The New York Times recently highlighted Dr. Laura Esserman, a breast cancer surgeon at UC-San Francisco for challenging traditional approaches to surgery. The usual response with detection of a mass is to issue a biopsy and then make the decision to have a lumpectomy or mastectomy. Dr. Esserman’s resistance to biopsy is specific for cases of DCIS: ductal carcinoma in situ.
DCIS is a non-invasive cancer that comprises 20-25% of newly diagnosed breast cancer—and it’s usually detected by a mammogram. The non-invasive cancer cells are contained within the ducts of breast tissue and is highly unlikely to spread. Incredibly, its cure rate is as high as 98-99%.
When first diagnosed with breast cancer, one of the biggest questions is the extent of surgery needed. A lumpectomy is localized removal of the tissue containing the cancer, leaving margins of healthy tissue. A standard mastectomy removes of all breast tissue, along with the overlying skin, and nipple. A mastectomy is often modified to spare either the pectoralis muscle, skin, or nipple from complete removal. A mastectomy is clearly a bigger surgical procedure with greater disfigurement and recovery time. But, because all of the breast tissue is removed, the risk of developing a new cancer is significantly reduced.
But how much lower is that risk?
So, what else did I learn from Dr. Elisa Port?
The only test that has proven to reduce the risk of dying from breast cancer by detecting breast cancer early is the mammogram. But when should you start?
For women who do not have identifiable risk factors, mammograms should start at age 40. However, if you have certain risk factors such as family history you may need to start screening earlier.
But what can I do in my twenties?
It’s a good idea to start regular self-exams. Getting to know what is normal for your breast tissue now will allow you to detect changes in your breast tissue and possibly identify a lump early on.
The two lifestyle factors that have been linked to breast cancer are obesity and heavy alcohol intake. Therefore maintaining a healthy weight and moderate alcohol intake may reduce your risk of development.
- It’s all hereditary: there’s a lot of talk about the BRCA genes. Yes, having the mutation of the gene increases your risk of developing breast cancer by 80-90% and that mutation can be inherited. However, it is also worth noting that 80-90% of breast cancer cases occur with no family history.
- Don’t worry about your coffee, deodorant, underwire bra, or birth control pill increasing your risk of breast cancer. It’s not true!
- Don’t leave the men out! Although much rarer (less than 1%), it is possible for men to get breast cancer.
“Each year, approximately 300,000 women will be diagnosed with breast cancer in the United States. And survival rates overall currently approach 90 percent. This means that of 300,000 women diagnosed this year, approximately 270,000 will be alive in five years or more. It also means that, tragically, 30,000 will not survive.” Dr. Elisa Port, M.D.
Breast cancer victims, their families, and the survivors of breast cancer undergo extreme physical and emotional battles. While the survival rate for breast cancer is high and improving, it is not 100%. Take time this month to not only become more knowledgeable about breast cancer, but to recognize the individuals and families who have faced or continue to face this battle.