When Cassandra Valentine found a lump in her breast at the age of 37, the furthest thought from her mind was that it could be cancer. Luckily, her mother advised her to go to the doctor right away and get it checked out. It turned out that she had a stage III ductal carcinoma which was very aggressive. Although, breast cancer is less common in African American then Caucasian women, it is often discovered at a more deadly stage. Thus it is imperative that all African American women follow the have any suspicious lesions investigated further.
Researchers have found that rates of mammography screening improved for U.S. women of all races during the 1990s, however, African Americans were less likely than whites or Hispanics to have their cancer diagnosed at an early stage, when it was still confined to the breast tissue. Several studies have also suggested that breast tumors may be more aggressive in black women. Researchers have also shown that breast tumors diagnosed in black women are four times more likely to have alterations in a gene linked to poor survival than in tumors in white women. These changes in the gene, called p53, are more prevalent in black female breast cancer patients. P53 is a tumor suppressor gene and protects cells from damage or mutations that can lead to cancer. Changes in the p53 gene lead to loss of this protection.
Breast Cancer and African American Women
Breast cancer is the most common malignancy (other than skin cancer) among American women. In fact, 1 in 8 women will develop breast cancer in her lifetime. Although White women develop breast cancer at higher rates than African American women do, it is important to realize that African American women have a higher likelihood of dying from the disease. According to a National Cancer Institute study, African American women were 2.2 times more likely to die from breast cancer than their White counterparts.
Breast cancer is the most common malignancy (other than skin cancer) among American women. In fact, 1 in 8 women will develop breast cancer in her lifetime. Although White women develop breast cancer at higher rates than African American women do, it is important to realize that African American women have a higher likelihood of dying from the disease. According to a National Cancer Institute study, African American women were 2.2 times more likely to die from breast cancer than their White counterparts.
The poorer outcomes with regard to breast cancer in African American women have been historically attributed to the more advanced stage of disease at the time of presentation for medical attention. This, however, does not totally explain the differences. Factors that contribute to the risk of developing breast cancer and the poorer outcomes of African American women with the disease are not completely understood.
What is Breast Cancer?
The human breast is composed of milk producing sacs (called lobules) and channels (called ducts) which drain to the nipple. Breast cancer is an abnormal growth of cells within the breast and is referred to as a malignant tumor.
The human breast is composed of milk producing sacs (called lobules) and channels (called ducts) which drain to the nipple. Breast cancer is an abnormal growth of cells within the breast and is referred to as a malignant tumor.
Breast cancer arises in the ducts in about 85% of cases (ductal breast cancer) and in the lobules in about 10-15% of cases (lobular breast cancer). When cancer begins in either the duct or the lobule and remains confined to that area, it is known as non-invasive or in situ cancer (e.g. ductal cancer in situ (DCIS) = non-invasive ductal cancer; lobular cancer in situ (LCIS) = non-invasive lobular cancer).
Once the cancerous tumor cells invade through the wall of the duct or lobule it is known as invasive or infiltrative cancer.
What Are the Risk Factors for Developing Breast Cancer?
| Risk Factor | Effect on Developing Breast Cancer |
| Gender | Simply being a woman puts you at risk. Breast cancer is 100 times more common among women than men. |
| Age | The risk of breast cancer increases with age. 50% of women who get breast cancer have no identifiable risk factor beyond gender and age. |
| Hereditary/Genetic Factors | Only 1-5% of breast cancer is hereditary, but there is definitely an increased risk among women whose close relatives have had breast cancer. Women who are diagnosed at an earlier age are more likely to have a hereditary basis to their cancer. |
| Hormones | Breast cancer is clearly related to hormonal factors. Early menarche (age when your periods begins) and late menopause increase the risk of breast cancer. There is no convincing evidence that the use of birth control pills increases the risk of breast cancer. Two recent analyses show a small but significant increase in the risk of breast cancer with the use of hormone replacement therapy after menopause. It is unclear whether this risk outweighs the benefits of hormone replacement therapy. |
| Nutrition | Specific studies of Black women show that high dietary fat and the tendency toward obesity may increase the risk of developing breast cancer. Excessive alcohol consumption increases the risk of developing breast cancer. |
| Environmental Factors | Exposure to radiation, active or passive tobacco smoking and certain pesticides are all known to increase the risk of breast cancer. |
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How Can You Be Tested?
Mammography
Mammograms are x-rays focused on the breast. Mammography is most often used as a screening tool for breast cancer in a woman who has no symptoms. Though mammograms do not show every breast mass, it is a very good tool for initial screening. There is a general consensus that women age 50 and older should get a mammogram annually. There is some controversy as to how often women age 40-50 should have a screening mammogram, but the American Cancer Society now recommends a mammogram every year for women over 40.
Mammograms are x-rays focused on the breast. Mammography is most often used as a screening tool for breast cancer in a woman who has no symptoms. Though mammograms do not show every breast mass, it is a very good tool for initial screening. There is a general consensus that women age 50 and older should get a mammogram annually. There is some controversy as to how often women age 40-50 should have a screening mammogram, but the American Cancer Society now recommends a mammogram every year for women over 40.
During a mammogram, the breast is compressed or flattened and a x-ray is taken, producing a black and white image of the breast. A radiologist will then look at the x-ray focusing on areas of calcium deposits (also called calcifications or micro-calcifications) or masses.
Mammography can also be used as a diagnostic tool to evaluate changes in the breast found on examination.
Breast Self Exam (BSE)
Women discover most breast masses by themselves during the breast self-examination. This exam allows a woman to become more familiar with her breast, making the detection of subtle changes or abnormalities easier. It is important to remember that most masses discovered are not cancerous, but they should be brought to the attention of your health care provider.
Women discover most breast masses by themselves during the breast self-examination. This exam allows a woman to become more familiar with her breast, making the detection of subtle changes or abnormalities easier. It is important to remember that most masses discovered are not cancerous, but they should be brought to the attention of your health care provider.
How often and when should the BSE be done?
Experts recommend monthly self-examination of the breasts. The BSE should be done 7-10 days from the beginning of your menstrual cycle. If your periods are not regular, perform the BSE on the same day each month.
How is the BSE done?
- Start by standing in front of a mirror. Inspect each breast separately. Note any asymmetry of size, contour, color, or shape.
- Raise your hands over your head. Note any changes, particularly in the skin, such as wrinkling, dimpling, or retraction in a specific area.
- Lie down with a pillow under your right shoulder and place your right arm behind your head.
- Place the finger pads of the three middle fingers of the left hand on the outer part of your bare right breast.
- Using small dime-sized circular motions without lifting your fingers, press first with light pressure then with medium pressure, and finally with firm pressure. You should be able to feel different layers of breast tissue using these different pressures. Make note of any masses or abnormalities that you feel.
- In this same fashion, examine all areas of the breast and chest area from the collarbone to below the breast and including the armpit. You can do this by going in lines, circles around the nipple, or wedges from the nipple. Whichever method you choose, do it the same each time.
- Once you are finished examining the breast, gently squeeze the nipple and look for any discharge. (Note: Overstimulation of the nipple may cause a normal discharge).
- Switch positions and examine the left side in the same way.
Clinical Breast Examination by Your Doctor or Health Care Provider
As part of routine screening, a thorough physical examination of the breasts by a physician or health care provider who is familiar with breast disease is recommended. This should be done annually for women over 40 and every three years for women 20-39.
As part of routine screening, a thorough physical examination of the breasts by a physician or health care provider who is familiar with breast disease is recommended. This should be done annually for women over 40 and every three years for women 20-39.
Currently the American Cancer Society recommends an annual mammogram, clinical breast exam and monthly BSE for women starting at age 40. Women between ages 20 and 39 are recommended to have a clinical breast exam every three years and monthly BSE.
What Happens if a Suspicious Lump is Found?
While a mammogram or examination can identify a suspicious lump or mass, neither test can establish with certainty the presence of cancer. Biopsy (obtaining cells or tissue from the tumor) is the only way to tell if cancer is really present. In some cases, a more detailed mammogram or ultrasound may be completed prior to biopsy.
While a mammogram or examination can identify a suspicious lump or mass, neither test can establish with certainty the presence of cancer. Biopsy (obtaining cells or tissue from the tumor) is the only way to tell if cancer is really present. In some cases, a more detailed mammogram or ultrasound may be completed prior to biopsy.
Types of Biopsies:
Fine Needle Aspiration (FNA): A thin needle is guided into the area of the mass either by direct palpation or guided by an ultrasound or mammogram. Once the needle is in place, fluid and/or cells are drawn out. This procedure can be performed in the doctor’s office.Core biopsy: This procedure is similar to the FNA but uses a larger needle and can provide more details of the cellular environment.Surgical biopsy: This is a surgical procedure performed under general or local anesthesia with sedation. The entire lump (excisional biopsy) or part of the lump (incisional biopsy) is removed.Once the biopsy is taken, it is reviewed under a microscope and special tests for estrogen, progesterone, and certain genes are done.
Treatment Options
In the treatment of breast cancer, two areas are important to consider and they can be classified as local and systemic treatment.
In the treatment of breast cancer, two areas are important to consider and they can be classified as local and systemic treatment.
Local treatment to the breast and surrounding areas is aimed at keeping the tumor from coming back to the breast or chest wall. Surgery and radiation are two types of local treatment. They can sometimes be combined for more effective treatment of some conditions of the breast.
- Surgery in the form of lumpectomy (when the lump is removed) or mastectomy (when the entire breast is removed) may be used after an initial biopsy that reveals cancer.
- Radiation therapy is treatment with a high-energy x-ray given to kill tumor cells that may remain in the breast, chest wall, or lymph nodes following initial biopsy or surgery.
Systemic treatment is aimed at keeping the tumor from coming back in other areas of the body. Chemotherapy and hormonal therapies are examples of systemic anti-cancer drug treatment that reaches the cancerous cells through the bloodstream.
Empowerment Points
Breast cancer is the most common malignancy (other than skin cancer) among American women. It affects a number of women in our community each year. While we cannot change two important risk factors for breast cancer (gender and age), the following recommendations are critical steps to help decrease your risk of breast cancer. :
Breast cancer is the most common malignancy (other than skin cancer) among American women. It affects a number of women in our community each year. While we cannot change two important risk factors for breast cancer (gender and age), the following recommendations are critical steps to help decrease your risk of breast cancer. :
- Avoid Smoking
- Avoid Excessive Alcohol Consumption
- Reduce Your Dietary Fat Intake.
- Learn how to perform a Breast Self Exam (BSE).
- Please remember that screening is very important! African American women often wait too long to get medical attention. Early detection leads to better outcomes
- If you are over 40, make sure you get an annual mammogram, clinical breast exam, and do monthly breast self exams.
- If you are between 20 and 39, have a clinical breast exam every three years and conduct monthly breast self exams
- Keep a copy of your test results as you may change insurance plans or jobs.
- Follow-up on your tests results in a timely manner.
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