BREAST CANCER – ARE YOU AWARE?

As many of you know, October is breast cancer awareness. Self examination helps the discovery of possible lumps. Mammograms should be done yearly. Some of the signs and symptoms are lumps or a mass in the breast. Swelling, skin irritation or dimpling, breast or nipple pain, nipple retraction, redness, scaliness or thickening of the nipple or breast skin, nipple discharge are among the symptoms.

Risk factors are being a woman. However, men are not excluded from developing breast cancer. Chronological aging, but this type of cancer knows no age. Inherited BRCA1 and BRCA2 genes. A woman with the inherited BRCA gene has about a 70% chance of getting breast cancer by age 80. Having a family history of breast cancer, having a personal history of breast cancer, having dense breast tissue, starting menstruation early. Going through menopause after 55, having radiation to your chest and exposure to synthetic estrogen.

Lifestyle risks include drinking alcohol, 2-3 drinks per day increases the risk of breast cancer by 20%, being overweight or obese, not being physically active, not having children, not breastfeeding and using birth control.

Anne McTiernan, M.D., Ph.D. reports that “Alcohol can increase estrogen in the blood”. Dr. McTiernan is a cancer prevention researcher at the Fred Hutchinson Cancer Research Center, in Seattle, Washington. Limit yourself to one drink or less a day.

Besides mammograms, breast ultrasound can be helpful in finding changes in the breast tissue. Lumps can also be determined to be a solid mass or a fluid-filled cyst. For women at a high risk for breast cancer, yearly MRI scans may be recommended. this scan can help find and measure the size of tumors.

41,070 is the estimated breast cancer death in 2017.  At this time there are more than 3.1 million breast cancer survivors in the U.S.

Estimated new cases in 2017 for men is 2,470.

These statistics came from the American Cancer Society.

Only 10 percent of breast cancers are due to an inherited genetic mutation, having a mother, sister, aunt or grandmother with the disease indicates that you have a higher risk. A strong family history of breast or ovarian cancer means you may need an MRI and a mammogram and screening as soon as 10 years before the earliest age of onset.

Fewer than 1 in 5 survivors of breast and ovarian cancers have undergone genetic testing for heritable mutations affecting genes such as BRCA1 and BRCA2, which means that more than a million women in the United States are not receiving recommended care.

The finding, reported in a study published online in the August 18th Journal of Clinical Oncology, highlights a huge underuse of genetic testing, say the researchers.

Christopher P. Childers, MD from the Department of Surgery at David Geffen School of Medicine at the University of California, Los Angeles, said in a statement that “identifying a mutation is often important for surgical decision-making and cancer therapy, but its importance extends further than that. If individuals are aware that they have these mutations, they can take steps to lower their future cancer risk.”

Kevin S. Hughes, MD from Massachusetts General Hospital and Harvard Medical School, in Boston, points to evidence from another recent study of patterns in genetic testing for breast and ovarian cancer risk in the United States showing that 90% of unaffected BRCA carriers, or an estimated 10.7 million women, also need to be tested. “Our problem, which desperately cries out for a solution, is that huge numbers of high-risk patients who could be identified by genetic testing are instead developing cancer and often dying of that disease,” he writes. Dr. Hughes also reports that “It will soon become impossible to practice medicine without genetics.”

The reality comes from an analysis of data from the 2005, 2010, and 2015 National Health Interview Surveys, which show that 1.2 million to 1.3 million women (or fewer than 1 in 5) did not have a simple blood or saliva test even though they may select National Comprehensive Cancer Network (NCCN) screening criteria for lowering future cancer risk, according to researchers at the NCCN.

Most of these women (including 70% of 800,000 eligible patients with breast cancer and 80% of 400,000 eligible patients with ovarian cancer) never discussed genetic testing with a healthcare provider, the researchers note.

In women age 45 years and younger, testing rates for individual eligibility criteria ranged from 6.2% to 18.2%. Among those with ovarian cancer, testing was discussed with 15.1%, while 13.1% were advised to undergo testing and 10.5% actually got tested.

For now, clinicians need a better infrastructure to communicate the risk and benefits of prevention strategies that vary by age. Better tools need to be developed so that clinicians can interpret and advise women based on genomic test results with resources for family members who need to understand their own potential risk.