By S. E. Williams
The journey starts in many ways—a small lump felt while drying after a shower; a nagging nipple itch and discharge; abnormal mammogram results—all indications that beckoned toward a journey no one wants to take; but, sadly too many do.
This is not information gleaned from research; but, the real life experiences of women very close in this reporter’s life. Marie received the news from her doctor by telephone the night before Thanksgiving four years ago. Sarah was told by her physician when she squeezed an appointment in ahead of a daily visit to her dying mom. Ellen’s doctor discovered her lump during a quick examination of her breasts during her monthly visit for a B12 shot; while Josephine’s breast cancer was caught during a routine mammogram.
This year according to the Susan G. Komen Foundation nearly 300,000 women (and some men) will join their loosely affiliated club of warriors, a club of survivors whose membership is a testament to strength and determination.
New members quickly become schooled in the meaning of such terms as invasive, in situ, ductal and lobular carcinoma. They are taught to better understand the various “stages” of the disease; and, then spend anxious hours contemplating the relationship between the “stages” and their own mortality. They carefully weigh various treatment options that can include any combination of surgery, chemotherapy, radiation and pills; and then weigh that treatment against potential risks factors that can include loss of breast(s); loss of lymph nodes; loss of hair; loss of appetite; vomiting; weight loss, weight gain and the list goes on and on. In some instances, women even lose a spouse.
They will consider lifestyle changes relative to how they manage stress, eat, exercise and sleep. Most will subconsciously navigate their way through the emotional stages defined in Helen Kubler-Ross’s epic work on Death and Dying. They include denial, anger, bargaining, depression and finally acceptance of their illness.
Any yet, in nearly every instance these women find the courage to rise and embrace life in spite of this challenge—they fight to beat the odds.
According to the Center for Disease Control (CDC) breast cancer is the second leading cause of cancer deaths among women in the United States. However for some the news is not completely bad, breast cancer deaths are actually going down the fastest among White women when compared to other races and ethnic groups, particularly African American women.
Forty thousand women die of breast cancer each year in America with Black women having the highest death rate among all women. Black women are 40 percent more likely to die of breast cancer than White women. The reasons for the differences in death rates are many; however, it is most important to point out that it has little to do with screening. According to the CDC, Black women get mammograms as often as White women but they are found to have breast cancer that has spread beyond the breast 45 percent of the time compared with 35 percent of the time in White women.
Unfortunately, more Black women (20 percent) wait over 60 days to follow up on abnormal mammograms compared to only 12 percent for White women who wait. Experts report the longer one waits before seeking follow up care may lead to cancers that spread beyond the breast and are harder to treat.
Starting treatment as soon as possible after the cancer is found is important. Sadly, Black women are behind in this area as well. Only 69 percent of Black women start treatment within 30 days compared to 83 percent of White women.
Another factor impacting Black women in this area may be the issue of dense breast tissue. Black women are much more likely to have dense breast tissue. Research shows dense breast tissue makes it harder to detect breast cancer via mammograms. The tissue is also believed to increase risks for the disease.
In 2013, California became the fifth state (there are now 21) to implement a law requiring health care providers to advise women whose mammogram reveals dense breast tissue with the following written notification: “Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.” This information now empowers women to act as their own advocates—remember it’s the law. Women should be sure to ask their radiologist and/or primary physician about this.
Also in 2013, a breakthrough study showed 20 percent of Black women with breast cancer carry the BRCA mutation, a mutation that greatly increases their risk of developing breast and/or ovarian cancer—the same mutation that prompted the actress Angelina Jolie to have a double mastectomy.
Testing for this mutation could save countless lives, especially the lives of African American women. Sadly, however, the bio-pharmaceutical company Myriad Genetics has patented both the BRCA1 and BRCA2 genes. As a result, the genetic testing is grossly expensive—reportedly costs can be in the thousands of dollars.
Research also identified other risk factors that can possibly be controlled by women themselves. For example, research shows that breastfeeding can lower breast cancer risks. Sadly and statistically speaking, Black women are less likely to breast feed than their White counterparts. According to the CDC, in 2010 only 62 percent of Black babies were breast fed compared to 79 percent of White babies. Breast feeding is important for mother and baby.
Research also shows a link between obesity and risks of several types of cancer, including post menopausal breast cancer. In addition, research has shown girls who eat high-fat diets during puberty are at increased risk of developing breast cancer.
Make sure all the women you love have clinical breast exams every three years in their 20’s and 30’s; and, every year after 40—the same age they should also begin yearly mammograms. For breast cancer survivors it is important to have diagnostic as opposed to imaging mammograms.
All women should do self breast examinations; get to know the feel and shape of their breasts, so they can report any changes to their doctors.
Collectively, the news about breast cancer and African American women is concerning. According to the CDC, for women who were diagnosed with breast cancer between 2005 and 2011, the five-year relative survival rate for breast cancer among African-American women was 81 percent compared to 92 percent among White women. However, not all news is bad. Although the survival rate for African American remains lower than the survival rate for White women it does continue to increase.
The breast cancer survivors in my life are women warriors in the true sense of legends. As the fierce author, activist, poet and breast cancer survivor Audre Lorde wrote of the African goddess Seboulisa, she stood “with outstretched palms hip high one breast eaten away by worms of sorrow.”
For more information on breast cancer visit http://www.cdc.gov/cancer/breast/ and for additional information on dense breast tissue visit http://pinklotusbreastcenter.com/breast-cancer-101/2013/05/the-california-breast-density-law/