Awareness, education key to preventing breast cancer

imageby Jill Fries

Since 1991, the Michigan Department of Community Health (MDCH) has implemented a comprehensive Breast and Cervical Cancer Control Program (BCCCP) through a multiyear grant from the U.S. Centers for Disease Control and Prevention. With these funds, low-income women have access to lifesaving cancer screening services and follow-up care, including cancer treatment if that should be needed.
Since 1992, eligible women between the ages of forty and sixty-four of Marquette County have been fortunate that the Marquette County Health Department has been coordinating this service. An annual exam includes a clinical breast exam, pelvic exam, mammogram and, when necessary, a pap smear. Marquette County Health Department also contracts with local specialists for diagnostic services. If cancer is diagnosed, there is an expedited Medicaid application process available and staff from the Marquette County Health Department can provide assistance with completing the form.
Income guidelines for the BCCCP are generous for this federally funded program. If a person’s family income is at or below the guidelines shown below, she would qualify financially.
If you believe you qualify for this life-saving program, call the Marquette County Health Department at 475-7844 to schedule your appointment. Currently, $25 gift cards are offered for persons new to the program.
Thankfully, there is more to this program than diagnosing disease. The all-female staff at the Marquette County Health Department also provides the latest information on disease prevention to clients. Can cancer be prevented? Certainly not all cancer, but numerous studies in recent years point to factors such as: body fatness, physical activity, dietary factors and tobacco use, all of which play a key role in a person’s risk in developing cancer in general and breast cancer specifically.
In 2008, about 184,450 cases of cancer were found in the United States. About thirty-eight percent of those cancers were preventable, which is 70,091 preventable cases.
According to the American Cancer Society, it is believed the figures are underestimated, because of shortfalls in data. For details, visit www.cancer.org
In 2008, there were three women diagnosed with breast cancer through the BCCCP in Marquette County. The good news for those women is that because they were receiving annual exams through the Marquette County Health Department, the cancer was caught early and their prognosis is very good. Early screening saves lives.
Deborah Fosler, a client since 1997, believes strongly this program saves lives.
“I love the idea that this organization is gently insistent on us taking care of ourselves on an annual basis,” Fosler said.
Another client, Janene Ericksen, was diagnosed with breast cancer through the program by a contracted physician.
“I am so thankful for this program,” Ericksen said. “Although my diagnosis is not typical in that it would not have been discovered through mammogram screening, I was diagnosed by one of the physicians that [BCCCP contracts] with. The cooperation between the Marquette County Health Department and the contracting physicians is spectacular. I can’t say enough how valuable this program is to our community. Jill Fries, BCCCP coordinator, provided education and support that I don’t think I would have received anywhere else.”
There are many risk factors that may increase your chance of developing breast cancer; unfortunately, it is not yet fully understood how all these risk factors create cancerous cells within breast tissue. Hormones, inherited DNA (BRCA1 and BRCA2 genes can account for ten percent of Breast Cancer Diagnosis), tobacco use, morbid obesity and lack of physical activity all seem to contribute to cell change and possibly developing breast cancer. Most breast cancer DNA mutations occur in single breast cells during a woman’s life, rather than having been inherited. The causes of most acquired mutations that could lead to breast cancer remain unknown.
There are several risk factors for breast cancer, some of which a person will have control over and some not. Obviously gender is a risk factor. Although men can develop breast cancer, more than ninety-nine percent of all breast cancers develop in women. As a woman ages, her risk increases. About one out of eight invasive breast cancers is found in women younger than forty-five, while about two out of three invasive breast cancers are found in women age fifty-five or older.
BRCA1 and BRCA2 inherited mutations increase the risk of developing breast cancer by up to eighty percent during a person’s lifetime. There are other genetic mutations that not only may increase the risk of breast cancer, but other cancers as well. If this is a concern, genetic testing may be warranted. Family history can be a risk factor. Having one “first-degree” relative (mother, sister or daughter) with breast cancer approximately doubles a woman’s risk. Having two first-degree relatives increases her risk about five times.
Personal history increases the risk of developing a new cancer in the other breast or in another part of the same breast by three to four times. Race and ethnicity have been found to be risk factors. White women develop breast cancer more often; however, African-American women are more likely to die as their tumors seem to be more aggressive. It is not yet known why. Asian, Hispanic and Native-American women have a lower risk of developing and dying from breast cancer. Dense breast tissue, as seen on a mammogram, has more glandular tissue and less fatty, tissue which leads to a higher risk of breast cancer. Unfortunately, dense breast tissue also can make it more difficult for doctors to spot problems on mammograms.
Women who start menstruating at an early age (before twelve) and go through menopause at a later age (after fifty-five) have a slightly higher risk of breast cancer. Women who as children or young adults had radiation therapy to the chest area are at significantly increased risk for breast cancer. Exposure: Women who were exposed to DES (Diethylstilbestrol) drug in the 1940s through 1960s have a slightly increased risk of developing breast cancer. Postmenopausal hormone therapy (PHT) used for several years or more, increases the risk of breast cancer and may also increase the chances of dying of breast cancer.
Large studies have found that there is an increased risk of breast cancer related to the use of combined PHT (estrogen and progesterone). Combined PHT also increases the likelihood that the cancer may be found at a more advanced stage, possibly because it reduces the effectiveness of mammograms.
Estrogen (ERT) when used for more than ten years has been found to increase the risk of ovarian and breast cancer in some studies (www.nhlbi.nih.gov/whi) Alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed.
Compared with nondrinkers, women who consume one alcoholic drink a day have a very small increase in risk. Those who have two to five drinks daily have about one-and-a-half times the risk of women who drink no alcohol.
Excessive alcohol use also is known to increase the risk of developing cancers of the mouth, throat, esophagus and liver. The American Cancer Society recommends women limit consumption of alcohol to no more than one drink per day.
Obesity has been found to increase breast cancer risk, especially for women after menopause. Before menopause, ovaries produce most estrogen, and fat tissue produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can increase estrogen levels, and thereby increase the likelihood of developing breast cancer.
The goal is to have a healthy weight by balancing your food intake with physical activity and avoiding excessive weight gain. Physical activity in the form of exercise reduces breast cancer risk.
It is unclear how much, but per the Women’s Health Initiative (WHI) as little as 1.25 to 2.5 hours a week of brisk walking reduced a woman’s risk by eighteen percent. Walking ten hours a week reduced the risk a little more. (www.nhlbi.nih.gov/whi)
The above information was gleaned from several sources: American Cancer Society, U.S. Centers for Disease Control and Prevention and the American Institute for Cancer Research. The latter organization published a comprehensive document in November 2007: “Policy and Action for Cancer Prevention: Food, Nutrition and Physical Activity.” This 200-page document can be read and/or downloaded free of charge from its Web site: www.aicr.org
This document was developed over five years and involved the work of nine teams of researchers, a panel of twenty-one experts and eighty-two peer reviewers.
“Because my income has fluctuated over the years, I have felt fortunate to be able to utilize the BCC program through the Marquette County Health Department,” longtime client Diane Tonella said. “They continue to have women’s health first and foremost in mind along with their annual needs. It’s been a relief to know this program has been available through the years—one less thing to think about. A big thank you to your wonderful staff.”
If you believe you may qualify for this lifesaving program, call 475-7844.
—Jill Fries

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