Think Pink: Breast Cancer Prevention, Detection and Treatment

Women and their doctors are much better informed about breast cancer than their grandmothers and their doctors two generations ago. The medical community knows more about prevention and detection. Treatment options are better too. Here’s what you need to know.

Preventing breast cancer starts well before a young girl even needs a bra. Exposure to chest radiation as a child increases the risk of breast cancer, says Dr. Jo Anne Guzman-Lee of Amelia Medical Associates in Norfolk.
“If you don’t need the X-ray, don’t do it,” Guzman-Lee says.
Starting your period before age 12 increases your risk of breast cancer later in life, Guzman-Lee says. So what can you do about that? Girls who are overweight are more likely to enter puberty earlier—so keeping your daughter active and at a healthy weight will help decrease her risk of breast cancer later in life.

In fact, maintaining a healthy weight throughout your life reduces the risk of breast cancer, Guzman-Lee says. “Being obese increases the risk because there’s more circulated estrogen in your body,” she says.

Finally, drinking alcohol increases the risk of breast cancer. “Alcohol in moderation is fine,” Guzman-Lee says. “But if you have a family history of breast cancer, you shouldn’t be drinking alcohol.”

Many of us don’t do a monthly breast exam—admit it—you squirm a bit when your ob-gyn asks you that question. The new mantra is breast awareness. “It’s not so formal as checking every month,” says Dr. Abby Anderson of The Center for Women’s Health, with offices in Newport News and Hampton. “We want women to make sure of changes. Make sure their breasts are still symmetrical. Check that there’s no discharge, no nodules. Women are still finding their own breast cancers.”

As for mammograms, Anderson is among many physicians who disagree with the U.S. Preventive Services Task Force recommendation in 2009 that women age 40 to 49 can skip a year between mammograms and wait until age 50 to get an annual mammogram. “That recommendation has not flown at all,” Anderson says. “Everyone else, including the American College of Ob-Gyns (ACOG) has come out against it. If women age 40 to 50 do get breast cancer, it tends to grow faster than in older women. You don’t want to lose that extra year.”

You’ll likely have a digital mammogram as opposed to the old X-ray mammogram, Anderson says, because the digital scans are easier to store and easier to magnify. If your mammogram is abnormal, you’ll come back for a diagnostic mammogram and ultrasound, focusing on the area that was not normal, Anderson says. If a cyst or mass is found, the radiologist often can do the biopsy, she says.

Women who have a family history of breast cancer or are known to have the so-called breast cancer genes may (in addition to mammograms) get an MRI, which can detect breast cancers earlier, Anderson says.

If you do have breast cancer, your treatment options are much improved from 20 or 30 years ago, says medical oncologist Dr. Thomas Alberico of Virginia Oncology Associates/U.S. Oncology in Norfolk. “Each treatment is much more tailored than they were 20 or 30 years ago,” Alberico says. Thirty years ago, mastectomy was the standard of care and lumpectomy was just being established, Alberico says, “Now we have dramatically different approaches.”

About 20 years ago, a study found that lumpectomy paired with radiation led to a better survival rate than modified radical mastectomy, Alberico says. But now, the pendulum has swung back to mastectomy with reconstructive surgery based on worries about the side effects of radiation and improvements in reconstructive surgery, he says.

As you begin treatment, you’re probably concerned about side effects. Will you have to take a leave from your job? Can you still take care of your family? Chemotherapy is no picnic but it’s not as rough as it was for your mother’s and grandmother’s generation. In the past, patients often had to be hospitalized for a couple of days for chemotherapy, Alberico says. That’s not necessary today. New drugs do a better job of controlling nausea and vomiting, Alberico says.

Chemotherapy also is tailored based on whether the cancer has estrogen receptors, whether the cancer is in the lymph nodes and how large the tumors are, Alberico says.

Chemotherapy will take about four hours per treatment, depending on the drug used, says medical oncologist Dr. Sowjanya Nagabhirava of Delta Oncology Associates in Chesapeake. About two days later, you’ll feel tired and that tiredness will last about a week, Nagabhirava says. You’ll bounce back ... until time for the next dose.

Chemotherapy also can affect your blood count and you’ll be monitored to make sure you don’t become anemic, she says. Most people undergoing chemotherapy can continue to work and some even maintain nearly full-time hours, just taking days off for treatment, Nagabhirava says.

Radiation treatments take only about 15 minutes. About two weeks after starting radiation, you’ll feel tired. Your skin may feel burned—but there are ointments and creams you can apply, she says. Some patients continue to work throughout radiation treatment, but you may need to build some rest into your day, she says.

With a lumpectomy, you’ll need at least a week to 10 days for your skin to heal, Nagabhirava says, and a couple of weeks to regain full hand and shoulder motion. If you have complications or infection, it could take longer, she says.

Recovery after a mastectomy might range from two to four weeks, depending on how extensive the surgery was, fluid buildup and whether there’s infection. Remember, whether you’re recovering or deciding how much to work, you have to listen to your body, doctors say.

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