Breast Cancer: Tips to Reduce Your Risk

Breast Cancer: Tips to Reduce Your Risk

For years, October’s pink ribbons are a reminder of the global Breast Cancer Awareness Month. Whether it is a relative, a friend, a colleague, or a neighbor, breast cancer’s impact is wide, and most people have been touched by this disease in some way.

Screenings for breast cancer are especially important this year when many health screenings are being delayed because of the COVID-19 pandemic. As a nurse, your schedule may have become so busy that you’ve put off scheduling your mammogram  until you have more time or more energy. Breast Cancer Awareness Month is a good reminder to get those essential screenings back on your calendar.

Because breast cancer can appear at any time, it’s critical to make sure you don’t skip any screenings. You may delay one and before you realize it, another year has gone by before you are getting another mammogram.

According to the American Cancer Society, one in eight women will receive a diagnosis of breast cancer in her lifetime. And many of those women have no known family history of the disease or any particular known risk factors.

Fortunately, advancements continue to develop in breast cancer detection and treatment. Improved drug therapies, surgical treatment, chemotherapies, and post-treatment plans continue to boost the survival rates of women and men diagnosed with breast cancer.

And each year seems to bring new awareness of steps you can take to help reduce your risk, especially if you are in a high-risk category.

What can you do to reduce your risk?

  1. Get Screened

Although screening might seem like it can’t prevent breast cancer from developing, it can prevent it from spreading if it’s caught early. Screening can detect breast cancer in its earliest stages, sometimes at a precancerous state. An early diagnosis can allow for more options.

  1. Get Regular Exercise

You don’t have to be a fitness guru to reap the benefits of moving your body when it comes to prevention. According to the National Breast Cancer Foundation, Inc., moderate exercise, such as a brisk walk, gardening (raking leaves counts!), or dancing, all count. Move your body in a way you enjoy because that means you’re more likely to do it. Get about 30 minutes a day of activity to help keep you strong, boost your immune system, and reduce inflammation.

  1. Keep Your Weight Steady

Remaining at or close to a normal weight for your height may help reduce your risk.

  1. Eat Purposefully

Nutrient-rich foods, particularly fruits and vegetables, can help reduce the risk of developing many cancers. Breastcancer.org offers plenty of tips for eating for cancer prevention. Include a range of fruits and vegetables, lots of omega 3 fatty acids, and try to reduce saturated fat.

  1. Limit Alcohol

According to the American Cancer Society, studies show that drinking alcohol  has a direct impact on increasing breast cancer risk and the risk increases the more you drink. If you drink alcohol, limit the amount to no more than one drink a day.

  1. Know Your Family History

Find out what kinds of cancers run in your family. Although many breast cancers are entirely unrelated to family history, if you do have specific cancers in your family, it gives you the chance to increase your vigilance with more frequent and different types of screening or even genetic testing. According to the Susan G. Komen organization, relatives with cancers of the breast, ovaries, or prostate could put you in a higher risk category. If you have relatives with any of those cancers, discuss your options with your physician.

Science is making huge advances in breast cancer detection and treatment, and taking some action to reduce your own risk can help.

A Breast Cancer Diagnosis Brings a Nurse Closer to Her Patients

A Breast Cancer Diagnosis Brings a Nurse Closer to Her Patients

In 2014, Melisa Wilson, DNP, ARNP, ACNP-BC, the Clinical Operations Director and Pulmonary Hypertension Program Coordinator at AdventHealth Orlando, discovered a lump in her breast. Fearing a cancer diagnosis, her husband encouraged her to see her doctor immediately.

Wilson nearly didn’t. After all, she didn’t have a family history of breast cancer. She thought it was a mammary duct drying up as she was pumping breast milk less for their child.

Thankfully, she listened to her husband. An ultrasound led to a biopsy and then a diagnosis.

“I was taken entirely by surprise. The journey was swift from the time we felt the lump to diagnosis—just eight days. I did not expect to hear, ‘I am sorry, Mrs. Wilson, you have breast cancer,’” Wilson recalls.

Wilson’s diagnosis was Stage IIB HER2 positive, and for the next 18 months, her treatments included Herceptin, Perjeta, Carboplatin, Taxotere, and Neulasta. Her inspiration was her son, who had been born at 23-weeks. “He fought for his life, and in turn, it inspired me to fight for mine,” says Wilson. “My faith in God got me though.” She also had tremendous support from her family, work family, friends, and her oncology team, including her NP, MD, and LCSW.

The most challenging part of her journey, Wilson says, was financial. “The bills for oncology treatment came in quickly and were very high. I maintained my full-time job as a nurse practitioner, though, with some accommodations. I would work up to the day of chemo, take six days to recover, and then return to work for another two-week cycle,” she recalls. “It was hard, and the bills would be overwhelming to deal with at times. I remember being at chemotherapy and getting a call asking me to pay several thousand dollars to pay for a test I needed.”

Wilson beat the cancer, and she says that she now can more easily empathize with her patients because of what she’s experienced. “As an NP, I can relate to my patients on so many different levels. My patients have a rare cardiopulmonary disease—pulmonary hypertension. Most have no idea what pulmonary hypertension entails,” she says.

A few years ago, Wilson says, she had a patient who was scared about having a line placed in her chest. This needed to be done for infusion of pulmonary hypertension treatment. The patient experienced a lot of pain due to being on a subcutaneously infused machine. “One day I called her and asked for her to come in for an office visit with me. I explained that I had done as much as I could to manage her pain, and she needed to consider a different route of infusion. She was tearful and upset. She was concerned about her body image,” says Wilson. “I showed her my port, though it was different and showed her my head, which was hairless due to chemo. I told her, ‘I understand what it is like for your body to change in front of your eyes, but these are the things we do to survive.’ We cried together, and she went on to have the line placed.”

Just recently, Wilson says that her mother was diagnosed with breast cancer. Wilson believes that she went through her journey so that she can help others and that cancer taught her how to live and not be as fearful. “My tribulation shaped me, and now I help my Mom. I am happy to be her advocate,” says Wilson. “Being there for her and not feeling helpless is rewarding. I know it gives her comfort.”

Real Talk about Breast Cancer

Real Talk about Breast Cancer

Breast cancer is one of the most diagnosed cancers among African American women, yet research into their experiences with treatment lags behind. In particular, few studies have examined how African American women cope with fatigue, the most common side effect of treatment. To help fill the gaps, my research colleagues and I explored how fatigue affects African American women undergoing breast cancer treatment.

When it comes to breast cancer and African American women, fatigue coupled with fear are a significant part of the experience, with many African American women viewing breast cancer as an automatic death sentence. When we examine the mortality rate of breast cancer among African American women compared with women from other ethnic and racial groups, this perception is understandable. The American Cancer Society’s Breast Cancer Facts and Figures 2013–2014 report indicates that African American women had a lower breast cancer incidence rate than non-Hispanic white women; however, that same report states that African American women with breast cancer have a higher mortality rate. Many factors contribute to this racial disparity, including inadequate or lack of health insurance, screening behaviors, obesity, and a genetic component that results in more aggressive tumors.

A fatalistic view of breast cancer leads some African American women to delay follow-up visits or even avoid obtaining mammograms, which can lead to them being diagnosed at a later stage and having a worse prognosis. Then fear can turn into reality. Of all types of cancer diagnosed in African American women, breast cancer is the second leading cause of death. The five-year breast cancer survival rate for African American women was 79% compared with 92% for their white counterparts.

As health care practitioners, we can help improve these outcomes. We play a major role in educating African American women about the importance of early screening, dispelling myths associated with breast cancer, and reducing fatalism. To do this effectively, we need to understand how breast cancer affects the lives of African American women and the ways they cope with a breast cancer diagnosis, which begins at diagnosis and continues through treatment and beyond.

Recognize the Impact of Fatigue
Research suggests that African American women may experience more fatigue than others with breast cancer, a condition that I’ve also observed in my own research. Rather than ordinary fatigue, they feel cancer-related fatigue—a form more distressing and severe and less likely to be relieved by rest.

For the women in our study, cancer-related fatigue began soon after their second chemotherapy treatment or midway through radiation. Symptoms worsened as treatment progressed, affecting their daily function. Their fatigue made it difficult to engage in the mental processes needed to complete simple tasks, make routine personal decisions, and balance work and health responsibilities.

Though our research involved a limited number of participants, our findings offer insights that can help health care practitioners become better prepared to treat African American women with breast cancer and address their cancer-related fatigue symptoms.

Encourage Open Communication
Interactions with health care practitioners are crucial to alleviating the fatigue African American women experience during breast cancer treatment. We can ask the women to rate their level of fatigue on a scale to gauge its severity, but the best approach is to ask them to describe it, and explore the fatigue experience from a qualitative perspective. For example, how does the fatigue make them feel, and what are they doing about it?

In our study, the response was “real talk,” a common term in the African American community to describe how people speak candidly and without reservation about their feelings. The women used words like these to describe how cancer-related fatigue made them feel: disconnected, depressed, tired, burned out, weak, broken down, and washed out.

Recognizing the terminology African American women use allows health care practitioners to determine the medical implications of the words and helps build understanding and trust between patients and their nurses and doctors. It is equally important that health care practitioners convey empathy and validate what they hear, including what African American women are conveying about their fatigue symptoms. We need to acknowledge the fatigue African American women experience and have open communication with them so their symptoms can be made more tolerable and manageable.

Consider Alternative Treatments
Many of the African American women in our study shared with us that the medications they were prescribed to combat fatigue were of limited benefit or made them feel worse. In contrast, choosing to exercise (such as walking) helped relieve their symptoms. Despite feeling too weak and tired to exercise, the women discussed how they pushed through the fatigue because they knew exercise would be beneficial to their health. This is consistent with past research indicating that walking has a positive effect on fatigue related to breast cancer. With permission from their physicians, the women also turned to alternative treatments, such as vitamins and supplements, herbal remedies, natural teas, and acupuncture.

Their experiences tell us that medication is only one option available to relieve fatigue. As health care practitioners, we should consider incorporating complementary therapies that may offer benefits to African American women undergoing breast cancer treatment.

Understanding the Power of Prayer and Community
More than anything else, faith and prayer helped the women in our study cope with breast cancer’s overwhelming effect on their lives. Their spiritual identity made both their diagnosis and cancer-related fatigue seem more manageable.

No woman should go through breast cancer alone, and studies show that African American women rely on a wide social network that includes their church, family, friends, and faith-based, Afro-centric support groups. Joining a group of women who have similar backgrounds and experiences can help spiritually, psychologically, and emotionally. Afrocentric support groups also offer a venue where nurses and oncologists can educate women about breast cancer and fatigue related to treatment. Other health care practitioners, such as physical therapists and nutritionists, should be invited to the support groups for a more comprehensive approach.

Provide Culturally Appropriate Care
Addressing racial disparities and quality of life issues for African American women with breast cancer calls for culturally appropriate care as well as effective outreach in the African American community. Health care practitioners who are part of the community and culture may better understand how to access and educate women about breast cancer screening and treatment.

Research studies support the idea that African American women are more comfortable relating their experience with breast cancer to health care practitioners who are from their same ethnic, racial, or cultural background. In a previous study I conducted, the African American women were more comfortable with breast cancer education and sharing of health tips when they heard them from African American health care practitioners and their peers. Unfortunately, the number of African American health care practitioners today is low. To provide culturally sensitive breast cancer education and care for African American women, we need to encourage more African Americans to become oncology nurses and enter related health care fields.

Breast cancer continues to take its toll on African American women, but the outlook is improving. Nurses and other health care practitioners have made significant strides in educating African American women about the disease and decreasing fatalistic views. Since 2000, screening has increased, and breast cancer is being detected earlier. Further research and better understanding of the fear, fatigue, and coping strategies of African American women with breast cancer will help us continue to build on this progress and provide better care.

Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, is a nurse educator, certified family nurse practitioner, and researcher focused on African American women’s health issues. She is the coordinator for the Family Nurse Practitioner specialization at Walden University and a nurse practitioner in northern Virginia for Minute Clinic.

Many Adults Ignoring Recommended Cancer Screening Tests

Many Adults Ignoring Recommended Cancer Screening Tests

Many adults in the United States are not getting the recommended screening tests for colorectal, breast, and cervical cancers, according to data published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. For 2013, screening for these types of cancers either fell behind previous rates or showed no improvement.

Among adults in the age groups recommended for screening, about 1 in 5 women reported not being up-to-date with cervical cancer screening, about 1 in 4 women reported not being up-to-date with breast cancer screening, and about 2 in 5 adults reported not being up-to-date with colorectal cancer screening.

The report found that colorectal cancer testing was essentially unchanged in 2013 compared with 2010. Pap test use among women aged 21 to 65 years was lower than in 2000, and the number of mammography screenings was stagnant, showing very little change from previous years.


“It is concerning to see a stall in colorectal cancer screening rates,” says Lisa C. Richardson, MD, MPH, director of CDC’s Division of Cancer Prevention and Control. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”
Researchers reviewed data from the National Health Interview Survey 2013, which is used to monitor progress toward Healthy People 2020 goals for cancer screening based on the most recent U.S. Preventive Services Task Force guidelines.

The screening data for 2013 show that 58.2% of adults aged 50 to 75 years reported being screened for colorectal cancer; 72.6% of women aged 50 to 74 had a mammogram; and 80.7% of women aged 21 to 65 had a Pap test. All of these percentages are below the Healthy People 2020 targets.
The report found that adults without insurance or a usual source of health care generally had the lowest screening test use. For example, less than one quarter of adults in these groups reported recent colorectal cancer screening, compared with more than 60% of adults with private insurance or a usual source of health care. More efforts are needed to achieve cancer screening goals and reduce screening disparities.

The authors did report some good news: the proportion of women in the highest education and income groups who were screened for breast cancer exceeded the Healthy People 2020 target, and the proportion of people aged 65 to 75 who were screened for colorectal cancer was also near the target.
Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as screening for some cancers that may be covered with no additional costs. Visit Healthcare.gov to learn more.

Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

Breast Cancer Prevention Beyond Mammograms: Addressing Root Cause

When Americans think of breast cancer, most consider it to be like a game of craps. If a woman is lucky she will avoid breast cancer during her lifetime, but if she is unlucky, then she may be diagnosed with this dreadful disease. This philosophy on breast cancer is unfortunately perpetuated in the United States health care system.

We doctors, nurses, and other health professionals learn early in our educations that breast cancer is virtually inevitable for many women. Currently, the lifetime risk of breast cancer in an American woman is about 12%. In other words,  a female born in the United States has about a 1 in 8 chance of developing breast cancer during her lifetime.1 This is one of the highest breast cancer rates in the entire world. It is well known that rates of breast cancer are substantially lower in many developing countries where diets consist of more plant-based whole foods (and less animal-based foods) and where lifestyles are generally less sedentary. For example, compared with a 12% lifetime breast cancer risk in the US, there is only a 3% lifetime risk in East Asia, Central and sub-Saharan Africa, and Western sub-Saharan Africa.

In the United States, our approach to breast cancer is tailored around its inevitability. As a result, instead of investing substantial research into dietary and lifestyle prevention of this disease, we prefer to focus instead upon early diagnosis and treatment. Techniques used for diagnosis most often include physical examination, mammography, ultrasound, and biopsy procedures. Such screening simply identifies cancers that have been around long enough that they have grown to where they can be detected. Breast cancer treatments often include surgery (e.g., mastectomy or lumpectomy), radiation, and chemotherapeutic agents. These approaches to breast cancer are unfortunately reactive, similar to how we typically approach many other diseases in our country, including heart disease, stroke, and hypertension.

“Wait until the disease is diagnosed. Then prescribe drugs and perform surgery.”

This approach ignores the root causes of these diseases, which is principally our diet and lifestyle.

Key risk factors for breast cancer include early age of menarche, late age of menopause, high levels of female hormones in blood, and high blood cholesterol. These were confirmed in the China Study and have been documented in many other research studies.2 With the exception of the blood cholesterol, these risk factors are all related to exposure to excess female hormones, such as estrogen and progesterone, which increases breast cancer risk. Women who consume diets rich in animal-based foods and relatively low in plant-based whole foods have menarche earlier and menopause later, resulting in greater lifetime exposures to estrogen. This explains why research has shown that lifetime exposure to estrogen is 2.5-3 times higher among Western women when compared with rural Chinese women.2 Estrogen is a direct participant in the breast cancer process.3 Its levels are a key determinant of breast cancer risk. High levels of estrogen and other female hormones result from consuming typical Western diets, high in fat and animal protein, but low in dietary fiber.4 This research strongly suggests that the risk of breast cancer can be markedly reduced simply by eating foods that keep estrogen levels at lower levels than is typical with the Standard American Diet (SAD).

Instead of addressing preventable dietary causes of breast cancer, we prefer to discuss other risk factors, including genes, hormone replacement, and environmental toxins. While it is true that genes play a role in breast cancer, it is wrong for women to feel that if they have a family history of breast cancer, there is nothing they can do to decrease their risk. This is simply untrue and it removes personal responsibility from the equation. In truth, most breast cancer is much more strongly tied to diet and lifestyle than to genes. Even in women who have so-called “breast cancer genes,” those genes would need to be expressed in order for breast cancer to manifest. Whether such genes are expressed is closely related to one’s diet and lifestyle.5 Hormone replacement therapy is considered a risk factor for breast cancer. As discussed previously, exposure to female reproductive hormones during the course of a woman’s life increases her breast cancer risk. Therefore, it is no surprise that administering these hormones as therapy in postmenopausal women would also increase breast cancer risk. The good news is that consuming a plant-based diet (as opposed to the typical American animal-based diet) reduces the abrupt hormone changes that typically cause menopausal symptoms and may make such hormonal therapy unnecessary in many women.5 Environmental chemicals such as dioxins, Polychlorinated Biphenyls (PCBs), and Polycyclic Aromatic Hydrocarbons (PAHs) have also been discussed as increasing a woman’s breast cancer risk. While such chemical exposures may contribute to carcinogenesis, it is important to realize that with similar chemical exposures, a plant-based diet has been shown to be protective against cancers, while an animal-based diet is more conducive to cancer cell growth.5

A review of more than sixty research studies suggests that premenopausal and postmenopausal women who exercise regularly may reduce their incidence of breast cancer by 20-40%.6 Also, a study of nearly 3,000 nurses with stages 1, 2, or 3 breast cancer published in The Journal of the American Medical Association indicated that simply walking three to five hours per week reduced the risk of breast cancer by 26 to 40%.7

Stress also seems to play a role in breast cancer. A study following nearly 60,000 African American women for six years found that women who reported feelings of racial discrimination were more likely to develop breast cancer than their peers.8

In summary, based on much research to date, there is reason to believe that the following may significantly reduce your risk of breast cancer … and that of your patients:

  1. Depart from the SAD, which is high in animal-based and processed foods, and instead adopt a plant-based, whole-food diet that is high in nutrients and fiber.
  2. Engage in regular exercise.
  3. Reduce your stress levels through prayer, yoga, meditation, and mutually supportive relationships.

Don’t sit back and let breast cancer find you. Be proactive and reduce your risk of this terrible disease in the first place. As health care providers, we can do more than merely suggest mammograms for our patients. We must educate them on dietary and lifestyle changes to prevent this terrible disease from happening in the first place.

References

  1. Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet. 2011 Oct 22;378(9801):1461-84.
  2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; People’s Medical Publishing House; 1990.
  3. Bocchinfuso WP, Lindzey JK, Hewitt SC, et al. Induction of mammary gland development in estrogen receptor-alpha knockout mice. Endocrinology. 2000 Aug;141(8):2982-94.
  4. Adlecreutz H. Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest Suppl. 1990;201:3-23.
  5. Campbell TC, Campbell TM II. The China Study. BenBella Books; 2006.
  6. Exercise and malignancy: Can you walk away from cancer? Harv Mens Health Watch. 2006 Nov;11(4):4-6.
  7. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86.
  8. Taylor TR, Williams CD, Makambi KH, et al. Racial discrimination and breast cancer incidence in U. S. black women: The Black Women’s Health Study. Am J Epidemiol. 2007;166(1):46-54.
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