Breast Cancer: How to Stay Informed, Stay Healthy

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Everyone knows someone who has battled breast cancer -- a family member, a co-worker, a cherished friend. The stories of support and awareness reach far and wide, and that's essential as an estimated 268,000 new cases of invasive breast cancer are expected to be diagnosed in the United States this year, according to cancer.net.
Here are a look at some common questions about risk factors, prevention, treatment, and common myths to help you stay informed.
How common is breast cancer?
The American Cancer Society reports that breast cancer death rates in the U.S. are higher than those for any other cancer besides lung. About 42,000 women in the U.S. are expected to die in 2019 from the disease.
And although about 1 in 8 women will be diagnosed in their lifetime, the five-year survival rate is still at 90 percent, according to cancer.net. A lot of the good survival rate numbers have to do with increasing discussion, awareness, and early prevention.
What are the risks?
The biggest risk continues to be a family history of breast cancer and having multiple previous breast biopsies, according to Dr. Lea Blackwell, a breast surgeon on the medical staff of Lee Health.
But there are some risks that aren't as well known.
Women who have their first child after age 30 face a higher risk, according to Dr. Blackwell, along with women who start menstrual periods at a younger age than normal and women who have menopause at a later age than normal.
For patients who have been diagnosed and undergone a mastectomy, doctors say there still a 5 percent chance the cancer can come back.
Other risks include a lack of physical activity, poor diet and nutrition, as well as alcohol use.
The more alcohol you consume, the more increased risk of not just breast cancer, but all cancer, said Jeanne Struve, a clinical dietitian with Lee Health.
What exams should I get?
It cannot be stressed enough: Women must perform self-examinations and get yearly mammograms after they turn 40.
I think there's some hesitation of people to get a mammogram because they think they are going to get a lot of radiation exposure -- and its really a very low amount of radiation exposure. Its a very safe option, Dr. Blackwell said.
Mammograms can help find tumors that you cant see or feel allowing doctors to catch the breast cancer early.
If women have a family history of breast cancer, doctors may recommend getting screened earlier.

A 2D mammogram looks at the breast in a couple of different plains: one from the top and one from the side. Those views cover as much of the breast tissue as possible.
A 3D mammogram uses the same positioned views but takes thin slices through the breast tissue instead of just one x-ray. 3D mammograms show clearer results and usually have better sensitivity and specificity.

Are there any foods that prevent breast cancer?
A lot of prevention starts in the gut.
Studies have shown that diets high in fruits and vegetables are not only healthy overall but they also decrease the risk of breast cancer, said Jeanne Struve, a clinical dietitian with Lee Health.
Soy has definitely been shown to decrease the risk of getting breast cancer and increasing survival rate if you are diagnosed with breast cancer, she said
In fact, Struve says studies show that half a cup of tofu or soy milk a day can decrease your risk of breast cancer by 30 percent.
Cruciferous vegetables also make a difference since they contain sulforaphane, which suppresses the ability of the breast cancer stem cells to form into tumors, Struve said.
Some examples of cruciferous veggies:

Broccoli
Cabbage
Brussels sprouts
Bok Choy
Kale
Swiss chard
Collard greens

Struve also recommends limiting alcohol, red meat, and high-fat dairy products.
What are some common myths?
Dr. Blackwell says many patients ask about risks including ill-fitting bras, bad deodorant, and even cell phones. But there is no evidence that any of those things increase the risk of breast cancer.
Another myth? Men cant get breast cancer. One percent of the population of breast cancer patients is men.
Typically a male presents with nipple discharge, and usually they will have a mass behind the nipple, she said.
And remember: Breast cancer doesn't always cause a lump you can feel, and treatment plans vary widely depending on the characteristics of the cancer and patient preferences, according to breastcancer.org,
Surgeries such as a mastectomy also don't ensure that cancer wont come back. Doctors say cancer can return in the armpit near the incision.
What are my treatment options?
The first step after a diagnosis is to deal with the shock and to lean on a firm support system. That shock can get worse when doctors start explaining cancer treatments.
Nurse navigators play a big role by meeting with patients and teaching them about their disease as well as the treatment process and connecting them to the right emotional, medical, spiritual, and financial resources.
We meet with patients one-on-one. We do teaching with patients about their whole disease process, said Tammy Zinn, a nurse navigator with Lee Health.
Surgery
For most breast cancer patients, surgery is the first leg of treatment.
Because not only does it treat the primary cancer, meaning to remove the tumors, but it also gives us answer by looking at the lymph nodes, says Dr. Rie Aihara, surgical oncologist on medical staff at Lee Health. And some of the answers we get from surgery actually dictate what kind of therapy would come next.
Once the path becomes clear, the baton is passed to a medical oncologist, radiation oncologist, or both, who, ideally, work as a team.
Based on the nature of their cancer and personal preference, women may opt to remove a portion of breast, one breast or both if they have genetic risk.
We do see a lot of women who choose a double mastectomy, especially in the younger population because they have so many years to think about recurrences and things like that, Dr. Aihara says. And we always emphasize if there's only cancer in one area, certainly if its treatable by lumpectomy. That's what we would advise.
Reconstruction
A majority of women then chose to undergo reconstruction. Many times it starts during a mastectomy using tissue expanders and is completed once they reach the finish line.
Radiation/chemo
Women with breast cancer will also likely need radiation therapy, chemotherapy, and immunotherapy or a combination. Many therapies can be done on an outpatient basis and cause much less damage to healthy tissue than previous methods. Your navigator, doctor, and other health team members will help you through the process and show you how to deal with side effects such as nausea, vomiting, diarrhea, fatigue, and depression.

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