Breast cancer is real, prevalent and scary.

I’m scared of breast cancer. And I probably should be. So should you.

But I’m not the expert on all facets of this disease so I’ve asked some people with professional expertise to give us facts on what we need to know. A special thanks to these women who are dedicating their lives to preventing and treating this disease.

Welcome to the first guest post on the As a Woman Blog!

On Cancer and Fertility - from an REI: Dr. Natalie Crawford (me)

My professional take on cancer is in the realm of helping preserve fertility. When women are diagnosed with cancer, certainly survival is goal #1. That said, we don’t want to lose out on the option of being a mom or completing your family if you are diagnosed with cancer.

Importantly, I don’t have a crystal ball when it comes to you and your future fertility. After standard chemotherapy for breast cancer (AC), 20% of women will be in ovarian failure because (menopause) and will never have periods again. This is important because if we don’t preserve your option to have children by freezing eggs or embryos, then you may lose this chance at parenthood.

However, we know that after chemotherapy, most women will have a significant drop non their ovarian reserve (number of eggs) even if they resume normal periods after treatment. This means that consideration of fertility preservation or earlier conception attempts are extremely important, as many chemo survivors will enter menopause 10+ years prior to the natural age.

I recommend that EVERY woman who has not completed her family see a Reproductive Endocrinologist after diagnosis. We usually get patients in quickly, without fees, and are able to negotiate lower rates of treatment with cancer assistance programs (such as Livestrong).

On Being a “Previvor” - from an OBGYN: Dr. Bailey Escaraga

As an obgyn, I am on the front line for breast issues - lumps, pain, nipple discharge. I'm also the provider who orders mammograms, breast ultrasounds, and breast biopsies. It's my job to make sure every patient is aware of their risk for breast cancer based on family and personal history. This is a topic very near and dear to my heart as I am a carrier of the BRCA1 gene. The BRCA genes are hereditary genes that considerably increase an individual's lifetime risk of breast and ovarian cancer, with an especially early onset of breast cancer. BRCA1 carriers have up to an 87% lifetime risk of breast cancer and BRCA 2 carriers have up to 70% lifetime risk. BRCA gene testing should be considered in anyone with a family history of breast cancer diagnosed prior to age 50 or ovarian cancer at any age. I believe that identification of the BRCA gene gave me so much power in my own care. It gave me the opportunity to pursue intensive screening at a young age and I made the choice to undergo a prophylactic risk-reducing bilateral mastectomy. This reduced my risk of breast cancer to less than 10% and helped me feel like I did something actively to prevent a cancer for which I was at very high risk. This makes me a "previvor." While my risk of developing cancer isn't zero, it is much less than it was, and that is something to celebrate. I believe it is so important that all women talk to their providers about genetic testing and ensuring they are up to date on age-appropriate breast cancer screening.

On the Genetics of Breast Cancer - from a Genetic Counselor: Gayle Patel, MS, CGC

Cancer is a group of diseases that can occur in any place in the body. Cancer starts when cells grow out of control and crowd out normal cells. All cancers are genetic, but only some cancers are hereditary or inherited. Cancer is caused by changes or mutations in certain types of genes, especially in those that control how cells grow and divide. As we live our lives, we can acquire mutations in our DNA, most of which occur by chance or due to environmental exposures. If a gene that is responsible for cell growth acquires a mutation, then that gene no longer works and cells will grow uncontrollably. This is cancer.

The majority of cancers happen by chance. Breast cancer is very common, about 1 in 8 or 13% of all women will develop breast cancer at some point in their life. While most breast cancer is sporadic about 5-10% of all people with breast cancer are born with a mutation in an important gene that can lead to an increased risk for certain cancers.

Individuals who are born with a mutation in a gene that is critical to cancer development have a hereditary cancer syndrome. Because the gene doesn’t work correctly, these individuals and their family members tend to be diagnosed at younger ages and have more cancers. The most common cause of hereditary breast cancer is mutations in the BRCA1 and BRCA2genes. Women who have a mutation in BRCA1or BRCA2have up to a 70% risk for breast cancer throughout their lifetime. The BRCA genes have long been known as the breast cancer genes, but we now know that these genes can cause a variety of types of cancer such as ovarian, male breast cancer, prostate cancer, pancreatic cancer and melanoma. It’s important to remember that men carry BRCA mutations as well and are at increased risk for cancer!

Everyone has the BRCA genes, but it is rare to have a mutation in a BRCA gene. About one in 200 people have a mutation in a BRCA gene. BRCA mutations are more common in individuals of Ashkenazi Jewish Ancestry, where about one in 40 people have a mutation. It is estimated that close to one million people in the United States have a BRCA mutation, but less than 10% are aware that they have a mutation that increases their risk for cancer.

We now also know that there are other genes that can lead to hereditary breast cancer. Genes such as PALB2, ATM and CHEK2 are also all known to cause Hereditary breast cancer. In addition, there are also now genes known to cause many other forms of hereditary cancer such as hereditary colon cancer. Given this expanded knowledge typically genetic testing is done through panel based genetic testing that will cover multiple genes based on an individual’s personal and family history of cancer. Panel based testing has significantly increased our ability to determine the genetic causes of cancers in families.

Knowing a person has a hereditary cancer syndrome is critical because this can help prevent cancers or find cancers earlier. For people with hereditary cancer syndromes we can design high risk surveillance protocols to start cancer surveillance earlier, use more advanced techniques or do more frequent surveillance. In addition, there are medications one can use to reduce the risks of certain cancers. Lastly, we also consider risk reducing surgeries to reduce the risks for certain types of cancers. For example, a BRCA carrier can consider a risk reducing mastectomy (removal of breasts) to reduce her risk for breast cancer and/or a risk reducing salpingo-oophorectomy (removal of ovaries) to reduce her risk for ovarian cancer. Everyone is unique, and we can use your personal, family history and genetic testing results to design the right plan for you.

It is important to know your family history of cancer and talk to your doctor about it. If you have a personal of family history of young breast cancer, multiple relatives with breast cancer, male breast cancer, triple negative breast cancer, ovarian cancer, prostate cancer, pancreatic cancer ask for a referral for a genetic evaluation for hereditary breast cancer. A genetic evaluation is conducted by a healthcare provider with specialized training in cancer genetics. The visit usually takes one hour and involves taking a thorough personal and family history, and a discussion of the risks, benefits, and limitations of testing. After this evaluation, if genetic testing is warranted, these healthcare providers can coordinate genetic testing (usually a simple blood draw). Once your test results are received, your provider will help create a personalized management plan, based on your personal and family history and your test results.

On Breast Cancer Screening - from a Breast Radiologist: Dr. Anjali Malik

As a breast radiologist, I detect and diagnose breast cancer using imaging technology and minimally invasive biopsy techniques. I interpret mammograms, and through my own eyes and experience see the benefit of annual screening mammograms starting at age 40. When caught early, treatment options increase and the risk of death decreases. My patients go on not only to survive, but to thrive.

As a medical advisor for Bright Pink, I aim to educate and empower young women on their breast health by helping them identify, reduce, and manage their breast cancer risk. Breast health does not start when we are 40, it starts at conception with our genetic makeup, and at puberty when those hormones start surging. Don’t wait until 40 - the time to take our breast health into our hands is in our late teens and early 20s. The lifestyle choices and decisions we make then impact our lives for years to come, whether it is genetic testing that dictates the need for risk reducing mastectomies and fertility preservation or high risk screening that could lead to early detection of breast cancer. That alcohol we sip or the oral contraceptives we take – those impact our risk, and young women often remain in the dark regarding the simple modifications they could be making.

While annual screening mammograms remain the bulk of what I interpret each day, my passion stems from these interventions that can affect generations to come. I want women to inform themselves, advocate for their health, reduce their risk and live their absolute breast lives

Diagnosis and Surgery - from a Breast Surgeon: Dr. Niamey Wilson

There are many different types of breast cancer, and each woman or man is treated for their unique cancer. We have many modalities of treatment for breast cancer, including surgery (usually lumpectomy or mastectomy), chemotherapy, radiation and hormonal therapy. Some women only need one or two of these modalities, while others may need all; every patient will have their own care plan that treats their individual cancer. As a surgeon, I am typically the doctor giving the news of a breast cancer diagnosis. It is the hardest part of my job. But my message is always clear: we are going to be a team, and we are going to beat this. The goal in surgery for breast cancer is two-fold: remove the cancer and provide an excellent cosmetic result. Breast surgery is a highly skilled field for this reason, and it takes many years of training to achieve oncologically sound and aesthetically pleasing results. Many breast surgeons these days are fellowship trained, which means they are trained not only in the newest surgical techniques like nipple sparing mastectomy, but also in the vast decision making that goes on when a woman is diagnosed with breast cancer.

Breast cancer today is extremely treatable. With early detection using mammograms, smaller cancers usually need less aggressive treatment. Our surgeries are smaller, more precise, and less invasive, but it’s important to know your surgeon. Ask how often your surgeon has performed your exact surgery. Ask about ways to hide the scars along natural creases, such as under the breast or along the areola. For reconstruction, ask about using your own tissue rather than implants. Get a second opinion. Be your own advocate and be positive.

Treatment Planning - from a Breast Oncologist: Dr. Eleonora Teplinsky

1 in 8 women will be diagnosed with breast cancer in their lifetime. Breast cancer is diagnosed every 29 seconds around the world and in the U.S., it’s every 2 minutes. Breast cancer is the most common cancer in women (except for skin cancer).
Mammography is used for breast cancer screening. Some people may also get a breast ultrasound if they have dense breasts and those with a 20% lifetime risk of breast cancer or higher may also get a breast MRI. However, it is important to stress that nothing takes the place of mammography. Thermography is not recommended for breast cancer screening.
Treatment of breast cancer depends on several factors, which include the size of cancer, whether or not lymph nodes are involved, whether or not the cancer has metastasized (i.e. spread outside the breast and lymph nodes to other parts of the body), hormone receptor status (whether or not the cancer is sensitive to estrogen), HER2 status, and Oncotype score. It is important to remember that not all cancers are the same and treatment is always individualized taking into account both the characteristics of the cancer as well as the patient’s medical status.
Treatment is divided into local therapy (surgery and radiation) and systemic therapy (chemotherapy, anti-hormonal (endocrine) therapy, anti HER2 therapy, immunotherapy). The best way to think about treatment for early stage (stage I-III) breast cancer is: 1) Get rid of the cancer 2) Treatment to decrease the risk of cancer recurrence.
In terms of breast cancer risk reduction, there are risk factors that are not modifiable (age, family history, dense breast tissue/benign breast conditions, history of radiation, genetic factors, race and menstrual and reproductive history) but there are many risk factors that are modifiable (alcohol use, use of hormonal replacement therapy or oral contraceptives, diet/nutrition, obesity, exercise). All treatment for breast cancer should incorporate lifestyle changes to lower your risk (limiting alcohol use, exercising on a regular basis, being at a healthy weight, limiting processed foods and eating lots of fruits and vegetables!).
A question that I get asked a lot is whether or not soy is safe and it is!! It is absolutely fine (and may even be beneficial in terms of breast cancer risk reduction) to consume soy.

Basic Facts - from a Breast Surgeon: Dr. Sadia Khan

1 in 8 women in the US are diagnosed with breast cancer in their lifetime, it is the most common cancer among women.
Breast pain is not typical for how breast cancer is diagnosed. Breast cancer typically presents with no symptoms or a “PANILESS” lump.
Only 5-10% of breast cancers are thought to be hereditary
Surgical choice does not impact survival from breast cancer. Women who choose Mastectomy over lumpectomy do not live longer
Get more sun! Check you Vitamin D levels!! Vitamin D deficiency is a risk factor for breast cancer.