Deb Kirkland first started performing breast exams in nursing school, practicing on peers at the behest of her instructor. It was the first time she learned the statistics, risk factors, and symptoms of the disease. She was healthy, had no family history of breast cancer, and was young, yet she noticed a lump in her right breast during a self-exam at age 32. Concerned, she went to her OB/GYN and was referred for a mammogram and ultrasound, which led to a biopsy that gave her a diagnosis. "I was shocked to hear the words, 'You have breast cancer,'" Kirkland says of the day she received the news. "That day I became a statistic: 1 in 8 women will have breast cancer in their lifetime."
Kirkland opted for a bilateral mastectomy—a decision that, she said, had no affect on her survival rate but decreased the risk of breast cancer recurring in her other breast to less than 1 percent—and started chemotherapy, followed by daily doses of Tamoxifen for the next five years. Now a survivor of 13 years, Kirkland continues the fight to promote self-awareness through her work as a patient navigator at the Hoffberger Breast Center at Mercy Medical Center in Baltimore.
Breast cancer discriminates no age and no gender: Twenty-one percent of women diagnosed in 2013 were under the age of 50. Kirkland's fight is no exception to the statistics, but her knowledge of the risks and self-awareness allowed for early detection and a quick response. Knowledge is power, so we talked to Kirkland and Dr. Dennis L Citrin, medical oncologist at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Illinois, to get the facts every young woman needs to know about breast cancer. Though October is dedicated to the awareness of the disease, we encourage you to continue the fight and spread the knowledge yearlong.
There's No Such Thing As Being Too Young
It's a myth that young women have virtually no risk of developing breast cancer. In fact, 25,000 women under the age of 45 develop breast cancer every year, according to Dr. Citrin. The youngest patient Dr. Citrin has treated was diagnosed when she was 22 years old, without a family history of the disease. "Just because a woman is young doesn't mean that if she feels something wrong with her breast, she shouldn't just either assume or allow a doctor to reassure her that it's a benign disease simply because of her age," Dr. Citrin says. "I would emphasize that if any woman feels anything different in her breast from what she's used to normally, she has to have it checked out by an experienced physician. If it feels different to the patient, it has to be evaluated, and that means an ultrasound usually followed up by a biopsy." Kirkland recommends women have annual clinical breast exams beginning at age 20, and annual mammograms at age 40.
Being Female Is the Biggest Risk
Simply being a woman is the No. 1 risk factor for developing breast cancer. One in eight women will develop breast cancer in their lifetime, according to the National Breast Cancer Foundation, accounting for 99 percent of breast cancer cases (men account for 1 percent and are diagnosed at a rate of 1 in 1,000). Although it's important to know and alert doctors of family history, only 5 to 10 percent of those diagnosed with breast cancer have a family history of the disease. And there is an increased risk associated with delaying pregnancy beyond the age of 30, opting against breast feeding, and having a family history of the disease. Dr. Citrin says that while these factors pose a risk, they aren't requisite indicators. "There are plenty of women who develop breast cancer who have no recognized risk factor other than the fact that they're women. That's why every woman has to be aware," Dr. Citrin says.
Estrogen Is The Culprit
Men and women both have breasts with the same equipment and structure, so why does the disease affect women more prevalently? Estrogen. The woman's body is in a constant cycle of hormones, and her breasts are stimulated by estrogen on a monthly basis. "Whenever cells are being stimulated to grow, that's when abnormal DNA can occur, genetic mutations that can result in cancer," Dr. Citrin says.
...So What About Birth Control?
According to Dr. Citrin, today's contraceptives are much lower in estrogen than the first prescriptions 60 years ago. Contraceptives used to be high in estrogen and were linked to an increased risk of breast cancer. Modern forms, however, use a much lower dose—some contraceptives include solely progesterone and completely omit estrogen—and the increased risk is nearly nonexistent.
Race, Ethnicity & Biology Matter
Race can play a role in the risk of developing breast cancer. White women are more likely to develop breast cancer, though it's typically less biologically aggressive. The instances of breast cancer in black women is a little lower, however the disease is often more biologically aggressive. Women with the BRCA gene—most commonly found in Jewish women of European origin—are at a higher risk for developing breast cancer in more biologically aggressive forms. Although race and ethnicity play into determining the risk, the biology of the cancer is most important in determining the outcome. A black woman and white woman with the same biological form of breast cancer sensitive to normal or direct treatment have the same prognosis and chance of survival.
Knowledge & Self-Awareness Are Power
Every woman should check her breasts on a regular basis and have an understanding of what is normal for her body. This familiarity and self-awareness is the most important step for early detection. Breasts change throughout the menstrual cycle, so it's important to perform a self exam at the same time every month—ideally 7 to 10 days after the start of the period, according to the National Breast Cancer Foundation. If you have a hard time remembering the geography of your breasts, keep a diagram for reference. Note any changes that feel or look different from month to month or from the mirror image of the opposite breast and call your doctor for an evaluation. Dr. Citrin notes that if a change persists through one or two menstrual cycles, it is called a dominant mass and must be investigated. For a full list of symptoms, visit the National Breast Cancer Foundation website.
There Are Three Main Types of Breast Cancer
Breast cancer can be broken into three broad types: ER Positive, HER2 Positive, and Triple Negative. ER Positive breast cancer grows in response to estrogen and is less aggressive and more responsive to treatment then the other two types. HER2 Positive is a much more aggressive and fast-growing type, resulting due to an excess of the protein HER2/neu. Both ER Positive and HER2 Positive generally respond to targeted treatment drugs that prevent recurrence. Triple Negative tends to have the poorest prognosis of the three. This type is typically linked to the BRCA1 gene and generally responds well to chemotherapy, though no targeted treatments have been developed to prevent recurrence. According to Dr. Citrin, younger women are much more likely to have either HER2 Positive or Triple Negative, while post-menopausal women are more likely to have ER Positive.
Breast Cancer Is A Fight That Can Be Won
It's important to understand the biology of the disease, and to create an individualized treatment plan with a team of medical professionals. "It's no longer the paradigm of one-size-fits-all, everyone will have surgery and whatever else is needed," Dr. Citrin says. "Bilateral mastectomy is really almost never required except on women who have the breast cancer gene, BRCA. I think it's important to emphasize that most women who have early stage breast cancer can confidently expect to be cured of their disease. As long as they have the proper treatment, which usually involves all three modalities of treatment including surgery, radiation and some form of drug treatment, then they can confidently expect to be cured of the disease."
The Future Is Bright
Myriad resources for financial, physical, mental, and emotional support exist today to help men and women affected by breast cancer. It's natural to be frightened at the possibility or prognosis of breast cancer, but Dr. Citrin is optimistic that the future is bright. "Over the last 20 years, there's been an explosion of knowledge about breast cancer," Dr. Citrin says. "Really and truly the prognosis is much, much better now than it has ever been before. Most women are completely cured of their disease and treatment is much easier and much more accessible than it ever used to be. I think the future is looking much, much brighter for women with breast cancer than it ever was before."