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Tips to be Fit: Breast Cancer and Black women

October is “Breast Cancer Awareness Month.” If you’re a woman and think your chance of getting breast cancer is one in a million, the fact is, it’s 1 in 8 women will develop breast cancer in her lifetime. About 180,000 American women developed breast cancer every year alone. It kills nearly 46,000 American women each year. According to the American Cancer Society, breast cancer is the most common form of cancer among American women. Every woman is at risk for breast cancer. Every 12 minutes a woman in America dies of breast cancer. Breast cancer is the most common malignancy. The United States has the 9th highest incidence of breast cancer. Belgium has the highest. About 2,550 new cases of invasive breast cancer are expected to be diagnosed in men in 2018. A man’s lifetime risk of breast cancer is about 1 in 1,000.

Older woman are more likely to develop breast cancer. Breast cancer rates are low in women under 40. Less than 5 percent of women diagnosed with breast cancer in the U.S. are younger than 40. Rates increase after age 40 and are highest in women over age 70.

The median age of diagnosis of breast cancer for women in the U.S. is 62. The median is the middle value of a group of numbers, so half of the women were diagnosed before age 62 and half were diagnosed after age 62. The median age of diagnosis varies by race and ethnicity. Black women tend to be diagnosed at a younger age than white women. The median age for black women is 59 compared to 63 for white women.

Breast cancer is thought of as a woman’s disease, but men can also develop a form of breast cancer. Each year, over 400 men die from breast cancer.

Breast cancer incidence of new cases is slightly lower among African-American women than among white women. But breast cancer mortality is higher in African-American women. Breast cancer mortality was 39 percent higher in African-American women than in white women. A main reason behind the differences is when a woman gets a mammography screening. Women who don’t have health insurance are much less likely to get mammograms than women with health insurance. In 2013 women ages 40 and older only 38 percent of those with no health insurance had a mammogram in the past 2 years. Seventy percent of those with health insurance had a mammogram in the past 2 years

Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. Even among the women above with insurance, only 70 percent had a recent mammogram. The Affordable Care Act requires all new health insurance plans since September 2010 to cover yearly mammography (with no co-payment) for women ages 40 and older. The rule may not be in effect now.

The incidence of breast cancer has continued to increase at about 2 percent a year. The death rate from breast cancer has declined. This decrease is believed to be the result of earlier detection and improved treatment. But 2% of the autopsies performed in 2003 showed undiagnosed breast cancer. That means a lot more women have breast cancer and don’t know it.

Breast cancer occurs when a group of cells grows out of control and divide more than they should, forming masses called tumors. Some tumors do not spread to other parts of the body but may interfere with body functions and require removal. These are known as benign tumors. Malignant or cancerous tumors invade and destroy normal tissue then break from the original tumor and migrate to other parts of the body and may form other malignant tumors. Breast cancer can spread through the lymph nodes to the lungs, liver, bone and brain.

Most breast cancers will begin in the ducts (ductal), some in the lobules (lobular) and the rest in other tissues. Almost all breast cancers start in the ducts or lobules of the breast. Because this is glandular tissue, they are called adenocarcinomas. The 2 main types of breast adenocarcinomas are ductal carcinomas and lobular carcinomas.

According to radiologist, Dr. Elizabeth Patterson of the Hospital of the University of Pennsylvania, cancer is an attempt of abnormal cells to overtake the normal cells and spread. The incidence of breast cancer in African American women is less than the general population, comments Dr. Patterson, but the death rate is higher. According to a National Cancer Institute study, African American women are 2.2 times more likely to die from breast cancer than their white counterparts. Black women generally have more aggressive breast cancer and have shorter survival times than white women. It’s been estimated that when comparing white and Black women who had breast cancer, black women had between a 70-90% increased risk of dying from breast cancer than white women, which was independent of the stage in which the cancer was diagnosed.

Some studies have made the argument that the difference in breast cancer mortality between Black and white women is a reflection of the different standards of care of women who have different incomes. Statically this statement could be true, but it does not answer the question as to why Black women have more aggressive breast cancer than white women, nor does it answer the question of why breast cancer mortality rates have risen faster in young Black women than in young white women.

Breast cancer is the second leading cause of cancer death among African-American women. The incidence of breast cancer for age groups younger than 40 years was higher among Black women than among white women. The incidence of breast cancer is increasing in both the young Black and white population, but young Black women are getting more breast cancer and dying from it more often than young white women.

When I asked Dr. Patterson why Black women tend to die more often once diagnosed, she responded, “There are several reasons. African-American women tend to seek treatment during latter stages of the disease process. Denial is a big problem which allows time for the disease to spread to other parts of the body.”

There are many myths that keep women from seeking treatment. These include the misconception that “cancer is a death sentence”, “once surgery takes place and the cancer is exposed to air it will spread like wildfire” and many women don’t believe there is a cure for cancer. Dr. Patterson believes that these myths exist partly because there aren’t any highly visible African-American role models to show that cancer can be cured and that you can resume a normal lifestyle. Studies show that African-American women don’t think of cancer as one of their diseases. Many older women believe the myth there is something wrong with touching their own bodies. There’s also a lack of awareness about the importance of mammography testing, and a lack of access to the health care system, commented Dr. Patterson. The survival rate is very good when breast cancer is detected and treated early says Patterson. On an encouraging note, she did comment that young African-American women are more aware and do perform self-examinations more frequently.

It is not known what causes breast cancer or how to prevent it. It’s known that the risk for developing cancer is greater in some women whose mother, sister or other close relatives who has had cancer. White women are slightly more likely to get breast cancer than are African-American women. But African Americans are more likely to die of this cancer. Although Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer, studies show that there has been a big increase in the numbers of these women developing breast cancer. Researchers are looking for answers by researching the possible roles of heredity, environment, lifestyle and a high fat diet play in the development of breast cancer.

A cancer risk factor is anything that increases a person’s chance of getting cancer. Some cancer risk factors, such as smoking, can be controlled. Others, like a person’s age or family history, can’t be changed. Having a cancer risk factor, or even several risk factors, doesn’t mean that a person will get breast cancer.

Women are at risk for breast cancer if they:

• are over age 40 and especially over 50

• have already had breast cancer in one breast

• have close relatives who had breast cancer before age 50 or menopause

• take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for 5 or more years after menopause

• began menstruation (had their first menstrual period) at an early age (before age 12), went through menopause late (after age 55), or never had children

• have mostly dense (not fatty) tissue on a mammogram (x-ray of the breast)

• after menopause, are obese.

• are physically inactive throughout life

• have had no children, or who had their first child after age 30

• have 2 to 5 drinks daily have about 2 times the risk of women who drink no alcohol

• smoke

Women with one or more of these risk factors should examine their breasts monthly. They should also have a health care professional examine them regularly, even though women themselves find most lumps.

The most common sign of breast cancer is a lump or thickening that does not go away or change how it feels. Keep in mind that four out of 5 lumps are benign and not cancerous. Other signs to look for are swelling, puckering or dimpling, redness, and soreness of the skin or nipple discharge. The nipple may become drawn into the chest, change shape, bleed or become crusty. Usually, early breast cancers are painless but if you experience pain and tenderness throughout your menstrual cycle, you should tell your physician.

According to Dr. Patterson, once cancer is diagnosed treatment becomes personalized depending on the patient’s age, risk factors, type of lesion and the individual’s treatment preference. A small lesion (less than a millimeter) has the greatest cure rate. Treatment for a small lesion may include a lumpectomy (removal of the lump and a border of surrounding tissue), a biopsy of the lymph nodes in the armpit (to make sure the cancer has not spread) and radiation treatment. Depending on the severity of the cancer a combination of therapies may be used explained Dr. Patterson. These may include radiation, a lumpectomy, a partial, modified or full mastectomy, chemotherapy and hormonal therapy.

Patterson commented that we need to talk about it more and be open about the disease. If you have a family member or someone in your life who has breast cancer be supportive she urged. Family members need to know what illnesses or diseases their relatives have had. This can be especially important when it comes to detection. When you hide diseases, you can place family members at a greater risk because they are unaware.

Every woman should have a baseline mammogram between the ages of 35 and 39 to help detect changes in later years. Between ages 40 and 50, a woman should have a mammogram everyone to two years. If you are over 50, you should have a mammogram every year.

Breast cancer is not a death sentence and neither are the treatments stressed Dr. Patterson. If you’re dealing with someone who has breast cancer she advises, “Be supportive and don’t forget that magic word love. If I had to tell you what to do to prevent breast cancer, I would say reduce your risk. Have a balanced diet, exercise, don’t smoke or live in a smoke free environment, reduce your exposure to cancer causing chemicals and get regular check-ups.”

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