Saturday, January 7, 2012

Early detection of breast cancer - for everyone and including Pinays

I'd like to take a bit of time to discuss early breast cancer detection via yearly mammograms after age 40, and bring a point-of-view relevant to younger women and inclusive of Filipinas.  While the concept of early detection via annual mammography in women over 40 is "preached" by family physicians and OB/GYNs, and dispersed with public service announcements and public health campaigns through all types of media, it is easy to procrastinate due to a schedule that's too busy, fear of cancer, fear of discomfort during the mammogram, or any number of other reasons.  But I can speak from experience how important and crucial mammography really is.  January 11th marks the one-year anniversary that my lovely wife was diagnosed, after a confirmatory second high-resolution mammogram (first one looked suspicious)  and then a stereotactic biopsy, with a type of breast cancer called ductal carcinoma in situ (DCIS).   She went in for her very first-ever mammogram just a few weeks after turning 40, and had no family history of breast cancer other than one case on her father's side of the family...  only a family history of breast cancer on the maternal side of a woman's family is considered to be a prognostic risk factor.  Thankfully we caught it early, and she is healthy and happy now.   

Statistically, Filipinas and Asian women in general do not have as high an incidence of DCIS and other breast cancer as Caucasians.  Ironically, however,  immediately before my wife went in for her first mammogram, a Filipina acquaintance of hers who is just a couple of years older than my wife had a mastectomy for DCIS.  While certain risk factors exist and various ethnic groups have a higher or lower propensity for different types of cancers, any given type of cancer can be (and is) represented in virtually any population.  So I'd like to take the opportunity to strongly encourage, urge, cajole, and prod every woman over 40 (or any man who has a wife, girlfriend, mother, aunt, sister, cousin, daughter, friend over 40) of any race or ethnicity who reads this to please try their best to get an annual mammogram, and additionally perform regular self physical breast exams. 

DCIS is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue (i.e., stage 0).  DCIS isn’t life-threatening per se, but having DCIS can increase the risk of developing an invasive breast cancer later on.  According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.  There are two main reasons this number is so large and has been increasing over time:   1) People are living much longer lives, and as women grow older, the risk of breast cancer increases;  2) More women are getting mammograms, and the quality of the mammograms has improved. With better screening, more cancers are being spotted early.  Additionally, the DCIS in my wife's case was not able to be detected via self physical examination because there were no palpable tumor masses, and therefore mammography was the only way to detect it so early.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future.  Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%.  My wife was advised to have a complete mastectomy of the affected breast, which was actually what she would have chosen anyhow, and she decided that a prophylactic mastectomy of the other (contralateral) breast would make her feel much better in terms of not needing to worry.  For my wife's non-aggressive grade of DCIS, bilateral mastectomy brings the risk of recurrence down dramatically, to a yearly chance of about 2% and a lifetime chance of about 10% up to a very old age.   She had the bilateral mastectomy in February and is doing great since - her lymph nodes were clear, and she has not required any radiation or chemotherapy at all.   She has adapted perfectly well, is as active as ever before, and is confident and happy with the outcome of her surgery, her physical appearance, and her new lease on life.

I've included a few pictures of a Susan G. Komen Foundation Race for the Cure 5K run/walk we participated in as a family during Mother's Day 2011, less than 3 months after my wife's surgery.  It was quite an inspirational event, as many of the ~30,000 participants were breast cancer survivors (and their families), many of whom were diagnosed with much more aggressive types of breast cancer or breast cancer that metastasized, and went through some real hardship and tribulations through extensive chemotherapy and radiation therapy after surgery.   Numerous of the paper race/walk entry tags that were pinned to the T-shirts being worn by participants had listed in memoriam the names of mothers, grandmothers, aunts, sisters, daughters, or friends who succumbed to breast cancer.  

Further information is available at the American Cancer Society and Susan G. Komen Foundation websites.  I've also included a link to a review article, "What every Filipina should know about breast cancer", by Tyrone M. Reyes, MD which is from the Philippine Star website:



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