While in the university, a student in a higher level had set up a foundation called the Pink Pearl Foundation, and one year had organised a programme to raise awareness about breast cancer on campus.
Even though she had brought in experts, who talked about breast cancer, how to perform self-examinations, and the first thing to do if you notice a lump in either of your breasts, students like me had been more interested in the razzmatazz of the day; free food, the fashion competition on who would come up with the most ingenious combination of pink (which was the colour for the day) and of course, pictures. Life was so simple back then.
That was my first introduction into the world of breast cancer. I was in my first year. It took years and several news of pink this and pink that, for it to sink that the event put together by the student wasn’t just a social gathering, or that she did it just because. It was an issue that had been killing women for decades, and is still decimating a large number of women in the world; leaving motherless children, wifeless husbands and plenty women in pain and fear on its trail. Breast cancer is endemic!
October is the month set aside globally to beam the searchlight on all aspects of breast cancer, research into developing medications that would work in treating it, new developments in new strands of the cancer genes. Coping mechanisms and, most important of all, how to prevent it and if that is not possible, then how to diagnose it early.
As it has become traditional with raising awareness, there are always new things to be learnt about breast cancer; they might seem small but they can make the difference between life and death. Five of them are listed below:
There is no effective breast cancer screening tool for women under 40
This is disheartening for women of reproductive age, most of whom have dense breast tissue that prevents routine mammograms from being a useful screening tool, according to experts. Mind you, mammograms do pick up the lumps but the density of the breast tissues doesn’t allow it do a thorough job.
According to a research, nearly 80% of young women diagnosed with breast cancer find their breast abnormality themselves. We can only say, thank God for small mercies and awareness of self-examination.
Breast cancer isn’t just one disease
“Breast cancer is, in fact, many diseases,” Dr. Laura Esserman, who leads the Athena Breast Health Network said. “Some can be indolent (unlikely to cause patients harm) and some can be very aggressive. We don’t want to treat them the same. Two people might walk into my office, both age 50, have the same size tumour, but it might be appropriate to have different treatments. A patient may have a condition that doesn’t make radiation possible. You have to make sure patients understand all of their options and are comfortable with their decisions, because there’s more than one choice.”
Not everyone needs the same approach to screening
Still with Dr. Esserman, the annual mammogram recommendation is based on 30-year-old evidence. According to her, “It’s high time to have a modern trial where we try to figure out who is at risk for different types of breast cancer. That’s what the WISDOM study is all about: Set up a framework where we can learn much more quickly. We are going to test what many people still consider to be the gold standard: one mammogram a year for women 40 and over.”
“We’re working with a next-generation sequencing company. We’re trying to define from the genetics side what influences risk and then we’re going to test it to see if it improves screening. We’ll integrate the data on a Salesforce platform. We’re going to generate a risk for women and that will trigger when to start screening, when to stop screening and how often to screen. Over time we’ll learn who is at risk for breast cancer and who is at risk for different interventions. If this works, this could be a good paradigm to approach any disease.”
A personalized approach to treatment due to more treatment options
Even though personalised screening is being thought of, there are more treatments for breast cancer than ever before.
Personalized medicine and targeted therapies are resulting in more long-term survivors. Though 80 percent of women diagnosed today are candidates for lumpectomy surgery, many are choosing to have a mastectomy and even bilateral mastectomies, however having a more invasive surgery doesn’t result necessarily in a higher survival rate.
Breast reconstruction is more sophisticated than ever. Implants are still an option but transferring body fat from one location (tummy, buttocks, inner thigh) has become a popular choice for survivors.
Though the vast majority of women diagnosed today will become long-term survivors, there continue to be about 39,000 women (that’s huge), who succumb to this disease annually.
These individuals dealing with stage 4 breast cancer report feeling isolated and misunderstood. Society assumes that they have neglected their health, resulting in breast cancer spreading to other organs within their body, which is rarely the case.
More cancer causing genes identified
There are more genes that have been identified in the last few years that are linked to causing breast cancer. There are also sophisticated pathology tests done by specialty labs that can provide more information about one’s breast cancer, what treatments are most appropriate to receive and who is most likely to have a recurrence. Such information can be really helpful in determining the treatment plan.
Due to a growing shortage of oncology specialists, especially in our clime, it is no longer rational to be followed by an oncologist in the long term. At some point after completion of acute treatment, the breast cancer survivor is transitioned back into the arms of her regular doctor, hopefully a gynaecologist, who should remain aware and involved in her care while she is receiving her treatment.
Meanwhile, the onus rests squarely on the survivor; she needs to be on top of her schedule so that she knows when she is due for an exam, a cancer screening of any kind, living a healthy lifestyle to reduce risk of re-occurrence and risk of another new cancer of a different kind.
Girls are reaching puberty earlier nowadays; sometimes starting at age 8. What does early puberty mean for breast cancer risk?
Initiation of puberty is related to a young woman attaining a specific height and weight. Presumably, the body knows when it is capable of childbearing and thus puberty begins. Populations in the world with greater health and nutrition during childhood will decrease the age at which their girls start puberty.
Reaching puberty earlier increases the amount of estrogen and progesterone a young woman receives in her lifetime, so earlier puberty increases her risk of developing breast cancer.
Lastly, cancer survivorship doesn’t start at the end of treatment; it starts at the moment of diagnosis. Therefore, early diagnosis becomes imperative if a woman is to live her life and still have whatever treatment she needed.
As someone said, no one should sacrifice their future goals to this disease if they don’t have to. For some women, that might mean fertility preservation before chemotherapy for women hoping to start or expand their family in the future, cancer rehabilitation to prevent fatigue and other side effects, and creating a flexible work schedule with a treatment plan to enable her career to remain on track.
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