Lori Rancik,RN BSN
Case Manager, The Women’s Health Center of Penn Highlands Healthcare
During the month of October, pink ribbons adorn store fronts, grocery items, specialty shops and sporting events all in the effort to raise awareness to the battle against breast cancer.
The effort has gained tremendous support. It serves as not only as a reminder to women on the importance of screening, but also, the pink ribbon demonstrates the reality of the impact on lives when breast cancer (or any cancer) is discovered.
While strides have been made on lessening the deaths from breast cancer, in these strides, new questions have surfaced. In recent years, there has been controversy in the recommended screening schedule for women to receive mammograms, advanced technologies in mammography have been discovered, genetic risk factors and testing are now available and many are living as breast cancer survivors.
In all of this, it becomes necessary to learn and know the facts surrounding breast cancer, so that the best decisions are made with consideration to personal risk and choice.
Breast cancer remains the most common type of cancer affecting women, regardless of their race or ethnicity. According to the CDC, the most recent statistics available from 2013 state that 230,815 women and 2,109 men in the United States were diagnosed with breast cancer.
Additionally, 40,860 women and 464 men in the United States died from breast cancer in that year. The trend in incidence of breast cancer has remained fairly stable. And, across all races and ethnicities, the mortality rate has decreased significantly by 1.9 percent in women overall.
In a recent article published in Cancer, “The past, present, and future of cancer incidence in the United States: 1975 through 2020,” it is concluded that while the cancer incidence rates/risk will stabilize for the majority of the population, the number of cancer cases are expected to increase by greater than 20 percent.
With this being said, a greater emphasis on primary prevention and early detection will be needed to counter the effect of an aging and growing population on the burden of cancer.
What then, are the current recommendations for screening mammography, clinical breast exam and self-breast awareness? This is where there are conflicting reports and women may be confused in what they should be doing for early detection and screening.
In recent years, updates to recommendations have been made in leading organizations such as the U.S. Preventive Services Task Force (USPSTF), The American Cancer Society(ACS), American College of Obstetricians and Gynecologists (ACOG) and the American College of Radiology (ACR).
Consideration to the age to start screening and the frequency of screening is taken given that every woman is having a discussion with her health care provider to determine if she is at average risk or higher than average risk for developing breast cancer.
While some organizations have changed their guidelines to begin mammography at later ages and screen every two years, local hospital systems such as Penn Highland Healthcare, continue to follow the guidelines released by the ACR and recommend screening with mammography annually in all women beginning at the age of 40.
The advances in breast imaging have led to greater accuracy in pinpointing breast abnormalities and thus, increase in early detection of disease. Mammography is a low-dose x-ray of the breast.
The technology has moved from traditional imaging with film to digital mammography with electronically stored images to breast tomosynthesis also called 3-D mammography.
Three-D mammography was introduced in 2011 and is an advanced form of breast imaging where multiple images of the breast are obtained as “slices” from different angles.
Breast centers across the state are beginning to introduce 3-D mammography to their departments to advance breast cancer diagnosis. Three-D mammography is currently available at Penn Highlands DuBois and will be coming soon to other Penn Highlands locations.
In addition to mammography, breast imaging may also be required for follow-up to abnormal findings through breast ultrasound or breast MRI. Breast density, which is common and not considered abnormal, is one factor that often negates these studies.
In 2014, a new law in Pennsylvania was passed requiring breast density to be noted on mammography reports. Breast density notes the amount of fibrous, glandular and or fat tissue in breast that may affect the imaging and hide underlying tumors.
In this four-level scale, radiologists classify breast density and make recommendations for the need for additional imaging. The amount of breast density is an additional factor to consider when discussing personal risk for breast cancer.
Shifting the attention to risk, there is ongoing research and increasing attention on genetic factors surrounding cancer. According to ACS, about 5 – 10 percent of breast cancer cases are thought to be hereditary. The two most common causes of inherited breast cancer can be traced to the BRCA1 and BRCA2 genes.
Patients who would benefit from genetic testing are those with a personal or family history of breast cancer (especially younger than 50), personal or family history of bilateral breast cancer and personal or family history of ovarian cancer.
While knowing if one has genetic predisposition does not prevent cancer, it does determine appropriate surveillance or risk reducing strategies, aid in the surgical and medical plan of care when cancer is diagnosed and provide information that is important for other family members.
When considering genetic testing, there are resources available to provide counseling both pre and post testing to help in making the decision of what test is necessary determining insurance support and henceforth, what treatment plan should be made.
In addition to screening through mammogram and genetic testing, women are encouraged to continue to receive clinical breast exams from their health care providers.
Subsequently, personal self-breast awareness is also an important component in breast health and early detection of cancer. Checking one’s breast frequently for lumps and changes along with visually inspecting the breast in front of a mirror can find abnormalities that may not have been present during annual screenings.
Finally, because of the efforts in early detection, advances in care and treatment, many are living as breast cancer survivors. In this, a person with a cancer diagnosis may have a health care team that extends beyond their primary care, surgeon and oncologist.
Integrated cancer care, navigation and survivorship are growing terms in this arena as patients move from diagnosis and treatment to life as a cancer survivor. A cancer diagnosis often opens the door to a rather complex and overwhelming health situation.
Knowing that healthcare is aware of the impact, having a trained navigator to see one through the journey is reassuring. Furthermore, it is also important to understand the impact of cancer treatment on other body systems, such as the heart and bones. Patient education on these matters will be vital to maintain optimal health as a survivor.
In October, the pink ribbon stands alone in its message to breast cancer. However, throughout the year, it is the hope that all other cancer color ribbons can be recognized as research continues to uncover the myths and secrets of cancer and more and more patients can live as cancer survivors.
The Women’s Health Task Force is a small group volunteering their time to educate women and families on important health issues. If you have an interest in health, work in a caring profession, or just want to volunteer with other sincere individuals, consider attending our planning meetings.
These meetings are held the first Thursday of the month beginning at 12 p.m. The next meeting will be held on Thursday, Oct. 6 at the Clearfield County Career & Technology Center, 1620 River Rd., Clearfield, PA 16830.
Additional information is available by calling Robin Kuleck, Penn State Extension, at 814-765-7878, Ext.2. Find the group on Facebook at www.facebook.com/whtfclearfieldcounty.