Breast Cancer, a Race We Can Win!

By Isabel M. Estrada Portales

En Español

Alice Brooklyn is a beautiful black woman, age 33. She has no health issues and no plans to have any, since she works out at the gym of her Baltimore building more often than most of us take the trash out.

Lida Valenzuela, 31, is a tall and a runway-model-thin Latina. She does not work out much, but watches what she eats with the zeal of a professional dietitian.

These two women, whose real names are not given, do share a fear - breast cancer. Alice's mother and one aunt died of the disease, and another aunt is still living with it. Lida's mom has also been diagnosed with breast cancer at an advanced stage and it seems to be very invasive. Her struggle is entering its ninth month.

Although the fears and worries of breast cancer tend to begin a bit later for most women, more into the 40s and 50s, these two young professionals have been directly affected by it, and by the pain and suffering it causes. They are constantly on the look out for the first sign on themselves, because they know it has some genetic component.

But breast cancer is not Russian roulette, and they are not passively waiting for the shot that kills them. The secret to defeat breast cancer is threefold: prevention, early detection, and faithful treatment.

October is National Breast Cancer Awareness Month (NBCAM). Since the program began in 1985, mammography rates have more than doubled for women age 50 and older and breast cancer deaths have declined.

However, minority populations are not sharing equally in this bounty. The essence of health disparities in our communities is manifested in the way breast cancer affects communities of color.

African American women have a slightly higher incidence rate of breast cancer than White women before age 35, but that situation reverses itself after age 35. However, African American women are more likely to die from breast cancer at every age.

Latinas are in a similar situation. Hispanic women are about 40% less likely to have breast cancer than white women; however, they have a higher risk of dying from the disease.

The cases of Alice and Lida's family members are poster examples.

"I knew my mom needed to get screenings. I had read about it, I had seen posters about monthly exams at the college clinic, but it never occurred to me to take her by the hand to the doctor's office," explains Lida.

"My mom [54] discovered the lump herself, and it was so noticeable that she saw it first, and then touched it. She was not doing a self exam. She would never have done that because she did not think it was 'proper'…You know, old people stuff," recounts Lida.

But there were other problems. Lida's mom did not have health insurance - Lida does, but can't add her mom to her plan - and she did not even know that she may qualify for a free mammogram with several programs, hospitals and clinics throughout the country.

"For many minority populations including African American women and Latinas, breast cancer is more frequently diagnosed at a later stage, when it's harder to treat and there is less chance of survival," said Cheryl Kidd, director of education for the Susan G. Komen Breast Cancer Foundation.

"Lower utilization of screening tests such as mammography and delayed follow-up of an abnormal screening is thought to contribute to later diagnosis, when the disease is more advanced," Kidd added.

In 2003, the reported percentage of women having a mammogram was 69.7%, according to the Centers for Disease Control and Prevention (CDC). White and African American women aged 40 and older had a similar use of mammography in the two years prior to the report, 70.4%.

But women in other race/ethnic groups were less likely to have had a mammogram. Only 40.2% of women without health insurance and 52.3% of immigrant women living in US for less than 10 years have had a mammogram.

The very fit Alice is always after new information about breast cancer, new treatments, drugs, screening test, and clinical trials. She knows that there is no sure bet to prevent breast cancer, but she is not sitting around waiting for it to catch up with her.

"I can't change my genes - nor do I want to, because I love everything I ever got from my mother - but I can certainly try to do other things right, so that even if I do get breast cancer, my body will still be in good enough shape to beat it," says Alice.

Prevention means avoiding the risk factors and increasing the protective factors that can be controlled, so that the chance of developing cancer - or any disease, for that matter- decreases.

Alice does follow the book in avoiding the risk factors. She does not smoke and she drinks only occasionally and no more than a glass or two of wine. On the other hand, she maximizes the protective factors by eating a very healthy and well balanced diet with plenty of fruits and vegetables. She is in great physical shape and exercises daily.

"I have already discussed with my doctor the possibility of starting on prevention drugs, but there has been no decision on that yet", said Alice.

There are certain drugs, and even more in the pipeline, that can help on the prevention of breast cancer and are prescribed to women are a particularly high risk.

Obesity is a problem among minority populations, and there seems to be a clear link with breast cancer.

A major study published last year in Breast Cancer Research found that, contrary to current belief, the risk of breast cancer increases not only for women who gain weight after the menopause, but also to those who gain weight in adulthood.

"The maintenance of a healthy weight during early adult life represents a potentially modifiable risk factor in hereditary breast cancer syndromes," says one of the study's lead scientists, Steven Narod, MD, of the Centre for Research in Women's Health at the University of Toronto.

The study found that a "weight loss of at least 10 pounds from age 18 to 30 was associated with a 65 per cent reduction in cancer risk between ages 30 and 49."

Not bad.

"Just because it's genetic doesn't mean you can't do anything about it," said Dr. Narod.

But Alice knows that, and she wants everyone else to know it. "I'm very committed, for personal reasons, to the fight against breast cancer. I run marathons every year, and I know we will win that race," said Alice.

Action Steps

Don't sit there to wait for breast cancer to catch up with you…Catch it early!

• Learn about your family's medical history.
• Evaluate your personal risk.
• Make sure your family members are also informed and taking the proper steps.
• Do a monthly self breast examination, preferably around the time you get your period.
• Get an annual breast examination by a health professional.
• If you are over 40 years of age, get an annual mammogram.
• If you have a family history of breast cancer, talk to your doctor about how often you should get a mammogram.
• If you don't have health insurance, call 1-800-444-6472 to locate a health center or hospital that will perform a mammogram free or at low cost.

Links

Breast Cancer from the National Cancer Institute, NIH
http://www.cancer.gov/cancertopics/types/breast

National Breast Cancer Awareness Month
http://www.nbcam.org/

Estimating Breast Cancer Risk
http://www.cancer.gov/cancertopics/factsheet/estimating-breast-cancer-risk

The Breast Cancer Risk Assessment Tool
http://www.cancer.gov/bcrisktool

The Cancer Research and Prevention Foundation
www.preventcancer.org

Latina Breast Cancer Agency
www.latinabca.org

Susan G. Komen Breast Cancer Foundation
www.komen.org

"Annual Report to the Nation on the Status of Cancer, 1975-2003, Featuring Cancer among U.S. Hispanic/Latino Populations."
www.interscience.wiley.com/cancer/report2006
For a Q&A on this Report, go to
http://cancer.gov/newscenter/pressreleases/ReportNation2006QandA

"Annual Report to the Nation on the Status of Cancer, 1975-2003, Featuring Cancer among U.S. Hispanic/Latino Populations."
For Spanish translations of press release and a Q&A
http://cancer.gov/newscenter/pressreleases/ReportNation2006ReleaseSpanish

Isabel M. Estrada Portales is the OMHRC Director of Communications.
Comments? Email: iestrada@omhrc.gov