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Other Voices: Replacing fear with knowledge

October is Breast Cancer Awareness Month. In my 34 years as a family doctor, I encountered a lot of people who were concerned, even anxious, about the possibility of a dreaded disease. They sought my advice and reassurance. Fortunately, most of them were the “worried well” and their health fears unfounded.

To foster a healthy view of vigilance without fear, it is important to know where the dangers lie. Breast cancer touches nearly everyone. Statistics tell us one in eight women will be diagnosed with breast cancer during their lifetime. The occurrence rate in America is about 110 per 100,000, or about 180,000 new cases of breast cancer per year. About 40, 000 will die annually.

There is good news about breast cancer, however. In the past several years, there has been a steady decline in the death rate by more than 2 percent per year. This is attributed to improved early detection and advances in treatment, swelling the ranks of breast cancer survivors to 2.4 million women in 2004.



As we seek increased awareness to obtain better health, we need to assess where our risks truly lie. It is important to be aware of your family history and personal health risk factors. You should review these with your family doctor.

For heart disease, the important risks factors are blood pressure, cholesterol, diabetes, smoking and family history. Where is your greatest danger? What can you do to reduce risk? Did you know that a woman is 11 times more likely to die of heart disease than breast cancer? And compared with men, women are more likely to be misdiagnosed and more likely to die of their first heart attack. Addressing cardiac risk factors could literally save your life.




That said, what are the factors that specifically increase risk of breast cancer? Obesity after menopause, high fat-diet, two drinks of alcohol per day, lack of exercise, breast density and family history – all these factors are important. Most are lifestyle factors that if addressed, provide opportunities to reduce risk.

When breast cancer occurs in clusters in families, there may be a hereditary genetic link … so asking about breast cancer in your family is critical. Women with high risk are those who develop breast cancer before age 45, have multiple family members with breast and ovarian cancer, a male relative with breast cancer or individual relatives with multiple breast cancers. This pattern of hereditary breast cancer affects 5 to 10 percent of the new cases of breast cancer each year.

Those at risk may be advised to obtain a blood test to detect the BRCA genetic marker, costing over $3000. This test is being utilized more frequently for identifying those patients with especially high risk of breast and ovarian cancer. At this price, it is not a screening test to address the anxiety of the “worried well” or the isolated case of breast cancer.

This marker helps identify those with a striking 33-50 percent risk of developing breast cancer by age 50 (vs. 2 percent in the general population) or an increase to 55-87 percent risk by age 70 (vs. 7 percent). They are also at increased risk of developing another cancer in the same or other breast or ovarian cancer. Awareness of such increased risk impacts the clinical decisions for this high-risk group. Clinical guidelines established by the American College of Medical Genetics indicate when this expensive test is appropriate.

Sierra Nevada Memorial Hospital’s Breast Imaging Center has been recognized as one of the top five in the nation. Besides using the advances of ultrasound and digital mammography, we now have Breast MRI. This remarkable technology will allow imaging of cancers sometimes not found by standard screening tests and is most useful in the same high-risk population described above. Using strict clinical guidelines, Breast MRI is slowly being embraced by health insurance plans. It has already shown its value for several local patients. We are proud to have access to these technologies in our small community.

I hope that Breast Cancer Awareness Month will inspire women to assess their risks and arm themselves with knowledge. If you know a young woman who smokes, encourage her to quit. Do your check-ups and get your mammogram, but don’t forget to take care of your heart with regular exercise, a healthy diet and a lifestyle that nurtures body, mind and spirit.

ooo

Dan Bibelheimer, M.D., is the medical director for SNMA-IPA and a member of the SNMH Foundation board of directors.


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