You may have heard the saying a good defense is the best offense. This strategy is based upon the idea that a strong defense will distract or block the opposition and ultimately hinder its ability to mount an attack. It creates a strategic advantage that can ultimately lead to victory. Where this strategy can have a great impact is in conjunction with our own health. I learned this last year firsthand, when I was diagnosed with and won my battle against breast cancer at the age of 30.
According to the American Cancer Society, the prognosis of breast cancer is strongly influenced by the stage of the disease when it is first diagnosed. The earlier cancer is found, the more likely the cancer will be eliminated and, in some cases, the less invasive and disruptive treatment may be. The National Cancer Institute's SEER Database cites a 100% five-year relative survival rate for breast cancer detected at Stage 0 and Stage 1 and a 93% five-year relative survival rate for breast cancer diagnosed at Stage 2. The statistics don't lie. Early detection saves lives.
In a society where the healthcare industry is laden with roadblocks and red tape, and where industry age guidelines for breast cancer screenings are inconsistent, how does someone protect themselves against a disease that 1 in 8 women will develop in their lifetime? The answer is simple: Arm yourself with knowledge and create an appropriate battle-plan with your healthcare professionals in defense against breast cancer.
The first question is when should one begin screening for breast cancer? As the child of a mother who was diagnosed with and passed away from breast cancer before the age of 35, I knew firsthand from an early age that I had to be proactive to protect myself against the disease. According to the American Cancer Society, women should begin self-breast exams in their early twenties to become familiar with how their breasts normally look and feel. If any abnormalities are detected, or if a change occurs, it should be examined by a doctor or nurse immediately.
While some argue that self-breast exams do little for diagnosis and cause stress to women who may feel they are performing self-exams incorrectly, research has shown that self-breast exams still play a role in detecting breast cancer. Self-exams should not be discouraged, even though the likelihood of finding a lump is small. More importantly, self-exams bring lifelong breast awareness to young women who are not yet of age for mammography, as it introduces a monthly regimen that can be performed at any age. Clinical breast exams by a healthcare professional are also recommended as part of a regular screening regimen for women in their twenties and thirties.
Beyond self and clinical breast exams, there are inconsistent guidelines regarding the appropriate age to begin mammography screening, which creates a cloud of confusion for women. The American Cancer Society and the National Comprehensive Cancer Network recommend annual mammograms beginning at age 40. The US Preventative Services Taskforce (USPST) recommends beginning screening at the late age of 50. Recent studies have shown that women diagnosed with breast cancer in their 40s require less intense treatment and their cancers recur less often if cancer was first detected in routine mammogram screening. This is due to detection at earlier stages, before a tumor becomes large enough to feel. With statistics like this, a 10-year delay in screening and detection has the potential to drastically weaken a defensive strategy against the disease, as cancer may be detected at a more developed stage if relying upon the USPST recommended age of 50. Further, the USPST guideline has been heavily criticized for not taking various studies into account that prove that there is a 30% reduction in mortality for women who get routine mammograms earlier in their 40s.
What should be the protocol regarding screening for high-risk women? While only 11% of breast cancer cases are diagnosed in women under the age of 45, the five-year survival rate is lower among women diagnosed with breast cancer before the age of 40. This is possibly due to the development of more aggressive tumors, which are less responsive to treatment. This fact underscores the need for all women, both young and old, to be aware of their bodies and screen regularly and appropriately for their risk level. While there are varying viewpoints on screening for at-risk women, Memorial Sloan Kettering Cancer Center recommends annual mammography screenings starting 10 years prior to the earliest diagnosis in the family (not earlier than 25, but not later than 40).
Additionally, MRI screening is recommended for women with an elevated risk of developing breast cancer. While this screening technique is more sensitive to abnormalities, MRI's are recommended in conjunction with mammography, as MRI's may miss some cancers that mammograms detect. While there is limited information with regard to the best age at which to start this secondary screening, the decision remains with patients and their healthcare providers, though many insurance companies do not begin coverage of such testing until age 30.
Finally, the greatest and most important weapon in the battle against breast cancer is knowledge of family history of the disease. Compared to those without a family history, the risk of developing breast cancer is 1.8 times higher for those with one first degree relative (mother, sister, father or brother) who has been diagnosed with the disease. The risk is nearly 3 times higher for those with two relatives diagnosed, and nearly four times higher for those with three or more relatives diagnosed with breast cancer. The risk is greater when the affected relative was diagnosed at an early age. It is important to note, however, that although most women with a first degree relative will not develop breast cancer, it is still important to be vigilant and be aware of the increased risks.
In tandem with understanding family history, genetic testing of the BRCA 1, BRCA 2 and PALB2 genes have now taken us further in understanding increased risks. With knowledge of a mutation and increased risk of the disease, women (and men) can add one more weapon to their arsenal to create a strategy for defending themselves against the disease. While it is important to understand genetic risk factors, it is also important not to rely solely on genetic factors, i.e., if genetic testing comes back negative, but there is still a family history. There are many genetic mutations that are not regularly tested. Additionally, it is estimated that only 5% to 10% of breast cancer cases result from inherited mutations. In short, while having knowledge of genetic factors is important, it is not definitive of a diagnosis. This is why vigilance and early detection continues to be the key regardless of increased risk due to known genetic factors.
Self-exams, mammograms, MRI's, family history and genetic testing, collectively, are detection methods that are highly effective weapons in the arsenal against breast cancer. When a strategy is created with a healthcare professional based upon individual risks, the likelihood of defeating the disease increases exponentially.
Know your risks. Know your battle plan. Waive the pink flag high, and be proud to know you've taken all defensive steps necessary in your fight against breast cancer. Early detection saves lives, and remember, a good defense is the best offense.