Q: How often and at what age should women begin having mammograms?
A: There are guidelines coming out from both the National Cancer Institute and the American Cancer Society. Basically, they will say starting from age 50, women need to have one once a year. They also recommend for women who either are at a higher risk than the general population or have a family history to have one (mammogram) earlier, maybe even at age 40.
Q: What about self-examination?
A: Self-examination hasn't been found scientifically to reduce breast cancer mortality. I don't do it myself, and I've also recognized that my doctor in the last couple of years hasn't done a clinical breast examination on me. I don't discourage it if it gives a woman more confidence. A very small portion of women might detect a fast-growing tumor between mammograms.
Q: What are some risk factors for breast cancer?
A: That's something that's been very challenging for breast cancer as compared to tobacco-related lung cancer. If you don't smoke, you reduce your risk of getting lung cancer. There are in breast cancer well-confirmed and well-established risk factors, but some of those are what I would call not modifiable. For instance, family history, age, number of children and when you have them, and sometimes your race and ethnic group determine your risk factor. The modifiable, the lifestyle factors, aren't as strongly related to the risk, but there are some of those that we consider as probable relationships. There's quite a bit of evidence coming out now about physical inactivity increasing risk as well as the use of estrogen-replacement hormones. There are some modest associations with alcohol use, oral contraceptive use (depending on the women's age). And obesity, independent of physical activity, is a risk factor, especially with post-menopausal women.
Q: What about genetics?
A: For cancer that occurs in young women " women who we would say have a young onset (younger than 40 years old) " it seems to have a genetic component. It could be a family history, or there are tumor-suppressing genes that if you lose that function, the tumor can appear earlier.
Q: How much of a factor is race?
A: It's not that much. In the past, breast cancer occurred more prevalently among Caucasian women compared with African-American women. Interestingly enough, with the alert about estrogen-replacement therapy for post-menopausal women increasing the risk, we've seen a significant and substantial decline among white women. We are not seeing that in African-American women. The gap now between African-American women and white women is narrowing. In Louisiana, it's not narrowing: now African-American women are having slightly higher incidence rates than white women. Hispanic women and Asian/Pacific islander women traditionally have a lower risk factor.
Q: Where does Louisiana fall in breast cancer incidence and survival?
A: If you compared our incidence rate with the rest of the U.S., our white women are about 8 percent lower. For African-American women, we are 5 percent higher.
Q: Survival rates have improved nationally, so how is Louisiana doing?
A: In order to determine survival rate, you have to actively be following patients, so you know how they are doing and what they are dying from. The Louisiana Tumor Registry was fortunately able to get funding from the National Cancer Institute. Starting in 2000, we became a SEER (Surveillance, Epidemiology and End Results) registry, so therefore we are collecting data, but we haven't had a chance to conduct survival analysis yet. But we have looked at: if this is our incidence and based on this incidence, we should expect this much mortality. We always find out that our mortality-to-incident ratio is higher in Louisiana compared to the rest of the nation. African-American women always have a poor survival rate compared to Caucasian women.
Q: What can we do to improve?
A: There are some things you can do and there are some things you can't do. First of all, African-American women have more aggressive tumors. If you look at tumor grade, which measures how fast tumors grow, they will often have a higher grade, a worst type of tumor. They also have a higher proportion of estrogen-receptor negative. Therefore, they can't be treated by hormonal therapy because they don't have the receptor to bind the hormones. We can't do anything about that. What we can do something about is that African-American women are being diagnosed at a later stage (in the cancer) than white women. In Caucasian women, we have about 30 percent of our breast cancer cases that were diagnosed as already spreading to the lymph nodes or other distant organs. The number for African-American women is 41 percent. Also the size of tumors for African-American women is larger, and the larger the tumor means the less chance of survival.
Q: Best advice?
A: Go and get early detection. Louisiana has a well-established and strong breast and cervical cancer detection program (Louisiana Breast and Cervical Cancer Early Detection Program: 504-280-1570), so women who can't afford it or are under-insured can get a mammogram.