By Monica Northington MD, MPH
Jackson Advocate Guest Writer

It’s that time of year again. The leaves change, and amidst the brilliant crimson, amber, and russet hues, the world explodes with bursts of pink ribbons and banners, pink caps, pink sports jerseys, neckties, headbands, wristbands, pom poms, and tennis shoes.

October is National Breast Cancer Awareness Month. This observation began in 1985 as a joint venture between the American Cancer Society (ACS) and the pharmaceutical branch of Imperial Chemical Industries (now part of AstraZeneca). It was originally intended to promote mammography as a primary tool to prevent breast cancer, but it has now grown to become an international campaign, supported by charities worldwide, to promote awareness of breast cancer and to raise money for research on the prevention, diagnosis, treatment, and cure of this disease.

An estimated 1 in every 8 American women will experience an invasive breast cancer in her lifetime. According to BreastCancer.org, 281,550 new cases of invasive breast cancer will be detected in women this year, with an additional 49,290 cases of noninvasive breast cancer being diagnosed. Importantly, 2,650 new cases of invasive breast cancer will be detected in men this year.

For American women, breast cancer is the most common type of cancer, comprising 30% of all new cancer cases in the nation. As of 2021, according to the World Health Organization, breast cancer is also the most common type of cancer worldwide, accounting for 12% of all new cancer cases. Breast cancer has the second highest death rate among all cancer types, behind only lung cancer in mortality.

Black women, especially those under the age of 45, experience a higher mortality rate from breast cancer than their white counterparts. The risk of Black women developing and dying of breast cancer is also higher than that experienced among Asian, Hispanic, and Native women.

Many factors contribute to the likelihood of developing breast cancer. The American College of Obstetricians and Gynecologists (ACOG) lists 16 individual risk factors (see them all at www.acog.org), but the greatest risk factors for the development of breast cancer are sex (female) and age (older than 40). A woman’s breast cancer risks nearly double with the diagnosis of breast cancer in a first-degree relative (mother, daughter, or sister). However, only 15% of women diagnosed with breast cancer will have a family member who was also diagnosed with it. Five to ten percent-10% of breast cancers can be linked to gene mutations inherited from one’s mother or father, most commonly the BRCA gene. Women with BRCA1 mutations have as much as a 72% lifetime risk of breast cancer. In women with BRCA2 mutations, the lifetime risk is 69%. Men with BRCA2 gene mutations face a lifetime breast cancer risk of 6.8% while BRCA1 gene mutations are much less common in men.

There are several types of breast cancer, and for that reason, the discussion of breast cancer can become overwhelming. The type of breast cancer is determined by which cells in the breast are involved. Most often, the epithelial cells that line the milk ducts or lobules (the glands that produce milk) are involved. Because they involve these epithelial cells, these cancers are called carcinomas, and because they involve glands, they are called adenocarcinomas.

Breast cancer can also be classified by whether it has spread or not. A breast cancer is called in situ if it has not spread beyond the milk duct into the rest of the breast. If the cancer cells have spread to the surrounding breast tissue, it is called invasive (or infiltrating) breast cancer. Some types of invasive cancers are more aggressive and more difficult to treat than others. Breast cancer cells that have spread to other parts of the body are known as metastatic breast cancer.

Symptoms of breast cancer may vary with the cancer type, but warning signs include:

• A new lump in the breast or armpit
  
• A change in size or shape of the breast, especially if it affects only one side (asymmetry)
  
• Thickening or swelling in part of the breast
  
• Irritation or dimpling of the skin of the breast
  
• Red, flaky skin in the nipple or areola
  
• Inversion (“pulling in”) of the nipple
  
• Non-milk nipple discharge, including blood
  
• Pain in any part of the breast, including the nipple

It is important to note that the above symptoms may be the result of other conditions that are not cancer. However, if you experience any of them, you should report them to your primary care provider at once.
Although breast cancer requires a diagnosis by your medical provider, you can detect the symptoms listed above through examination of your own breasts. Despite research that questions its usefulness as a part of routine breast cancer screening, self-breast examination (SBE) is still recommended as a weapon in the fight against breast cancer. If you are uncertain about how to do SBE, your primary care provider can help you. Both women and men should develop a habit of checking for lumps, asymmetry, discharge, nipple changes, or enlarged lymph nodes. As early as age 20, young women should learn to do SBE and continue them throughout their lives. In premenopausal women, SBE should be done 3-5 days after the start of the menstrual period, when breasts are less lumpy and tender. SBE should be done during the same time each month, so that any changes from the norm will be readily identified. You can download instructions for your SBE at www.breastcancer.org. You may find it helpful to set an alert in your smartphone and/or to engage a friend or relative as an accountability partner to remind one another to do your SBE monthly.

Mammography is the most effective clinical tool for the early detection of breast cancer. According to the most recent ACS and ACOG guidelines, women at average risk for breast cancer should obtain screening mammograms on the following schedule:

• Age 40-44 – Yearly (optional)
• Age 45-54 – Yearly
• Age 55 and -older – Every other year (or yearly if desired and warranted by other risk factors)
  Mammograms should continue until age 75, if the woman is in good health and is expected to live at least 10 more years.

Oftentimes, people avoid visits to their primary care provider and skip routine screening tests. They don’t think these appointments are important, and they believe they’re too expensive, anyway. Other times, people don’t go to their appointments because they’re “afraid they’ll find something.” As physicians and other health care providers, we understand. Healthcare is very expensive. Insurance doesn’t always cover everything, and the possibility of a cancer diagnosis is scary. However, we cannot overemphasize the importance of early detection. It is the key to surviving any cancer, especially breast cancer. The sooner a breast mass is discovered, the more likely it can be removed completely, and the less likely a lengthy, invasive treatment will be required. If you are concerned that you might have breast cancer, see a health care provider as soon as possible. If you are healthy, but you’ve never been screened, make an appointment for a wellness exam.

If you need more information on breast cancer, go to www.breastcancer.org. If you are uninsured and worried about the cost of an office visit or a mammogram, consider making an appointment with your local community health center where your cost will be based on your income. If you already have Medicaid or Medicare, your screening tests will be covered. If you purchased your health plan through the Marketplace under the Affordable Care Act, you automatically qualify for a mammogram free of charge if you are over the age of 40.

If you are uninsured, you may also qualify for financial assistance for mammograms through the following programs and organizations.

• Mississippi State Department of Health – Mississippi Breast and Cervical Cancer Early Detection Program; Call 1-800-721-7222 for program information and to find out if you qualify.
• American Breast Cancer Foundation – Breast Cancer Assistance Program; call 1-844-219-2223 or email info@abcf.org to get information and eligibility requirements.

These are only two of the many organizations that support the fight against breast cancer. If you have the opportunity, please consider participating in a breast cancer fundraising activity in the greater Jackson metropolitan area this month. If you cannot participate, please consider donating to the organization of your choice to support research and treatment of this disease. When you see all the pink around you during the month of October, THINK PINK for Breast Cancer awareness, and be sure you are doing everything in your power to prevent breast cancer in yourself or in someone you love.