Breast cancer specialists: Don’t wait

Breast cancer is the most common form of cancer worldwide. In the United States, about 12.9% of women will develop it at some point in their lives. For breast cancer awareness month, two local doctors spoke with the Lewiston Tribune about how patients can reduce their risk of breast cancer, and safeguard themselves against late diagnosis.

Dr. Sallee Jones is a surgeon at St. Joseph Regional Medical Center with a focus on breast cancer and benign breast disease. Her biggest piece of advice to patients, she said, is to never delay mammograms.

“I’ve seen too many people who put something off for months at a time because they were afraid of the mammogram even though they felt something in their breast. Some people have discomfort during the mammogram, some don’t,” she said. “The discomfort you will feel is nothing compared to delaying a diagnosis.”

Women with an average risk of breast cancer are advised to get annual screening mammograms starting at age 40, and annual clinical exams.

Sometimes, Jones said, patients delay mammograms because of lapses in insurance coverage.

“I hear this all the time, ‘I switched my insurance. And I didn’t get (an exam) for two years, because I didn’t have insurance coverage.’ (But) There are organizations that can help with that, too. (So) don’t let that be an excuse.”

Factors including a family history of breast cancer, genetics, previous exposure to radiation and other factors can all affect a patient’s risk of developing breast cancer.

Some risk factors patients can influence. Patients who binge drink, live a sedentary lifestyle, are obese or have unhealthy diets may increase their risk of breast cancer.

Patients who are considered high-risk, which is a status determined by a doctor, are recommended to get clinical exams and annual mammograms starting at 10 years younger than the age at diagnosis of the youngest person with the disease in the family, Jones said — but no younger than 30 years old.

According to breastcancer.org, anyone assigned female at birth should have a breast cancer risk assessment by age 25, which helps determine when it’s best to start having screening mammograms.

High-risk patients may also qualify for additional services, she said, including genetic counseling, annual MRIs in conjunction with mammograms, and risk reduction therapy with a medical oncologist.

Patients should also be familiar with how their breasts are normally so it’s easier to detect abnormalities, said Dr. Byron Wright, a surgeon specializing in breast cancer at Tri-State Memorial Hospital.

“Breast self-exams should generally begin early in a woman’s life once adulthood has been reached,” he said. “The idea (is) to become very familiar with how your breast normally feels, so that if an abnormality does arise in the future, it can be more easily and earlier detected by the patient.”

Despite some misconceptions, Jones said, monthly Breast self-exams, or “breast awareness” checks are a valuable tool for everyone.

“A lot of people will say, ‘Well, Sallee, my breasts are lumpy anyway, it’s not worth it.’ But it is worth it, because then you know what’s normal for you,” she said.

Breastcancer.org provides an in-depth guide for self-exams, but generally, Jones recommends patients check once a month, one week after their period.

They should start by looking in the mirror with their hands on their hips, and check for protruding masses, asymmetry, dimpling, or retracted nipples, as well as any fluid coming from the nipples.

After that, Jones recommends lying on the floor with one arm extended above the head. With the opposite hand, patients can check each breast, moving in a circular motion.

“Don’t use the tips of your fingers. Imagine if you had a marble underneath a towel, and you use the tips of your fingers, you could kind of move that marble around all day and never find it,” she said. “Use the pads of your fingers ... and roll the tissue underneath you so that marble can’t escape the tip of your finger.”

Men can also get breast cancer, though they account for only about 1% of diagnosed cases. Usually, breast cancer in men presents as a lump around, or in close proximity to, the nipple or areola.

“(Breast cancer in men) still occurs with a high enough regularity that men should be made aware that they, too, can develop breast cancer,” Wright said. “So men, just like women, should check this area of the body with some regularity, be aware of how the area normally feels and bring any concerning changes to the attention of their health care provider.”

Tenderness around the breast tissue can also be indicative of breast cancer, or of gynecomastia, which is benign.

“If that comes on, they need to have a mammogram,” Jones said. “A lot of times, men think that mammograms aren’t for them, or that’s not feasible, but that’s not true. We do mammograms and ultrasounds on them all the time.”

Despite its prevalence, breast cancer has a high survival rate. According to cancer.net, the average five-year survival rate for women in the U.S. with non-metastatic invasive breast cancer is 90%, and the average 10-year survival rate for women with non-metastatic invasive breast cancer is 84%.

“Breast Cancer is a very treatable and highly curable disease,” Wright said. “Optimal outcomes rely on increased awareness, widespread screening, and early-as-possible diagnosis followed by the appropriate application of a patient-specific (management plan).”

Above all, Jones said, if a patient thinks they may need a screening, they shouldn’t wait.

“I have people who I see, and they ended up with advanced breast disease, and now they’re not only dealing with the disease itself in the treatment, but now they’re dealing with, ‘Oh, my gosh, why did I wait so long?’ And it just adds another component of the emotional aspect of cancer. So denial will help no one.”

More information about breast imaging and other breast health services at Tri-State Memorial Hospital and St. Joseph’s Regional Medical Center is available at tristatehospital.org/womensimaging and sjrmc.org/breast-imaging-center.

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made possible by the Lewis-Clark Valley Healthcare Foundation in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.