Breast Cancer Awareness

Breast Cancer Facts:

NEW CASES

Breast cancer is the most commonly diagnosed cancer among African American women. An estimated 26,840 new cases of breast cancer are expected to occur among African American women in 2011. The overall incidence rate of breast cancer is 10% lower in African American women than in white women. Among younger women (under age 45), however, the incidence rate of breast cancer is higher in African Americans than in whites. Breast cancer incidence rates increased rapidly among African American women during the 1980s, largely due to increased detection as the use of mammography screening increased. Incidence rates stabilized among African American women aged 50 and older during 1995-2005, while rates decreased by 0.7% per year among women under age 50 from 1991-2005.

At this time, there is no guaranteed way to prevent breast cancer, which is why regular mammograms are so important. A woman’s best overall preventive health strategy is to reduce her known risk factors as much as possible by avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake. Women should consider the increased risk of breast cancer associated with menopausal hormone therapy (MHT) use when evaluating treatment options for menopausal symptoms. More information about breast cancer is available in the American Cancer Society publication Breast Cancer Facts & Figures, available online at www.cancer.org.

SURVIVIAL

The 5-year relative survival rate for breast cancer diagnosed in 1996-2004 among African American women was 78%, compared to 90% among whites. This difference can be attributed to both later stage at detection and poorer stage-specific survival among African American women. Only about half (51%) of breast cancers diagnosed among African American women are diagnosed at a local stage, compared to 62% among white women. Within each stage, 5-year survival is also lower among African American women.

Studies have documented unequal receipt of prompt, high-quality treatment for African American women compared to white women.6, 13-15 There is also evidence that aggressive tumor characteristics are more common in African American than white women.16-18 Other studies suggest factors associated with socioeconomic status may influence the biologic behavior of breast cancer.19-21 Thomson and colleagues, studying an all white Scottish population, suggest that poor women with breast cancers are more likely to be diagnosed with estrogen receptor-negative tumors.22 Poverty likely influences disease pathology and genetic markers of disease through lifelong dietary and reproductive habits.

*ACS African American 2010-2011 Cancer Facts

DEATHS

Breast cancer is the second most common cause of cancer death among African American women, surpassed only by lung cancer. An estimated 26,840 new cases of breast cancer and 6,040 deaths from breast cancer are expected to occur among African American women in 2011. Breast cancer death rates among African American women increased 1.5% annually from 1975- 1992 and declined thereafter. This decrease was larger in women under 50 (1.9% per year) than in women aged 50 and older (1.2%).4 The steady decline in overall female breast cancer mortality since the early 1990s has been attributed to improvements in both early detection and treatment.11,12 However, the decrease in breast cancer death rates has been smaller in African American than white women. Per 100,000 women, the incidence rate in African American women ranged from 60.9-127.3, and 111.5-139.1 in White women. However, the breast cancer death rate in African American women ranged from 20.9%-40% compared to 21.7%-27.3% in White women. This difference accounts for more than one-third (37%) of the overall cancer mortality disparity between African American and white women. The higher breast cancer mortality rate among African American women compared to white women occurs despite a lower incidence rate. Factors that contribute to the higher death rates among African American women include differences in access to and utilization of early detection and treatment and differences in tumor characteristics.

If you have been diagnosed with breast cancer, the following are:


KEY QUESTONS TO ASK YOUR DOCTOR

"You are a survivor at the time of diagnosis"-NCCS (National Coalition for Cancer Survivorship)
Being diagnosed with breast cancer can be a life changing experience for many women and their families. Sisters Network® Inc. developed this guide to help recently diagnosed breast cancer patients ask their doctors important questions following their diagnosis. During this time, it is important that you gather as much information as possible, AND keep a copy of your medical records!

KEY QUESTIONS TO ASK YOUR MEDICAL ONCOLOGY TEAM AFTER BEING DIAGNOSED WITH BREAST CANCER:

SURGICAL ONCOLOGIST

  • Why do I need this surgery?
  • What are surgical options?
  • Is the procedure performed on an inpatient or outpatient basis?
  • Will I receive general or local anesthesia?
  • Do you recommend any treatments prior to surgery to shrink the tumor?
  • What is the recuperation process?
  • How long before I can resume my normal lifestyle?

MEDICAL ONCOLOGIST

  • Please explain my diagnosis.
  • What stage is my disease?
  • What treatments are available and appropriate for my diagnosis?
  • What are the cure/remission rates for this treatment?
  • What results do you expect?
  • How will you know if the treatment is working?
  • Are there clinical trials available?
  • Could the recommended treatment cause a secondary problem (i.e., lung, heart, kidney, damage/disease, fertility problems)?
  • What is the time frame for me to make a decision?

RADIATION ONCOLOGIST

  • What is the goal of this treatment? Is it to eliminate the cancer?
  • What are the chances that this treatment will prevent the cancer from coming back?
  • What are the potential side effects of this treatment? (long and short term side effects especially to the heart, lung, spinal cord, esophagus) Will I burn?
  • How can I ease the side effects?
  • How is the radiation planned in order to limit the radiation to the heart, lung, spinal cord and
  • Other critical structures?
  • How often will I receive radiation therapy? What is the duration of each treatment, and what is the course of radiation?
  • If I decide to have the reconstructive surgery, how would radiation therapy affect my treatment plan?
  • Will this treatment affect my fertility in the future and will I be radioactive and a danger to my loved ones?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and preform my usual activities?

BREAST RECONSTRUCTION QUESTIONS

  • Am I a candidate for breast reconstruction?
  • What types of breast reconstruction are available?
  • Which type(s) am I a candidate for?
  • What are the disadvantages and advantages of each type?
  • How will my other treatments (i.e., chemotherapy and radiation) affect my reconstruction?
  • Will the reconstruction match my other breast?
  • How will the reconstructed breast feel?
  • Will I need to have surgery again in the future?
  • How will weight change or pregnancies affect the reconstruction?
  • How and when can the nipple and areola be reconstructed?
  • What are the costs involved with breast reconstruction?
  • Will my insurance cover the surgery?
  • Tell me about your training and experience with reconstruction.
  • Are you board certified? How many cases do you do a year?

RISK FACTORS ON BREAST CANCER

What are the risk factors? Age, Gender, Heredity/Genetic Factors, Long menstrual history, Never having children, Hormones, Personal history of breast or ovarian cancer, Environmental factors and Early Menopause.

What are the warning signs?
- Lump, hard knot or thickening in the breast
- Swelling, redness or increased warmth in the breast
- Change in the size or shape of the breast
- Itchy, sore or scaling area on the nipple/areola
- Nipple discharge (particularly if bloody) that starts suddenly
- Pulling in of the nipple (inverted nipple) or nipple change direction (retracted nipple)
- Dimpling or puckering of the skin on the breast
- Unusual pain in an area of the breast

What are the recommended steps for early detection? The best defense against breast cancer starts with you! Sisters Network® Inc. recommends these steps for early detection:

- Monthly breast self-exam (BSE) starting at age 20*
- Clinical breast examination by a trained medical professional every 2-3 years beginning at age 
  20, and annually after age 40
- Mammography screening every one to two years for women ages 35-40 (If your mother or 
sister has had breast cancer, you may need to get mammogram earlier and more frequently)
- Annual mammography screening for women age 40+**

*BSE should be done just as your period ends or for post-menopausal women, the same day each month. Most women discover breast masses during monthly breast self-examination. This simple and easy to follow examination allows a woman to become more familiar with her breast, making the detection of subtle changes or abnormities easier.

**Women receiving annual mammography screening are 30% less likely to die from breast cancer compared to unscreened women.

***Breast ultrasound is frequently useful in evaluating breast and mammographic abnormalities, especially in young women.


What are the factors that place a woman at increased risk for breast cancer? Every woman has some risk for developing breast cancer during her lifetime, and that risk increases as she ages. However, the risk of developing breast cancer is not the same for all women. The following are the some factors known to increase a woman's chance of developing this disease.

Personal History: Women who have had breast cancer are more likely to develop a second breast cancer. Family History: The risk of getting breast cancer increases for a woman whose mother, sister, or daughter has had the disease; or who has two or more close relatives, such as cousins or aunts, with a history of breast cancer (especially if diagnosed before age 40). About 5 percent of women with breast cancer have a hereditary form of this disease.

Genetic Alterations: Specific alterations in certain genes, such as those in the breast cancer genes BRCA1 or BRCA2, make women more susceptible to breast cancer.

Abnormal Biopsy: Women with certain abnormal breast conditions, such as atypical hyperplasia or LCIS (lobular carcinoma in situ), are at increased risk.

Other conditions associated with an increased risk of breast cancer: Having children at a later age or never having children at all, early onset of menses, taking hormones over an extended period of time, and exposure to environmental hazards.

What is the best method of detecting breast cancer as early as possible? A high-quality mammogram, with a clinical breast exam, is the most effective way to detect breast cancer early. Using a mammogram, it is possible to detect breast cancer that cannot be felt. However, like any test, mammograms have both benefits and limitations.

How much does a mammogram cost? Most screening mammograms cost between $50 and $150. Most states now have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms. Details can be provided by insurance companies and health care providers. Medicare pays 80% of the cost of a screening mammogram each year for beneficiaries age 40 or older. There is no deductible requirement for this benefit, but Medicare beneficiaries are responsible for a 20% co-payment of the Medicare-approved amount. Information on coverage is available through the Medicare Hotline at 1-800-MEDICARE. Some state and local health programs and employers provide mammograms free or at low cost. Information on low-cost or free mammography screening programs is available through the NCI's Cancer Information at 1-800-4-CANCER; or contact the SNCNJ office at 732-246-8300.