Breast Cancer Series Wrap Up & Prayer

March 18, 2023

Breast Cancer Series

Wrap Up and Prayer

by Jamal Ross

Our journey to discover more about breast cancer has been long, but I hope you have learned something that will prevent this disease from taking a hold of your life and those around you. Our breast cancer series cover many areas of this topic including risk factors, symptoms, screening methods, biopsy types, genetic testing and treatment for the most common breast cancer types, specifically DCIS and invasive breast cancer. Let’s review these topics one more time.

There are several risk factors that are important to recognize to help prevent breast cancer. Some risks we can change and others we cannot. Gender, race, age and genetics are considered non-modifiable risk factors, or risk factors we cannot change. Remember, breast cancer is 100 times more common in woman than men and Caucasian woman, followed by African Americans, are at the highest risk of breast cancer. Breast cancer risk also increases with age. Women in their 60s and 70s are at the highest risk. When we look at lifetime exposure to estrogen, beginning your menstrual cycle at an early age and starting menopause later in life are considered risk factors. Since women with multiple children have less exposure to estrogen during pregnancy, there their risk of breast cancer is less. Use of estrogen or progesterone pills after menopause can increase the risk of breast as well, although the risk occurs after 3 years of use. Increased risk of breast cancer with an BMI greater than 30 only appears to be significant after they have reached menopause. Weight loss, regular exercise, adequate vitamin D, tobacco cessation and decreased alcohol use can go a long was in decreasing breast cancer risk as well.

Recognizing breast cancer symptoms are important, but it is even more important to detect breast cancer at its early treatable stages before symptoms develop. The classic symptoms of breast cancer involve a hard, immovable mass with boarder that feels irregular. There may also be bloody nipple discharge. Self-breast exams are still of value and It is important to look for breast asymmetry, dimpling of the skin and any hard masses as breast cancer can spread to the lymph nodes under your arms. up to 15% of woman will have breast cancer without a mass found on mammogram. Additionally, another 30% of woman may have a mass found between mammograms. Knowing the signs of breast cancer is an extra step you can step to help know if you at risk for this disease.

The most common form of hereditary breast is that which involves the BRCA mutation. BRCA stand for the BReast CAncer gene. The BRCA 1 and 2 gene mutations are the most common inherited breast cancer syndromes, representing 5-10% of all breast cancers. Those with the BRCA mutation have a 50 – 87% risk of developing breast cancer and 20 -45% chance of developing ovarian cancer in their lifetime. Removal of the breast and ovaries can be used as a preventive strategy to fight breast cancer in this high-risk group. Notwithstanding, such strategy is extremely personal and should be balanced against family planning considerations. Genetic testing should be considered for those with a family member known to have a BRCA gene mutation, an immediate family member that had cancer in both breasts, any family member that has both breast and ovarian cancer or any male family members with breast cancer. Genetic testing should also be considered if 2 or more members your immediate family (parents, siblings or children) that had breast cancer before the age of 50.

Screening for breast cancer is performed with a mammogram. A mammogram is an x-ray of the breast that can detect either harmless cysts or calcium build up that may be concerning for cancer. A mammogram result is expressed as a BIRADS score. BIRADS stands for “Breast Imaging Reporting and Data System” and was developed by the American College of Radiology to create a standardized and easy to follow method for reporting all mammogram results.  Between the ages of 50-74, most medical societal guidelines recommend breast cancer screening with a mammogram once every 2 years. A mammogram is only recommended every 2 years if there are no concerning abnormalities; otherwise, mammograms can be performed yearly or every 6 months and include an ultrasound. Women with the BRCA mutation should have a breast MRI at the age of 25 or a mammogram at the age of 30. A BIRADS score of 1 is considered normal and without any abnormalities.  A BIRADS score of 2 or 3 may have an “abnormality” that usually is harmless. Mammograms with BIRADS scores of 4 or 5 require further investigation with a biopsy. A biopsy can be performed with a fine or core needle, each with their own drawbacks and benefits. Results from a breast biopsy are typically not needed immediately and the discomfort associated with a core needle biopsy is worth the improved accuracy. Therefore, the core needle biopsy is the most common biopsy method.

Once a biopsy report is received there may be word in this report that may be difficult to understand, but there are some key phrases you can learn to help unravel the meaning of this report. First, you will need to become familiar with two terms, which are ductal carcinoma in situ and invasive breast cancer. Ductal carcinoma in situ, or local cancer of the breast duct, does not invade other structures and can be treated with breast conserving surgery and radiation. Invasive breast cancer has a tendency to invade other tissues and structures nearby. In general, most women with invasive breast cancer will require chemotherapy.  There are also some hormonal properties to your breast biopsy that can not only help personalize your treatment options, but also predict the success of a cure.  The most favorable breast biopsy is positive for estrogen and progesterone, but negative for HER2. It also is well differentiated. Those with the HER2 gene would not only receive chemotherapy, but also trastuzamab to help target therapy for those with invasive breast cancer. If the cancer cells are responsive to estrogen, then additional therapy with tamoxifen can be considered.

You have done a great job up to this point in educating yourself about breast cancer. Let’s not forget to trust God at every step in this process, both in giving us wisdom to prevent and well as treat this disease. Let me pray for you today. Open your heart and receive these words:

“Lord God we trust You. We know that you are God alone. There is nothing to hard for You. Your powerful, mighty and strong. We believe You and we believe you can do anything… heal anyone… and restore us. You have already restored us to Yourself through the blood and sacrifice of your son King Jesus. So, we thank you. Give us wisdom today. Guide our decisions. Guide our hearts. Some of us are trying to prevent a disease that has affected someone in our family. Give us wisdom for this moment. Some of us have this disease, but we don’t own it. Instead, we give it to You. We give You all our burdens. Give us strength for this moment. We look towards you for all of our help. Our eyes remain fixated on You. Our hearts remain in your hands. Help us God. Heal us. Open our eyes. Soften our hearts. Take control of our thoughts. Guide our path. Give us the desires of our hearts. Make us new… even as a child. We thank You. And we count all these done by faith. In Jesus name. Amen.”

Remember, a healthy live cannot truly be lived unless you know Jesus. Accept Him into your heart and He’ll change your life.

Jamal Ross

Dr. Jamal Ross is an internist and pediatrician who possesses a passion for prayer and preventative medicine. He has worked in the fields of primary care and hospital medicine.

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