October is breast cancer awareness month

More important than pumpkin spiced everything, October is also Breast Cancer Awareness Month.

This is the second-most-common cancer in women, as skin cancer is first. While the vast majority of those who develop breast cancer are women, this disease also can affect men.

The most recent compilation (2019 statistics) showed 264,121 new cases were reported in the United States and 42,280 women and 500 men died of breast cancer that year.

In Arizona, 5,234 breast cancer deaths occurred.

According to the National Cancer Institute, 12% of women in the United States (that’s one in eight) will develop breast cancer during her lifetime. One in 800 men, or .12%, will be diagnosed. While most breast cancer occurs in women over age 55, young women are not immune, and 12% occur in women under 45.

So, what is cancer? It is the rapid growth of abnormal cells when the DNA in some normal cells somehow becomes damaged. Sometimes the body can destroy these aberrant cells, but more often they proliferate and divide more quickly than healthy cells.

They form a mass or lump and can spread to other parts of the body, invading healthy tissue. There are several types of breast cancer, depending on where it is in the breast. Ductal carcinoma in situ (DCIS) is an early form of breast cancer. The abnormal cells inside a milk duct have not spread to other parts of the breast or adjacent lymph nodes.

Invasive ductal carcinoma is the most common type of breast cancer and starts in those cells that line a milk duct. Cancer cells break through the duct wall and spread into adjoining breast tissue and can then spread to other parts of the body though the bloodstream or lymph system.

Invasive lobular carcinoma (ILC) starts in the milk-producing glands, or lobules. This, too, can spread to other parts of the body. Of interest is that this form of breast cancer will affect both breasts in about 20% of women with ILC.

What can be confusing is lobular carcinoma in situ. This is not actually cancer but the precursor and is often found on biopsy or imaging studies other than mammograms for another suspicious lump or mass.

Triple negative breast cancer does not have the cell receptors estrogen, progesterone and HER2 (human epidermal growth factor), that are usually found in breast cancer (a receptor is a site on a cell surface that can bind with a particular substance). This cancer is more difficult to treat, because many drug therapies need those receptors to get into the cancer cells. There are other, less common, breast cancers also, such as angiosarcoma, Paget’s disease and inflammatory breast cancer.

There are breast cancer symptoms that warrant evaluation. A lump that is new and not associated with the menstrual cycle (not all breast lumps are cancer), changes in the appearance of the nipple, any change or puckering of breast skin, any nipple discharge, and changes in the size or appearance of one breast compared to the other, need to be evaluated. And these symptoms apply to men as well as women. Breast pain is not a common symptom of cancer.

Treatment of invasive breast cancers will depend on the type and “stage” of the cancer — how advanced it is and where it may have spread. Different surgeries include lumpectomy (just tumor removal), mastectomy (breast removal) and lymph node removal.

Radiation treatment is an external beam to target either just the cancer site or the entire breast. Systemic treatments include chemotherapy, anticancer drugs that may be given as intravenous medication on a scheduled basis or an oral pill taken daily, depending on the cancer.

Hormonal therapy is used when the cancer cells have receptors for estrogen or progesterone. Hormone blockers help prevent cancer growth and may be taken for many years. Then there is “targeted therapy,” which kills cancer cells by interfering with specific proteins in the cell that promote growth. Research has opened new avenues for successful treatment and continues to explore ways to treat breast cancer.

The five-year survival rates are approximately 99% for localized disease (breast tissue only), 86% for regional involvement (cancer affecting nearby lymph nodes) and 28% for distant reach (a farther spread such as to bones, lungs and liver). But these statistics change with improved treatment and should be individualized.

Breast cancer cannot be prevented, but there are ways to reduce the risk of any cancers. Not smoking, staying physically active, maintaining a healthy weight and eating vegetables and fruits every day are healthy lifestyle choices that promote overall good health.

Excessive alcohol consumption and obesity are considered risk factors for developing different cancers including breast cancers. And approximately 5% to 10% of breast cancer is hereditary. If a close relative has it, your chances of developing breast cancer are greater.

As with many other illnesses, screening is essential. Monthly self breast exams are recommended by some organizations and health care providers, but they have not been found to be as effective as clinical exams.

Routine mammograms, ultrasound imaging and MRIs can detect the smallest cancers for earlier treatment. Certain blood tests are more widely available for those who have a hereditary risk. Screening rates vary by state, with Massachusetts taking the prize last year at 87% and Wyoming the worst at 66%, as reported by the National Cancer Society.

Arizona’s screening rate was 75%. Not bad, but we can do better.

Unfortunately, the COVID-19 pandemic halted or delayed many screening exams, but, hopefully, we are getting back on track this year.

There are many national campaigns to raise awareness and promote screening. From the CDC’s serious “Right to Know Campaign” and The National Breast Cancer Foundation’s “Together We Rise” to the humorous “Know Your Lemons” and “Lux Soap with a Lump” promotions, there are messages galore that can appeal to women across the age and demographic spectrums.

The Estee Lauder Companies have had a goal and a mission to help eradicate breast cancer worldwide since 1992 and have donated over $108 million to prevention and research. The Susan G. Komen Foundation sponsors an annual walk to raise money. There are also many other organizations with various campaigns and projects.

Get that mammogram. They are not the painful procedure noted in cartoons. OK, sometimes a little uncomfortable, but well worth the effort. Maybe we should offer pumpkin spiced lattes or cookies with the mammograms in October.

If I may share a personal note — my dear grandmother was diagnosed with breast cancer at the age of 99. She had a total mastectomy followed by oral chemotherapy, tolerated both and lived alone till she was 102. She had no cognitive decline when she died, not from breast cancer, just before her 104th birthday. So don’t let age stop you from following up on any suspicious symptoms and enjoying good health.

Mia Smitt is a longtime nurse practitioner. She writes a regular column for Tucson Local Media.