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October 2007 | MH
Survival skills One hygienist offers her experience as a lesson in understanding the risks and the research behind breast cancer.
As a professor of dental hygiene, I have been speaking about cancer patients for 18 years. However, until my mammographer said “the biopsy came back positive,” I didn’t know what it was to be a special needs patient. I was so sure that the biopsy was going to be negative that I forgot to call the doctor’s office to get the results. After all, I was busy! When I finally got around to calling, they informed me that I had invasive ductal carcinoma (IDC), found at an early stage and still very treatable. I had to make a myriad of decisions in a short amount of time, which, to this day, remains the most stressful part of having breast cancer.
Being a college professor, I was accustomed to finding information and I immediately went to work researching breast cancer. I found many great sources that helped me to sort out all the medical options. Fortunately, I also had a friend in cancer research who informed me of diagnosis and treatment options that aren’t available on a widespread basis. What I was shocked to find out was that despite all the pink ribbons and being “aware” of breast cancer, there was so much I didn’t know. No history, no problem? You may be aware of some of the risk factors for breast cancer, but one question I was asked over and over again was, “Is it in your family history?” I learned that only five to 10% of all breast cancers have genetic factors—such as the BRCA 1 or BRCA 2 mutations—so the answer for myself and most women is no. This may change, as current research is focusing on identifying other genetic mutations such as fibroblast growth factor receptor 2(FGFR2), which may be more prevalent. What all women should know is, outside of being female, age is the biggest risk factor; 76% of women who develop breast cancer had no other known risk factors. For women at average risk for breast cancer, the chances of developing the disease at age 20 is one in 1,773; by age 70 it is one in 20. finding it early There are several things you can do to optimize your chances of detecting breast cancer while it is still small and treatable. Breast self exams (BSE) are recommended once a month—the week following your menstrual period if you are 20 or older. A clinical breast exam (CBE) is recommended at least every three yeras for women between 20 and 39. After age 40, women should have a CBE and mammogram every year. For women with risk factors, including a close family member with the disease, annual mammograms should begin 10 years earlier than the age at which the relative was diagnosed. Younger women have denser breasts that show up very opaque on a mammogram; this makes it difficult to see pathology.2,3 Digital mammograms and breast MRIs are more effective on dense breasts (for more on breast cancer, check out this month's web exclusive, Personal Standards). If your mammographer sees something concerning, an ultrasound is an excellent, non-invasive way to evaluate breast abnormalities detected by mammography. If a suspicious mass is visible on ultrasound, an ultrasound guided biopsy may be performed; there are several other methods for obtaining tissue for biopsy. Biopsies also may be guided with an MRI, stereotactic (x-ray guided), or a wire may be placed as a guide.
after the diagnosis You’ve just been diagnosed with breast cancer. Where do you go from there? Research every line of your pathology report so you have as much information as possible before treatment starts. A positive biopsy in one breast may qualify you for a breast MRI on both breasts, according to the latest American Cancer Society guidelines. This can aid in adequate treatment planning and surgical planning for breast cancer. An MRI takes advantage of the electromagnetic qualities of the body’s cells. During a breast MRI, a dye is injected that is picked up most rapidly by lesions like cancerous tumors that have many blood vessels. These lesions can be seen on the 3-D picture of the breast produced through MRI. MRI’s are more expensive than mammograms and, because they show so much detail, give more false positives that need to be biopsied. It does give you better information about the size and location of tumors, which is helpful in staging the tumors and surgical planning. It may help you to decide whether you want to get a plastic surgeon on your team for reconstruction options. The Women’s Health and Cancer Rights Act of 1998 mandates that reconstruction options must be covered for breast cancer patients. Get all the information possible so you can evaluate all the options open to you. Being an informed patient won’t necessarily stall the storm of breast cancer, but it will help you weather that storm better. Janella Spencer, RDH, MSEd, is a professor at Bluegrass Community and Technical College, Lexington, Ky., and has been 2nd year coordinator since 1988. She earned her bachelor’s and master’s degree from the University of Kentucky and also obtained a graduate certificate in gerontology.
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