Coming Home

In October, Breast Cancer Awareness Month, we all hear that 1 in 8 women, or 12.5% of women, will develop breast cancer in their lifetime. That is the cumulative lifetime risk for breast cancer, which is a statistically derived number that assumes all women will live to be the age of 82 and not die of something else first. Many times, women hear that number 1 in 8 and they look about the room and start counting off. 1, 2, 3…they believe that someone in that room will get breast cancer if there are more than 8 of them.

But we also need to know that if a women has no risks for breast cancer (other than that she is a woman, living in this country and getting older) her risk of getting breast cancer is only 3.3%. Unfortunately few women have no risk factors. But even if she has a risk factor the increases her risk 100%, or doubles her breast cancer risk, her risk is now only 6.6% That‟s a lot different from one in eight.

We also need to hear is that a woman’s chance of dying from breast cancer in this country is 1 in 35, or less than 3%.

So can we really hope for a cure?

Most women are unaware that it’s already happening.

Lots of women are being cured without great fanfare. You see, one is only officially cured of breast cancer when one dies of something else first, like a heart attack in old age. That’s just how statistics are done and reported. We hear about 5 and 10 year survival rates. Maybe some 10 year survivors will have a relapse of cancer. So we have to wait ’til they die of something else first before we say they were cured.

But what about women who have stage 0 breast cancer, also known as ductal carcinoma in situ or DCIS ? With a partial mastectomy and radiation, they have a 97% cure rate. With mastectomy they have a 99.9% cure rate. No chemotherapy is needed to cure them. According to the American Cancer Society, there will be 62,280 women diagnosed with in-situ breast cancer in 2009. We can expect that a minimum of 60,411 to be cured! We just can’t know who they are
until they die of something else first.

Dr. Angela Lanfranchi

What about women with Stage 1 invasive breast cancers? Those are the women with small tumors, less than ¾ of an inch, which have not spread to the lymph nodes under the arm. Those women have a 95% cure rate. Since there are many patients with Stage 1 breast cancer treated at Steeplechase, I would expect the vast majority to be cured to be with present treatment regimens.

At the Steeplechase Cancer Center where I work, 53% of all patients who are found to have cancer just because they went for a screening mammogram, (nobody thought they had cancer when they were screened), 53%, or over half, were Stage 0 and Stage 1. That’s why mammograms are so important. They give women excellent odds for a cure and no bookie would take a bet against them. Based upon data when treatment wasn’t as sophisticated and effective as it is now, the 5 year survival rate for tumors up to 2 inches and which had already spread to local lymph nodes, or Stage 2 breast cancers, is 86%. So I do believe there will be even higher cure rates in the future.

We know for sure that there is hope for prevention.

Look at what happened in 2002 after the Women’s Health Intiative Study became known to the public because it made the 6 o‟clock news. Women found out that hormone replacement therapy, Pempro, increased breast cancer risk by 26%. That summer 15 million or half of the 30 million women that were on HRT abruptly stopped. As one of my patients said, “I’d rather have hot flashes than cancer.”

Just a few years later in 2007, it was reported that there was an 11% decline in breast cancer rates in women over 50 with estrogen receptor positive cancers. After much scientific debate, those in the medical field conceded that the decline in rates was attributable to the reduction in the use of HRT. {Hormone Replacement Therapy}

Information that these hormones could cause breast cancer was in the medical literature for over 20 years. But when that knowledge was put in the hands of women who needed and considered it, many acted upon it and breast cancer rates fell.

What do you think will happen when women learn that these same hormones are in oral contraceptives but in much higher doses? Will half of the 75% of premenopausal women in the United States who take hormonal contraceptives stop these hormones like their mothers did after menopause?

What if they learn that in 2005 the UN’s World Health Organization listed oral contraceptives as Group 1 carcinogens, the same group that contains asbestos and cigarettes? I bet that they will learn about the safer methods of fertility control, especially if they have a family history of breast cancer. Breast cancer rates will fall for women less than 50 too.

Dr. Joel Brind

What if women knew that having children and breastfeeding decreased breast cancer risk substantially?

Would we wait so long to have our children if we knew that a woman who waits to have her first child at 30 has a 90% higher risk of breast cancer than the woman who has her first child at 20? I wouldn’t have waited ’til I was 41 to have my first and only child if I had known. Unplanned pregnancies could bring unplanned joy and adoption could be a better option.

It is often said by cancer organizations that 70% of women with breast cancer have no identifiable risk factors and that we should give them money to find a cure. It is simply untrue that 70% of all breast cancer patients have no identifiable risk factors. If 75% of women of reproductive age have taken oral contraceptives they are at increased risk. If 20% of the women in this country remain childless, they are at increased risk. If 50% of post menopausal women have taken hormone replacement therapy, they are at increased risk.

Let’s be more more than “aware” in Breast Cancer Awareness Month. You’d have to be deaf, dumb and blind not to be aware that breast cancer exists and is a threat to many women. It’s on the TV news and cable channels, radio, the internet, magazines, newspapers, and even the shopping channel as a patient once told me. You can‟t even go to the grocery store in October without being faced with pink ribbons on food containers to benefit one organization or another.

Let’s be proactive and not just aware. Let’s be pro active make and women aware that breast cancer is curable in many cases if not in at least half those diagnosed with screening mammograms.

We already know lots about what causes breast cancer and what can increase a woman’s risk. Breast cancer is not the fickle finger of fate randomly pointed at women. There are many other avoidable risks. We can hope and expect to reduce breast cancer rates with prevention.

And what of the hope in survivorship?

There are 2.5 million survivors of breast cancer in our country right now. Wouldn’t it be a shame if they worried everyday that their cancer might come back, waiting for the other shoe to drop or with the sword of Damocles over their head? Not able to enjoy life to the fullest? Or didn’t do the things that would reduce the risk of it coming back? They need to know that there is a wonderful survivorship programs with the Wellness Community of Central NJ which is just down the street from here. The name of one program is Transitions. It is a national Wellness Community program that helps women to overcome the challenges of survivorship. There is also a Kids Connect program that helps children to
overcome the challenges of having a parent with a cancer diagnosis.