Breast Cancer Awareness Month 2021: Rally In Supporting, Serving and Screening Everyone

Epidemiologist discusses breast cancer risk factors, common misconceptions, and how often we should be screening for symptoms.

By Katherine Gianni

October is Breast Cancer Awareness Month, an annual initiative that invites survivors and supporters from around the globe to learn more about the impacts of breast cancer, life-saving screenings, and research breakthroughs aimed at preventing, treating, and curing the disease. The National Breast Cancer Foundation’s call to action for the 2021 campaign is RISE — Rally In Supporting, Serving and Screening Everyone. Dr. Kimberly Bertrand, an epidemiologist and associate professor of medicine within Boston University’s School of Medicine highlights the importance of this call to action through all aspects of her work.

Dr. Bertrand’s research focuses primarily on the epidemiology of breast cancer, with an emphasis on understanding racial disparities in incidence and outcomes. She currently serves as a co-Investigator with the Black Women’s Health Study (BWHS), a prospective cohort study of over 59,000 African American women. Since 1995, the information provided by BWHS participants has been used to investigate various health issues and has resulted in many research publications that have contributed to the understanding of Black women’s health. Recently, Dr. Bertrand and her BWHS collaborators investigated the links between chemical hair relaxing products and increased breast cancer risk.

“Overall, our results are generally reassuring: we found no clear evidence that hair relaxer use is associated with breast cancer risk for most women,” Bertrand said in an interview on the research. “However, there was some evidence the heaviest users of lye-containing products — those who used these products at least seven times a year for 15 or more years, which represented approximately 20 percent of women in our study — had about a 30 percent increased risk of estrogen receptor–positive breast cancer.” Are there other risk factors we should be concerned about? How can we best prepare for screenings, or work to slow cancer progression? For answers to these questions and more, we turned to Dr. Bertrand to share her expertise and recommendations.

Photo by Angiola Harry on Unsplash.

What is breast cancer? Can it occur in both women and men?

Breast cancer occurs when cells in the breast grow out of control. These cells don’t look or behave like normal cells and they have the potential to spread to other parts of the body. Both men and women can get breast cancer, but being female is the strongest risk factor. Less than 1% of all breast cancers diagnosed in the U.S. occur in men.

How often should we be screening for breast cancer? When should these exams or self-checks begin?

Screening guidelines differ somewhat between medical organizations, but most recommend annual or biannual mammography beginning at age 50, 45, or 40. Some women with a very strong family history or who are otherwise at high risk may be recommended to start screening even earlier. Women should talk to their health care provider about what screening strategy makes sense for them. While breast self-exams are important for women to learn how their breasts normally look and feel, they are not a substitute for regular mammography.

What is a mammogram? How can you best prepare for this type of screening?

A mammogram is a low-dose X-ray of the breast, which allows doctors to visualize abnormalities in the breast tissue. The purpose of a screening mammogram is to detect small breast tumors earlier than they might be felt as a lump. The mammogram machine is a bit intimidating. A technician will help you position your breasts (one at a time) on a chest-high plastic plate. Then a top plate will be lowered to compress the breast fairly firmly. You have to hold your breath for a few moments while the X-ray is taken and then the plate is released.

Some women feel discomfort; others describe pain. To prepare for this type of screening, try not to schedule your appointment the week before or during your period, when your breasts may be more sensitive. Ask your doctor if it’s okay to take a Tylenol ahead of time. Also, don’t wear deodorant as this can interfere with the X-ray image.

Can physical activity reduce the risk of breast cancer?

Some studies have suggested that women who are more physically active have a lower chance of developing breast cancer. There is also strong evidence that physical activity can greatly improve survival in women diagnosed with breast cancer.

Photo by Peter Boccia on Unsplash.

What are some common breast cancer misconceptions?

Myth #1: Wearing underwire bras or using antiperspirants can cause breast cancer.

There is no scientific evidence to support a link between bras or antiperspirants and breast cancer.

Myth #2: Most breast cancers are due to family history.

In fact, about 85% of breast cancers occur in women who have no family history of breast cancer.

Myth #3: A lump in the breast is likely to be cancer.

Most lumps in the breast are benign and are not cancer (i.e., cannot spread outside of the breast). Conversely, breast cancer might not initially present as a lump. Pain, redness, swelling, and nipple discharge are all symptoms that should be evaluated by a health care provider. Early breast cancer often shows no symptoms and is diagnosed by screening mammography.

Myth #4: Breast cancer is nearly always fatal.

Breast cancer mortality rates have been declining since 1989, largely due to increases in early detection and advances in medical treatments. The overall 5-year survival rate for breast cancer is 90% and many women survive much longer. Survival rates are even higher if the cancer is detected at an early stage. Despite overall improvements in survival, important disparities remain: compared to white women, Black women are 40% more likely to die of their disease.

Photo by National Cancer Institute on Unspalsh.

What are some of your top recommendations for breast cancer prevention or slowing progression?

There’s not much you can do to control some important breast cancer risk factors, such as age, high breast density, family history, and genes. But there are some things you can do to reduce your risk, including maintaining a healthy weight, eating a healthy diet, and limiting alcohol consumption. Some women at very high risk because of mutations in known breast cancer genes may choose prophylactic mastectomy which can reduce risk. For all women, early detection is the key to preventing death due to breast cancer because treatment is most successful when breast cancer is caught early. Therefore, routine screening with mammograms is the most important thing women can do to reduce their chances of dying from breast cancer.

For additional commentary by Boston University experts, follow us on Twitter at @BUexperts. Follow Dr. Bertrand at @kbertrand. For research news and updates from BU’s School of Medicine, follow @BUMedicine.

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