Breast Cancer: A Baffling Battle

by Molly M. Ginty

Whatever stage of life you’re in, and whether you’re physically fit or living with chronic illness, you can find ways to be a wise steward of your health and well–being. Our health and wholeness are important keys to responding to God’s call for us and acting boldly on that call. That’s why Women of the ELCA have embarked on a new health initiative: Raising up Healthy Women and Girls. This ongoing column represents our commitment to the issue of women’s health.

It strikes 14 percent of American women and claims 44,000 lives each year. It attacks without warning in three–quarters of cases, appearing in women with no known risk factors. Breast cancer —the leading cause of death among American women ages 34 to 44 and the focus of October’s National Breast Cancer Awareness Month — has confounded scientists for decades. And in light of recent developments, its causes, prevention, and treatment can seem as baffling as ever.

According to the Atlanta–based Centers for Disease Control and Prevention, the cases of breast cancer have spiked since 1950 (when one in twenty–two women were diagnosed with the disease, compared to one in seven today). Scientists have examined every possible cause from earlier onset of puberty to later age at first pregnancy. But they have yet to determine whether breast cancer is triggered by our genes, our health habits, environmental pollutants — or some combination of all these.

"Every day, we’re exposed to hundreds of carcinogens," says Dr. Marilie Gammon, an epidemiologist at the University of North Carolina, Chapel Hill. "But since these chemicals are at very low levels and since the timing of exposure is difficult to track, scientists have struggled to establish the link between breast cancer and the environment."

As researchers press on to find breast cancer’s cause, new discoveries are shooting down long–held theories about how to prevent this disease. In July 2002, the Women’s Health Initiative study found that hormone therapy to treat the symptoms of menopause, once believed to reduce breast cancer risk, actually increases the risk. In May 2003, the Atlanta-based American Cancer Society determined that monthly breast self-exams don’t reduce the number of breast cancer deaths and started recommending self–exams as an option — rather than a requirement — for most women.

"Breast cancer prevention is perplexing in that even prophylactic mastectomy (the removal of both breasts in the case of high–risk patients) fails to ward off the disease 100 percent of the time," says Judy Norsigian, executive director of Our Bodies Ourselves, a women’s health advocacy organization based in Boston.

Recent advances in treatment are also sparking questions of their own. Tamoxifen, the only drug approved for breast cancer prevention, reduces the risk of recurrence in postmenopausal women but may lead to blood clots and other complications. Aromatase inhibitors, new drugs that can dramatically diminish breast cancer incidence in high–risk women, are widely prescribed even though health activists say that their long–term effects have not been well studied. Meanwhile, older treatments continue to have their own drawbacks: nausea and hair loss for chemotherapy and inflamed, raw skin for radiation treatment.

At a time when breast cancer research may be raising more questions than it answers, what can women do to protect themselves?

"Plenty," asserts Barbara Brenner, the founder of Breast Cancer Action, an advocacy group based in San Francisco. "Women can study all these controversies — and make informed appropriate decisions to safeguard their own health. They can rest assured of what we do know for certain: that when breast cancer is diagnosed and treated in its early stages, the five-year survival rate is 95 percent."

The first line of defense? Taking preventive measures that are tried and true. These include getting three hours of exercise per week; eating nine servings of fruits and vegetables per day; drinking no more than one alcoholic beverage per day; and avoiding cigarettes, fatty foods, and repeated rounds of antibiotics. They include avoiding chemicals that have been linked to breast cancer: organic solvents (used to make computer parts); ionizing radiation (from X–rays and power lines); dioxin (produced by burning plastic); polycyclic aromatic hydrocarbons (found in auto emissions and tobacco smoke); polyvinyl chloride (PVC, found in plastics); and organochlorine pesticides (found in agricultural uses). They include getting a clinical breast exam once every three years if you are under forty, and getting a clinical exam and a mammogram (an X–ray of the breast) once a year if you are over forty.

The next step? Knowing your personal profile. If you use birth control pills or take hormone therapy, be aware that these drugs can slightly elevate your risk. If you have a grandmother, mother, or sister with breast cancer, know that your risk is double the norm. And if genetic testing reveals that you are among the 5 to 10 percent of women with defects of the BRCA1 or BRCA2 genes, have clinical breast exams once every six months and mammograms yearly beginning at age twenty-five.

Above all, watch for new breakthroughs. Scientists recently discovered that taking tamoxifen followed by the drug letrozole can cut the risk of recurrence in half — as can combining chemotherapy with the drug trastuzumab. Researchers are making new strides with biomarkers (proteins in the blood that indicate the presence of cancer and how it may behave), cutting off the blood supply to tumors (which stops their growth), and developing drugs that can fight cancer cells without damaging healthy ones. With time and more research, these advances could help us beat — and even reverse — the odds in our battle against breast cancer.

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

FOR MORE INFORMATION:
American Cancer Society
www.cancer.org

Breast Cancer Action
www.bcaction.org

Susan G. Komen Breast Cancer Foundation
www.komen.org

Article published in Lutheran Woman Today, October 2005