JOPLIN, Mo. —
Clearly, nothing is good about the fact that breast cancer is the most common cancer diagnosis in women. An estimated 227,000 American women will develop the disease in 2012. One fortunate outcome of this startling statistic, however, is the powerful community that has developed with one clear goal — to raise breast cancer awareness. This community, comprised of public and medical professionals alike, has become one of oncology’s success stories. It has raised both money and awareness, with the aim of eradicating a common disease.
It has been 30 years since Susan G. Komen for the Cure, one of the most well-known breast cancer advocacy groups, was established. In the decades since, October has become synonymous with breast cancer awareness, symbolized by the color pink. Thus, the reflective question arises: Have the goals of breast cancer awareness initiatives been achieved?
Although developed in the late 1960s, mammography did not become a standard screening tool until 1976. Even then it was not widely used. Throughout the 1980s, advocacy initiatives led to a dramatic rise in the use of routine screening mammograms. Today, an estimated 70 percent of American women undergo this all-important test. In addition, awareness of the importance of routine breast exams — both self-exams and those performed by medical professionals — has increased steadily. While these screening tools are not perfect, they have greatly affected the mortality of breast cancer.
Since 1990, the number of women dying from breast cancer nationally has decreased steadily. While some of this is because of more effective treatment, a substantial portion is because of early diagnosis. In terms of less-advanced cases — stage 0 through stage II — five-year survival rates are 75 to 95 percent; stage III through stage IV rates are 15 to 60 percent. For patients at Freeman Health System, from 1992 to 1996, only 48 percent of breast cancer diagnoses were stage 0 through stage II. From 2007 to 2010, a remarkable 80 percent of breast cancer diagnoses were Stage 0 through Stage II. These numbers mirror the national trends. While our ability to cure breast cancer at any stage is improving, there is absolutely no doubt that earlier diagnosis leads to higher potential for a cure. Breast cancer awareness initiatives have clearly helped to achieve this goal.
Where we are still missing our mark, both in medical and advocacy communities, is prevention. While mammograms and breast exams can detect cancer at an earlier stage, they cannot prevent breast cancer. Again, the “good” of breast cancer being so common is that research has been able to identify clear risk factors for the disease — several of which are modifiable. Well-established ways to reduce the risk of developing breast cancer include reducing body mass index, particularly after menopause; regular physical exercise, especially before menopause; minimizing alcohol intake; quitting tobacco use; and limiting hormone replacement therapy after menopause to four years or less, if at all.
Furthermore, several preventive medications are available for women at an increased risk of developing breast cancer. Tamoxifen and raloxifene decrease the risk of breast cancer by about 40 percent for those who are at greater risk. In a different class of drugs, exemestane decreases the risk by 60 percent. In general, these medications are safe and well-tolerated, although the decision to use them should involve an estimation of breast cancer risk based on a clinical evaluation and careful discussion with a provider accustomed to prescribing these medications.
Clearly, continued attention should be given to improving the quality of and access to routine screening. Hopefully, though, with increased awareness of how women can reduce risk, prevention will be the new success story of breast cancer awareness initiatives.
Dr. Elizabeth C. Kent is a medical oncologist and co-medical director at Freeman Cancer Institute.