiation. The bottom line: If breast cancer runs in your family, it’s not necessarily a diagnosis, but if it doesn’t, that’s not a free pass either.
What about the BRCA gene?
Recent developments in understanding genetic mutations, not to mention the well-publicized experience of celebs like Angelina Jolie, have led to lots of buzz surrounding the BRCA genes. “Since the genome was sequenced over a decade ago, we have more and more information about the genetic risk of breast cancer—including mutations in genes such as BRCA—and now understand that these women need to be screened differently,” explains Dr. Morris. But it’s important to remember that everyone has both the BRCA1 and BRCA2 genes, and that it’s mutations in these genes that increase your risk. And while these are the most well-studied, there are many other genes at play, too.
Women with BRCA1 and BRCA2 mutations are estimated to have up to a 70 percent risk of developing breast cancer by age 80, according to The American Cancer Society. Those are some scary stats, especially when you’re told that you are in fact a carrier, as was the case for Caitlin Brodnick, author of Dangerous Boobies. A strong family history prompted her to get tested at 25: “At the time it felt like a cancer diagnosis, even though it wasn’t. I ran away from it for three years,” she says. After finally meeting with a genetic counselor—whom she describes as a “an incredible therapist mixed with a scientist”—who explained her options, Brodnick chose to undergo an elective double mastectomy, though notes that the choice is completely individual and that surgery may not be the right move for everyone.
Unsure as to whether or not you should get tested? “Testing for BRCA is a personal choice,” explains Dr. Morris, who adds that a personal or family history of breast cancer at 50 or younger, ovarian cancer at any age, and being of Ashkenazi Jewish heritage are a few of the risk factors that warrant a referral to a genetic counselor.