This summer, my cousins from Nebraska came to the Northeast for a visit. I invited them to stay with us for a few days during our Berkshires vacation to catch up. One of our conversations was about personal health. I asked Cindy, a public school teacher in her sixties, when her last mammogram was. She responded, “It’s been a while, four or five years ago.”
“How come so long?” I inquired. “Just haven’t gotten around to it,” she replied. Hmm. I thought and then probed more. “Do you have a family history of breast cancer?” “Yes,” she said, “my father’s mother and sister both had breast cancer and died from it.” “So that doesn’t scare you a little?” I said. She looked like she was thinking about the question for a while before saying, “I just don’t think it’s going to happen to me.”
And there you have it. The health care community isn’t able to convince women that mammograms save lives. Sure, once you’re sick, doctors and treatments are tolerated and appointments are kept. But somehow, we just keep thinking it’s not going to happen to us—until it does.
As a breast surgeon at Montclair Breast Center, I see women who find breast lumps that turn out to be cancer, and there’s almost always a sense of shock. How could this have happened? It’s not possible. And then comes the regret and the self-blame. Why didn’t I pay more attention?
If we know one in eight women will develop breast cancer in their lifetime, why should this come as such a surprise? When my own breast cancer was found at age 50 on my annual mammogram, I wasn’t shocked. In fact, my thinking was…why not me? There are 30 women who work in our center. Statistically speaking, at least three of us will get breast cancer in our lifetime. I was treated for an early stage of breast cancer by my colleagues at Montclair Breast Center. I had a lumpectomy and took Tamoxifen for five years. It wasn’t a big deal. It hasn’t changed my life because it was caught so early with a mammogram. I still have my breasts. I haven’t had a problem since, but I could get a recurrence, so I’m diligent about getting a 3-D mammogram and MRI every year. I don’t fear breast cancer.
WHAT EXAMS DO I NEED?
In my clinical breast cancer research, I’ve found that the biggest health care improvement we can make on a public health level is to educate women that breast cancer is a real possibility that can happen to them, and science can help. I’ve corroborated what health care science has already proven: Mammograms save lives.
I gave my cousin the right advice: Get a digital 3-D mammogram. Try and find a facility that specializes in breast care. You should ask if you have dense breast tissue, and request an ultrasound exam if you do. You should strongly consider genetic testing to see if you carry a mutated gene (like the BRCA gene) that’d put you at an even higher risk for breast cancer, because you can inherit that from your father.
I recommended that she get to know her breasts well. Call it a self-breast exam, although I prefer to call it a daily breast massage for wellness. And every year, you should get another mammogram and ultrasound. It’s well worth your time.
DON’T SKIP YOUR ANNUAL
The American Society of Breast Surgeons recommends women over age 25 undergo a formal risk assessment for breast cancer with a specialist, who’ll consider your personal risk factors (including family history, BMI and age at first pregnancy) and give you a personal risk score. The average woman has a 12 percent lifetime risk of breast cancer. If you are 20 percent or higher, we consider that high risk. Many women are high risk without realizing it or understanding that they could benefit from a different screening plan.
High risk women should undergo yearly screening mammography and be offered yearly supplemental imaging (ultrasound or MRI) initiated at a risk-based age. An MRI is the most sensitive test available and one that we use frequently. Studies have proven that women who have yearly breast exams (mammogram, ultrasound) have smaller breast cancers, receive less treatment and have higher survival rates. This was certainly true in my case and in all of our patients with screen-detected breast cancers.
I don’t want to send any more women for chemotherapy. Chemotherapy is something that can and should be avoided. With decades of Breast Cancer Awareness Month and pink ribbons, we haven’t gotten very far. Awareness doesn’t seem to be helping.
We need to convince women that health care science can prevent them from having to go through toxic treatments. We need more action. Let’s rename October Breast Cancer Action Month—because it can happen to you.
—Dr. Nancy Elliott is a breast surgery specialist at Montclair Breast Center.
