Breast cancer: stay proactive to reduce risk
By Alvaro Carrascal, MD, MPH, Vice President, Health Systems, American Cancer Society
Confusion about breast cancer abounds. But the truth is, we know a great deal about how to reduce risk, how to screen effectively, and how to treat it successfully. Thanks in part to American Cancer Society-funded research and education, breast cancer death rates have declined 39 percent in the last two decades. And when breast cancers are detected at Stage 0 or Stage 1, the 5-year relative survival rate approaches 100 percent.
Factors that influence cancer risk
There are certain breast cancer risk factors over which we have little control, including being a woman, getting older, menstrual history, and family history of breast cancer. Having a mother, sister, or daughter with breast cancer almost doubles a woman’s risk. Having two first-degree relatives increases risk about three-fold. However, less than 15 percent of women with breast cancer have a family member with this disease. And only about 5-10 percent of all breast cancers are the result of genetic mutations, such as BRCA1 and BRCA2. The American Cancer Society is currently conducting the largest cancer prevention study of its kind–Cancer Prevention Study 3–examining environmental, lifestyle, and genetic factors that affect cancer risk. Although the direct cause of most breast cancers is not yet known, we do know how to manage lifestyle factors that increase risk.
Limit the wine
Drinking alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who have one alcoholic drink a day have a very small increase in risk. Those who have two to five drinks daily have about 1½ times the risk of women who don’t drink alcohol. The American Cancer Society recommends that women have no more than one alcoholic drink a day. A drink is 12 ounces of regular beer, five ounces of wine, or 1.5 ounces of 80-proof distilled spirits.
Watch your weight
Being overweight or obese after menopause increases breast cancer risk. Before menopause, your ovaries make most of your estrogen, and fat tissue makes only a small amount. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can raise estrogen levels and increase your chance of getting breast cancer. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have been linked to some cancers, including breast cancer. Still, the link between weight and breast cancer risk is complex. For instance, risk appears to be increased for women who gained weight as an adult, but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this. The American Cancer Society recommends staying at a weight throughout your life by balancing your food intake with physical activity and avoiding excessive weight gain.
Evidence is growing that physical activity in the form of exercise reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women’s Health Initiative, as little as 1¼ to 2½ hours per week of brisk walking reduced a woman’s risk by 18%. Walking ten hours a week reduced the risk a little more. To reduce your risk of breast cancer, the American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week. Examples of moderate intensity activities are brisk walking, easy bicycling, or heavy cleaning. Examples of vigorous activities include basketball, jogging, or tennis singles.
Avoid tobacco smoke
For a long time, studies showed no link between cigarette smoking and breast cancer. But in recent years, more studies have shown that heavy smoking over a long-time is linked to a higher risk of breast cancer. In some studies, the risk was highest in certain groups, such as women who started smoking before they had their first child. The 2014 US Surgeon General’s report on smoking concluded that there is “suggestive but not sufficient” evidence that smoking increases the risk of breast cancer. Researchers are also looking at whether secondhand smoke increases the risk of breast cancer. Both mainstream and secondhand smoke contain chemicals that, in high concentrations, cause breast cancer in rodents. Studies have shown that chemicals in tobacco smoke reach breast tissue and are found in breast milk of rodents.
Bust the myths
Contrary to internet legends, the use of antiperspirants, wearing bras, use of vitamins, or having a spontaneous or induced abortion have not been linked to breast cancer risk. In 2015, the American Cancer Society strongly affirmed the use of mammography as a screening tool. Overall, about 78 percent of New York women aged 50-74 had a mammogram in the last two years, but disparities still remain. For example, less than 52 percent of uninsured women had a mammogram in the past two years. Screening programs, such as the New York State Cancer Services Program, provide free mammograms to uninsured and underinsured women. For women at average risk for breast cancer, the American Cancer Society recommends:
• Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so. The risks of screening, as well as the potential benefits, should be considered.
• Women age 45 to 54 should get mammograms every year.
• Women age 55 and older should switch to mammograms every 2 years or have the choice to continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
• All women should be familiar with the known benefits, limitations, and potential harms associated with breast cancer screening. They should also be familiar with how their breasts normally look and feel and report any changes to a health care provider right away. Women at higher risk of breast cancer–those with personal or family history of breast cancer, a genetic mutation known to increase risk of breast cancer (such as BRCA), and women who had radiation therapy to the chest before the age of 30–should refer to the Society’s guidelines for higher risk women at www.cancer.org and consult with their health care provider. With earlier detection, less invasive surgery, and improved targeted treatments, science has made great progress in saving more lives from breast cancer. But the most important advocates in the fight against breast cancer are women themselves. Stay proactive. Get screened. Stay healthy.
Oral cancer: screenings are critical
By Beth Krueger
When health care professionals tell you to say “ahhh” and look into your mouth, they are looking into the portal of your health and what they are seeing can say much about your well-being. One of those screenings is for oral cancer. It’s critical. Just consider the numbers.
48,250. That’s the number of people in the United States expected to be diagnosed with oral cancer this year or 132 each day. It is more than twice as common in men as in women. There will be more than 9,575 deaths, about one person every hour of every day. Oral cancer occurs in the mouth, in the very back of the mouth known as the oropharynx, and on the exterior lip of the mouth. Oral cancer is the largest group of those cancers in the head and neck cancer category, including mouth, tongue, tonsil, and throat cancer. And the number of cases has been increasing in the past 10 years.
The American Cancer Society explains that oral cancer starts in the mouth and oropharyngeal cancer starts in the oropharynx, part of the throat just behind the mouth. Tumors (abnormal growth cells) in these areas include benign or non-cancerous growths that do not invade other tissues and do not spread to other parts of the body; harmless growths (pre-cancerous conditions) that can later develop into cancer; and cancerous tumors that can grow into surrounding tissues and spread to other parts of the body.
The Oral Cancer Foundation points out that most people develop oral cancer through two pathways – (1) use of tobacco and alcohol and (2) exposure to the HPV-16 virus (human papilloma virus version 16), which is responsible for the vast majority of cervical cancers in women. There is no identifiable cause in less than seven percent, with thoughts that some genetic predisposition is involved in these cases.
When found at early stages of development, oral cancers have an 80 to 90 % survival rate, but the most are found as late stage cancers. That is a major factor in the high death rate of about 43% at five years from diagnosis for all stages. Often, oral cancer is only discovered when the cancer has metastasized or spread to another location, most likely the lymph nodes of the neck. In metastasis, at these later stages, the primary tumor has had time to invade deep into local structures. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized oral area.
Screenings at your dental appointment can improve chances that any suspicious changes in your oral health will be caught early, at a time when cancer can be treated more easily, the American Dental Association advises. The screening will include taking your health history and examining signs of mouth and/or throat cancer, with a visual inspection of the mouth and palpation of the jaw and neck. Some doctors or dentists use lights or dyes. The process is not invasive or painful.
At home, you should watch for possible symptoms Some symptoms may include: a sore or irritation that doesn’t go away; red or white patches; pain, tenderness or numbness in mouth or lips; a lump, thickening, rough spot, crust or small eroded area; difficulty chewing, swallowing, speaking or moving your tongue or jaw; and a change in the way your teeth fit together when you close your mouth.
The Oral Cancer Foundation explains that oral cancer is particularly dangerous because in its early stages it may not be noticed by patients, as it can frequently develop without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. HPV-positive oropharyngeal cancers may occur in the throat at the base of the tongue and near or on the tonsils making them difficult to detect. Patients who survive a first encounter with the disease have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for 5 to 10 years after the first occurrence.
Multidisciplinary approach to treatment
According to the Oral Cancer Foundation, treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. Treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed cases where the disease has spread to distant locations. The Foundation adds that when cancer is found at a later stage, the results of surgical removal of the disease may require reconstruction of portions of their oral cavity or facial features. Therapy may be needed to assist in speech, chewing foods, the problems associated with the lack of salivary function, as well as the fabrication of dental or facial prostheses.
The foundation website includes a support forum for patients family and caregivers to raise questions and discuss experiences.
Resources American Cancer Society – www.cancer.org American Dental Association – www.mouthhealthy.org Oral Cancer Foundation – www.oralcancer.org Centers for Disease Control and Prevention – www.cdc.gov National Cancer Institute – www.cancer.gov National Institutes of Health – www.cancer.gov CancerCare – Resources & support information – www.cancercare.org
Melanoma of nail: misdiagnosed and often fatal
By Vikki Moran
Melanoma of the nail usually affects either a thumb nail or great toenail but any finger or toenail may be involved. It is usually a variant of acral lentiginous melanoma (melanoma arising on the palms of the hands and soles of the feet). Other types of melanoma that rarely arise under the nails are nodular melanoma and desmoplastic melanoma. New York-based nail specialist Dr. Dana Stern is at the forefront of warning of this potentially deadly nail cancer – not technically the nail itself, but malignant melanoma of the nail bed, the skin under the nail.
People will sometimes develop an early melanoma and think it’s an injury. They don’t even realize they’re supposed to go to their dermatologist. In my case, I went to medical professional after medical professional and was told it was not anything to worry about—“probably an injury or pigment issue.” I was advised to “just wear darker nail polish” if how it looked look bothered me. That is how my personal saga started and in the 2012 March issue, I wrote about it in real time. I chose to share my story here because this cancer is so very hard for most to catch or even imagine. My cancer was on my big toe. The thumb, big toe, and index finger nail are the most common nails to be affected.
Some of the warning signs include:
•A stripe that is very dark on your digit
• If there are blurred borders
• If there are changes in a stripe that’s been there Treatment depends on the stage of cancer, ranging from removing the melanoma and tissue around it, to amputation of the digit.
I still use a band-aid to hide my surgery, but I am proud and grateful to be a survivor of this disease that claimed many lives, including my new soul mate, reggae legend Bob Marley. My band-aids over the past three years make their own style statement. With a little help from my grandchildren, I have pickle cuties, Barbie, camo, and of course, designer varieties.
Nail cancer is more common in African-Americans, but I am not African American and everyone can be at risk. While most discolored nails or nail stripes are not cancer, it is something that you should have checked out by a dermatologist because, like most cancers, early detection and treatment increases your chances for a cure. The medical profession and the public needs to be as aware of this melanoma variety as any other cancer that is regularly screened. We need to seek out answers when we see dark lines on our nails or anything else that looks suspicious. No one knows your body like you do. Scream on the highest roof tops for answers until you are satisfied with why you have this nail discoloration.
Help increase awareness
Today, three and a half years later, I am cancer free and very grateful and happy publishing this marvelous magazine each month. I still take every opportunity I can to educate people and, frankly, would love to see other media forms do the same. This is the time of year when we are out in the sun and as uncovered as we will be any time of year. Protect with sunscreen. Even if this melanoma form may not have anything to do with sun exposure other melanoma forms are affected and even caused by sun exposure.
Please check the 2012 article out on our website, www.crlmag.com, and share with others. Since the article appeared, we have received hundreds of calls and emails. We have helped many through this piece. Some turned out not to be melanoma but, sadly, as many were. Even more sadly, a few did not have the happy ending that I have had.
Help me to spread this word. I am grateful for my health beyond the written and spoken word but I am committed to spreading it. As I mentioned in my original story, please feel free to contact me personally with questions. While I am not a medical professional, I can support you and assist you with finding the right professionals.