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STAR BEACON • OCTOBER 2016
2 — Breast Cancer Awareness Star Beacon, Wednesday, October 5, 2016
ASHTABULA — Octo-
ber is National Breast
Cancer Awareness
Month and while many
people are wearing pink
to show their support,
options for state-of-the-
art exams, imaging and
support exist all-year
long.
Breast cancer is still
the second leading
cause of cancer death
among women in the
United States, exceeding
only by lung cancer.
About one in eight
women (about 12
percent) will develop
invasive breast cancer
during the course of her
lifetime. In 2016, about
246,660 new cases of
invasive (when the can-
cer has spread to nearly
tissue) breast cancer are
expected to be diag-
nosed in women in the
U.S., along with 61,000
new cases of non-inva-
sive (when abnormal
cells grow inside milk
ducts) breast cancer.
Cleveland Clinic
oncologist, Mohammad
Varghai, MD, who prac-
tices full-time at ACMC,
said with early detec-
tion, there are more
treatment options and
better results for breast
cancer patients.
“The earlier we can
detect the cancerous
growth, the more
options we have for
treatment. Do not put
off scheduled exams or
recommended tests,”
Varghai said. “We do all
the tests and, if neces-
sary, treatment right
here in Ashtabula.”
A physician’s referral
is needed to sched-
ule a mammogram. A
family physician, or
the Ashtabula Wom-
en’s Health Center, will
provide a referral from
an OB/GYN, according
to information provided
by ACMC.
Two years ago, ACMC
BY SHELLEY TERRY
ACMC adds digital mammography
METRO CREATIVE SERVICES
Breast cancer risk is inluenced by many things, including heredity, age and gender. Breast density is another factor that may affect cancer risk and the ability to detect breast cancer in its earliest stages, say some experts.
SEE ACMC, 8
October 5, 2016 Star Beacon, Wednesday, October 5, 2016 Breast Cancer Awareness — 3
REDUCING
YOUR RISK
BY THE NUMBERS
SOURCES: www.cancer.org www.breastcancer.org
2.8 MILLION
1 in 8 1 in 1,000
The approximate number of breast cancer survivors in the U.S. today, including
those undergoing treatment and those who have completed treatment.
The estimated number of men and women
who will be diagnosed with invasive breast
cancer in 2016.
The approximate number of men and
women who will die from breast
cancer in 2016.
The survival rate for early detection
cases is 98%, and the survival rate for
advanced stage breast cancer is 27%.
About 1 in 8 women and 1 in 1,000
men will be diagnosed with breast
cancer during their lifetime.
Know Your Family History
Healthy Habits
Avoid Alcohol, Tobacco
Be Careful With Hormones
Early Screening
Those with a family
history of breast cancer can
take steps to help protect
themselves. Know your
family history, and if you’re
at risk, discuss preventative
options with a physician.
Maintaining a healthy
weight and exercising at
least 30 minutes per day
can help reduce the risk
of breast cancer
Both alcohol and
tobacco have been
shown to increase the
risk of breast cancer.
Avoiding them can help
lower that risk.
Taking birth control pills
or post-menopausal
hormones can increase
the risk of breast cancer.
These options should
be discussed with your
doctor before starting or
stopping.
For most women, regular
mammograms can begin
at age 40, but speciic
recommendations can
vary by age and risk.
Breast Cancer Awareness
246,660
40,450
27%
2,600
440
98%
EARLY DETECTION
ADVANCED STAGE
ff scheduled exams or
all
A physician’s referral
en’s Health Center, will
ed
CMC adds digital
4 — Breast Cancer Awareness Star Beacon, Wednesday, October 5, 2016
GENEVA — Univer-
sity Hospitals (UH)
Conneaut and Geneva
Medical Centers now
offer one of the latest
breakthroughs in mam-
mography.
The advanced mam-
mography program
began at both medical
centers in August and
so far 255 women in
Geneva and 68 in Con-
neaut have taken advan-
tage of the screenings,
said Denise DiDonato,
business development
manager of Universi-
ty Hospitals Geneva
and Conneaut Medical
Centers.
“The newest break-
through in mammog-
raphy is digital breast
tomosynthesis,” said
University Hospitals
Spokesperson Dan
Bomeli.
He said unlike two
dimensional mammog-
raphy, this technology
provides a more ac-
curate, detailed view
of breast tissue and
enables a more deini-tive detection of irregu-
larities.
“With digital breast
tomosynthesis, the
mammogram machine
takes a series of images
at different angles and
constructs a semi 3-D
image of the breast tis-
sue,” said Krissie Stich,
manager of diagnostic
imaging at UH Geneva
Medical Center. “This
detailed imaging lets us
see structures at a spe-
ciic depth in the breast. It’s better than a regular
2-D mammogram where
the structures can over-
lap and make it dificult to detect very small
cancers.”
She said a breast
tomosynthesis image
test has the same low
radiation as a 2-D test
while the enhanced
detail of the new 3-D
technology reduces the
chances of a woman be-
ing called back for more
diagnostic images. That
minimizes unnecessary
radiation exposure
and the stress of being
notiied with concerns about an inconclusive
test result, she said.
Stich said digital
breast tomosynthesis
is accessible for annu-
al preventative breast
cancer screenings.
BY DAVE DELUCA
UH adds 3-D technology to detection eforts
‘This technology has been especially welcomed by women
with dense breast tissue. The radiologist can study the tissue
one layer at a time and see sizes, shapes and locations of
abnormalities much more clearly.’
Bonnie Bloodmanager of diagnostic imaging at UH Conneaut
The stages of breast cancerStage 0 — Non-invasive breast cancers are considered to be in stage 0.
When doctors have determined the cancer is in stage 0, that means they have
not seen any indication that the cancer cells or the abnormal non-cancerous
cells have spread out of the part of the breast in which they started. According
to the American Cancer Society, the five-year survival rate for women with stage
0 breast cancer is nearly 100 percent.
Stage I — Stage I refers to invasive breast cancer and is broken down into
two categories: stage IA and stage IB. Stage IA refers to invasive breast can-
cers in which the tumor is up to two centimeters and the cancer has not spread
outside the breast. In some stage IB breast cancers, there is no tumor in the
breast but there are small groups of cancer cells in the lymph nodes larger than
0.2 millimeter but not larger than two millimeters. But stage IB breast cancers
may also refer to instances when there is both a tumor in the breast that is
no larger than two centimeters and small groups of cancer cells in the lymph
nodes that are larger than 0.2 millimeter but no larger than two millimeters. The
ACS notes that the five-year survival rate for stage I breast cancers is roughly
100 percent.
Stage II — Stage II breast cancers are also divided into two subcategories:
stage IIA and stage IIB. Both subcategories are invasive. Stage IIA describes
breast cancers in which no tumor can be found in the breast, but cancer that is
larger than two millimeters is found in one to three lymph nodes under the arm
or in the lymph nodes near the breast bone.
Stage IIB breast cancer describes breast cancers in which the tumor is larger
than two centimeters but no larger than five centimeters, and there are small
groups of breast cancer cells in the lymph nodes. The five-year survival rate for
stage II breast cancers is about 93 percent.
Stage III — Stage III cancers are invasive breast cancers broken down into
three categories: IIIA, IIIB and IIIC. When patients are diagnosed with stage IIIA
breast cancer, that means doctors may not have found a tumor in their breast or
the tumor may be any size. In stage IIIA, cancer may have been found in four
to nine axillary lymph nodes or in the lymph nodes near the breastbone. Tumors
larger than five centimeters that are accompanied by small groups of breast
cancer cells (larger than 0.2 millimeter but no larger than two millimeters) in the
lymph nodes also indicate a breast cancer has advanced to stage IIIA.
A stage IIIB breast cancer diagnosis indicates the tumor may be any size
and has spread to the chest wall and/or the skin of the breast, causing swelling
or an ulcer.
In stage IIIC breast cancer, doctors may not see any sign of cancer in the
breast. If there is a tumor, it may be any size and may have spread to the chest
wall and/or the skin of the breast. The ACS notes that the five-year survival rate
for women diagnosed with stage III breast cancer is 72 percent.
Stage IV — Invasive breast cancers that have spread beyond the breast and
lymph nodes to other areas of the body are referred to as stage IV. Stage IV
breast cancer may be a recurrence of a previous breast cancer, though some
women with no prior history of breast cancer receive stage IV diagnoses. The
five-year survival rate for stage IV breast cancers is 22 percent.
SEE UH, 8
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www.nassief.com
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October 5, 2016 Star Beacon, Wednesday, October 5, 2016 Breast Cancer Awareness — 5
Dr. Melissa Thomas
founded her statewide
breast cancer outreach
program close to 20
years ago, but she said
its principle formed
when she was young.
She lost her grand-
mother to a cancer
that was avoidable and
detectable.
Thomas said her
grandmother didn’t
have access to quality
healthcare or education
about the disease. She
started Project Hoff-
nung in 1997 to bring
those life-saving ele-
ments to Ohio commu-
nities that are largely
isolated from the
healthcare web — the
Amish and Mennonite.
“Hoffnung” means
“hope” in German. It’s
the lagship program for the community-led
nonproit Center for Appalachia Research
and Cancer Education,
or CARE.
“Our goal is to keep
the ‘C’ in cancer silent,”
Thomas said. “We’re the
program that tries to
empower women with
knowledge to make
their own educated
health decisions.”
The program, which
provides free clinical
exams to Amish and
Mennonite women,
celebrates its 20th
anniversary next year.
And as one of the Susan
G. Komen foundation’s
highest priority areas in
2015, Ashtabula County
is one of Project Hoff-
nung’s greatest focuses.
According to the
foundation’s 2015 com-
munity proile, while the county’s breast
cancer incidence rate
was slightly lower than
the averages across the
state and the founda-
tion’s service area, its
death rates are higher.
Those statistics are
mirrored in research on
the state’s Amish pop-
ulation, Thomas said.
In the project’s early
years, research found
breast cancer to be the
leading cause of death
in women younger than
60 living in some of the
state’s largest Amish
settlements, she said.
Incidence rates, how-
ever, were also found
to be slightly lower, but
Thomas attributed that
to lack of screenings.
Forty percent of women
40 and younger living
in the state’s largest
Amish settlement in
Holmes County report-
ed never having a mam-
mogram, and more than
two-thirds didn’t keep
up with recommended
breast cancer screening
guidelines.
In developing the
project, Thomas said
she identiied a number of barriers that keep
Amish and Mennonite
women from cancer
screening and/or
treatment — one of the
biggest is access to the
healthcare system.
Amish communities
largely rely on horse-
drawn buggies, creating
distance limitations.
Paying an automobile
driver for a routine
hospital trip can cost
about $50.
Another barrier is
more intrinsic — com-
munication. English is
a second language in
most Amish communi-
ties, Thomas said, and
Pennsylvania Dutch is
not a written language.
And the healthcare
system itself is confus-
ing enough to navigate
without a language
barrier, Thomas said.
One Ashtabula Coun-
ty woman Thomas met
was awaiting follow-up
exam results from her
hospital. Her family had
a phone, but it wasn’t
inside their home.
“The hospital kept
calling and leaving
messages. They told
her to go to a website
and check her results,”
Thomas said. “They
never sent her results.
They just expected her
to go online.”
Thomas said it took
13 years for Project
Hoffnung to make con-
nections in Ashtabula
County.
She said many of the
Amish and Mennonite
communities the proj-
ect has visited are leery
at irst. Being allowed to spread information
and educate people on
the importance of early
breast cancer detection
takes time — and a lot
of trust, she said.
Project Hoffnung
connects with individu-
als in each community
— often women — to
be their community
representative. Having
Thomas’ parents on-
board with the project
also helps gain that
trust, she said, because
the Amish and Menno-
nites see the efforts as
a family project, which
makes it more agree-
able.
“I think that family
component really adds
to the strength of the
program,” she said. “I
feel like as much as this
program has been able
to give and serve, it’s
returned tenfold in the
friendships and connec-
tions we’ve made in the
last 20 years.”
Over time, outreach
workers have reined their message, and
they share what they’ve
learned about working
in those communities
with other health
agencies around the
state.
“We still encourage
women who are inter-
ested in volunteering.
We’ve ended up with
some amazing local
members of communi-
ties who just want to
help,” he said.
“I feel like every
community’s a little
different,” she said.
“We treat each church
district very personally.
We try to address the
needs and customs and
cultures of that commu-
nity.”
Project Hoffnung
hosts two breast cancer
events in the area each
year: the irst in June in the Conneaut area; the
second in the Andover
area. This year’s south
county screening is
set for 9 a.m. to 5 p.m.
Oct. 19 at First United
Methodist Church, 181
S. Main St., Andover.
For more information
about Project Hoffnung,
call Thomas at 1 (877)
HOFFNUNG.
BY JUSTIN DENNIS
Crossing barriers: Program reaches out to Amish
‘We’re the program that tries to empower women with knowledge to make their own educated health
decisions . ... I feel like every community’s a little different. We
treat each church district very personally. We try to address the
needs and customs and cultures of that community.’
Dr. Melissa ThomasDirector of project Hoffnung
Goal to bring healthcare and knowledge to communities that are largely isolated
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8 — Breast Cancer Awareness Star Beacon, Wednesday, October 5, 2016
invested more than
$500,000 for digital
mammography technol-
ogy.
Digital mammogra-
phy has been in use
for several years, but a
study completed 2012
conirmed the newer technology results in
a better image for the
physician to review and
base a diagnosis, ac-
cording to information
provided by ACMC.
For the patient, hav-
ing a digital mammo-
gram is about the same
as having a convention-
al ilm mammogram. A digital exam re-
quires the same com-
pression as an analog
exam; however, the
technology faster so
patients spend less
time in uncomfortable
positions.
Instead of using X-ray
ilm, the equipment is similar to a digital
camera and stores the
images electronically.
Because there is no
waiting for ilm to be developed, the technol-
ogist can evaluate the
quality of the images
as they are taken. The
image brightness,
darkness or contrast
can all be adjusted so
the technologist can
more easily distinguish
between tissue and
cancerous cells.
Previously, if a shad-
ow was seen on an
image, the patient
would have to return
for a second mammo-
gram, something the
new technology pre-
vents.
The digital image can
also be magniied after the mammogram is
complete, which makes
it easier to see subtle
differences between
tissues.
Electronic transmis-
sion of images from
one physician to anoth-
er is quick, easy and
secure.
The images can also
be printed to special
ilm, if needed.Both ACMC and its
Conneaut Family Health
Center have digital
mammography.
ACMC also offers
breast ultrasound and
MRI.
“If a biopsy is needed,
it can possibly be done
via a procedure called
stereotactic breast
biopsy, which is less in-
vasive and does not re-
quire the patient to be
put under anesthesia,”
said Tina Stasiewski,
vice president of busi-
ness development at
ACMC. “Our surgeons
use breast-conserving
techniques when a tra-
ditional biopsy has to
be done.”
Cancer patients can
receive chemotherapy
treatments at the ACMC
Cancer Center next to
the hospital on Lake
Avenue.
ACMC said it’s
important women 40
and older get screened
annually.
Women who have
a irst-degree rela-
tive (mother, sister,
daughter) should begin
screening at age 30.
Having a grandparent
or aunt with a histo-
ry of breast cancer is
important to note but
it only raises the risk
moderately.
For more information,
call ACMC at 440-997-
6915 or visit www.ac-
mchealth.org for more
information.
FROM PAGE 2
ACMC: Digital mammography now ofered
“This technology has
been especially wel-
comed by women with
dense breast tissue,”
said Bonnie Blood,
manager of diagnostic
imaging at UH Con-
neaut. “The radiologist
can study the tissue
one layer at a time and
see sizes, shapes and
locations of abnor-
malities much more
clearly.”
DiDonato said she
was one of the irst tomosynthesis screen-
ing patients at UH
Conneaut.
“The uncertainty is
taken away with this
new technology and
that’s very important
to me,” she said. “The
exam is very fast and
offers a less abrasive
breast compression,
too. It’s wonderful to
be the irst to offer this service and lead-
ing edge technology to
women in our commu-
nity.”
She said because
the 3-D mammog-
raphy technology is
new, some insurance
plans don’t yet cover
it, though Medicare,
Medicaid, CareSource,
Apex and Cigna
currently do. She said
potential users of the
technology should
consult their insurance
company irst to see if it’s covered.
“For me, the extra
cost was worth it to
avoid not knowing
what a standard 2-D
mammogram might
have detected,” she
said. “My tomosynthe-
sis images showed no
abnormalities. This
technology reduces the
nerve-racking occur-
rence of inding some-
thing suspicious and
then having additional
imaging only to learn
it was nothing to be
concerned about.”
She said women
interested in learning
more about digital
breast tomosynthesis
or scheduling an imag-
ing appointment at UH
Conneaut or Geneva
Medical Centers should
call 1-855-844-1858.
FROM PAGE 4
UH: 3-D mammograms available in Geneva, Conneaut
TRIBUNE DEMOCRAT
A 3-D mammography machine like this one at the Joyce Murtha Breast Care Center in Pennsylvania, is now available for patients at UH Geneva and UH Conneaut.
October 5, 2016 Star Beacon, Wednesday, October 5, 2016 Breast Cancer Awareness — 9
Lymphedema is an
uncomfortable, often
painful, swelling that
may occur in the arm
following breast cancer
surgery.
When the surgeon
removes a small tumor
with a procedure called
a lumpectomy, at least
one or two lymph nodes
are removed from the
adjacent armpit area
to be tested for can-
cer. The lymph node
dissection can lead to
lymphedema.
“Surgery interrupts
the lymphatic system,”
occupational therapist
Monica Berkey said at
Crichton Rehabilitation
Center in Johnstown, Pennsylvania. “When
you are removing
lymph nodes, you’re
causing injury to them.
So you don’t have a
smooth route for the
lymphatic luid.”The lymphatic system
is a major part of the
body’s immune system.
The National Library
of Medicine’s medical
encyclopedia, MedLine
Plus, describes the
system as a network of
organs, lymph nodes,
vessels and ducts that
create and move lymph
luids from tissues to the bloodstream.
Advances in breast
cancer treatment have
reduced the risk of
lymphedema, said
Nazneen Billimoria, a
surgeon at Indiana Re-
gional Medical Center.
In the past, a large
section of lymph nodes
were removed for
testing to see how far
the cancer had spread,
Billimoria said.
“We don’t do that now
because the morbidity
associated with that
was quite high, the
main one being lymph-
edema,” she said.
“It can be up to
20 percent with no
post-operative radiation
and up to 30 percent
with radiation.”
Instead, only one
or two lymph nodes,
called sentinel nodes,
are removed for testing
in most lumpectomies.
That reduces the risk to
about 7 percent, Billi-
moria said.
‘SWELLING AND WEEPING’
Treatment involves
compressing and
massaging the affected
arm, Berkey said. Com-
pression bandages and
garments are the most
common tools used by
therapists, but a com-
pression pump and
special sleeve may also
be brought into play.
“You want to push the
luid back up through your arm and back into
your system,” she said.
Breast cancer patients
are not the only ones
affected by lymphede-
ma. Any interruption of
the lymph system can
bring on the condition.
“The bulk of lymph-
edema patients we treat
come to us from the
wound center,” Teresa
Hoffman, Conemaugh
Memorial Medical Cen-
ter’s director of reha-
bilitation services, said
at the Crichton Center
in Conemaugh’s Lee
Campus.
“Most of those pa-
tients have swelling and
weeping of their lower
extremities,” Hoffman
said, explaining that
“weeping” is when the
luid seeps out through the skin.
Lymphedema can
occur within a few days
of lymph node surgery,
but may take up to a
year or more to show
up, nurse Tess Kostan
said at Joyce Murtha Breast Care Center of
the Chan Soon-Shiong
Medical Center at Wind-
ber.
Early symptoms
include swelling in the
hand, or pain, numb-
ness or a heavy feeling
in the arm or the chest
near the armpit.
Patients may notice a
ring or watch is getting
snug, or even that a bra
strap is feeling tighter.
‘Quality of life’
The Joyce Murtha center has taken a
proactive approach
with new technology to
detect lymphedema be-
fore symptoms become
uncomfortable.
The L-Dex measuring
system, developed by
ImpediMed Inc., can
detect a difference of
just two tablespoons of
luid, Kostan said.“If there is a more
than a 10-point dif-
ference between their
affected limb and the
unaffected one, we are
going to send them to
occupational therapy to
the lymphedema spe-
cialists here,” Kostan
said.
Although treatment is
effective and usually al-
lows patients to resume
daily activities without
pain, Hoffman said
she is concerned that
many breast cancer
patients don’t seek
treatment for lymph-
edema because of the
additional emotional
trauma.
Lymphedema spe-
cialists are therapists
who receive addition-
al training not only
for the compression
treatments, but also in
easing the emotional
stress, Hoffman said.
“Our goal is to im-
prove your quality of
life,” Berkey said.
BY RANDY GRIFFITH
Lymphedema can be painful side efect of breast cancer
a irst-degree rela
rmation,
Digital mammography now ofered
TRIBUNE DEMOCRAT
Annette Illig, site supervisor at Crichton Rehabilitation Center’s outpatient clinic in Ebensburg, Pennsylvania, checks on a patient with lymphedema on Sept. 20.
1059 Route 46 North Jeff erson
1-877-371-5791
www.nassief.com
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10 — Breast Cancer Awareness Star Beacon, Wednesday, October 5, 2016
For most of the com-
mon cancers, a major
cause has been identi-
ied: smoking causes 90 percent of lung cancer
worldwide, hepatitis
viruses cause most liver
cancer, H pylori bacteria
causes stomach cancer,
Human papillomavi-
rus causes almost all
cases of cervical cancer,
colon cancer is largely
explained by physical
activity, diet and family
history.
But for breast cancer,
there is no smoking
gun. It is almost unique
among the common
cancers of the world
in that there is not a
known major cause;
there is no consensus
among experts that
proof of a major cause
has been identiied.Yet, breast cancer
is the most common
form of cancer in
women worldwide.
The risk is not equally
distributed around the
globe, though. Women
in North America and
Northern Europe have
long had ive times the risk of women in
Africa and Asia, though
recently risk has been
increasing fast in Africa
and Asia for unknown
reasons.
IS DIET TO BLAME?
Up until about 20
years ago, we thought
it was all about diet.
As people abandon
their local food sources
and begin to eat highly
processed foods with
lots of fats, the hypoth-
esis went, breast cancer
was thought to be more
likely to develop.
This hypothesis was
logical because when
researchers analyzed
countries’ per capita
fat consumption and
breast cancer mortal-
ity rates, they found
a strong correlation.
In addition, rats fed a
high-fat diet are more
prone to breast tumors.
By studying Japanese migrants to California,
researchers found that
the irst generation had low risk like their par-
ents in Japan, but then by the second and third
generation, risk was as
high as white American
women. So, the genetics
of race did not account
for the stark differenc-
es in the breast cancer
risk between Asia and
America. This was also
consistent with the idea
that the change in food
from the lean Asian diet
to the high-fat Ameri-
can diet causes cancer.
So it all made sense.
Until it didn’t.
DIET STUDIES FIND THAT
FAT IS NOT THE ANSWER
Starting in the mid-
1980s, large, well-done
prospective studies of
diet and breast cancer
began to be reported,
and they were uni-
formly negative. Fat in
the diet of adult wom-
en had no impact on
breast cancer risk at all.
This was very surpris-
ing – and very disap-
pointing. The evidence
for other aspects of
diet, like fruits and
vegetables, has been
mixed, though alcohol
consumption does in-
crease risk modestly. It
is also clear that heavier
women are at higher
risk after menopause
which might implicate
the total amount of
calories consumed if
not the composition of
the diet.
There is a chance that
early life dietary fat
exposure, even in utero,
may be important, but
it’s dificult to study in humans, so we don’t
know much about how
it might relate to breast
cancer risk later in life.
If diet is not the major
cause of breast cancer,
then what else about
modernization might be
the culprit?
WHAT WE CAN MODIFY,
AND WHAT WE CAN’T
The factors shown
to affect a woman’s
risk for developing
breast cancer fall into
two categories. First,
those that cannot be
easily modiied: age at menarche, age at birth
of irst child, family his-
tory, genes like BRCA1.
And second, those that
are modiiable: exercise, body weight, alcohol
intake, night-work jobs.
The role of environ-
mental pollution is
controversial and also
dificult to study. The concern about chemi-
cals, particularly endo-
crine disruptors, started
after the realization
that such chemicals
could affect cancer risk
in rodent models. But
in human studies the
evidence is mixed.
Because child bear-
ing at a young age and
breast feeding reduce
risk, the incidence
throughout Africa,
where birth rates tend
to be higher, and where
women start their fam-
ilies at younger ages,
has been lower.
Death rates, however,
from breast cancer in
sub-Saharan Africa are
now almost as high as
in the developed world
despite the incidence
still being much low-
er. This is because
in Africa, women are
diagnosed at a later
stage of disease and
also because there are
far fewer treatment
options.
The question is
whether the known risk
factors differ enough
between the high-risk
modern societies and
the low-risk developing
societies to account for
the large differences in
risk. The answer: prob-
ably not. Experts think
that less than half the
high risk in America is
explained by the known
risk factors, and that
these factors explain
very little of the differ-
ence in risk with Asia.
A related question is
BY RICHARD G. ‘BUGS’
STEVENS
Professor, School of Medicine,
University of Connecticut
The mystery of breast cancer
METRO CREATIVE SERVICES
Many factors determine whether a woman will develop breast cancer, but experts have been unable to identify a major cause. Research into the most common form of cancer is often changing.
October 5, 2016 Star Beacon, Wednesday, October 5, 2016 Breast Cancer Awareness — 11
whether the high risk
in America and North-
ern Europe is due to a
combination of many
known exposures, each
of which affects risk
a little bit, or mostly
due to a major cause
that has so far eluded
detection. And maybe
some of the known risk
factors have a common
cause which we don’t
yet understand.
ARE WE JUST FINDING
MORE CANCER?
Since the 1980s,
screening by mammog-
raphy has accounted for
some of the increase in
incidence in the mod-
ern world compared to
the developing world,
but not nearly enough
to explain the entire
difference. About 20%
of the cancers found by
mammography are now
believed to be of a type
that would never have
progressed beyond the
very small early stage
that mammography can
detect. But the prob-
lem is that we can’t tell
which are the benign
ones and which are not.
WHAT ABOUT ELECTRIC
LIGHT?
Electric light is a
hallmark of modern life.
So, maybe the introduc-
tion and increasing use
of electricity to light
the night accounts for
a portion of the world-
wide breast cancer
burden.
This might be because
our circadian rhythm is
disrupted, which affects
hormones that inluence breast cancer devel-
opment. For example,
electric light at night
can trick the body into
daytime physiology in
which the hormone mel-
atonin is suppressed;
and melatonin has been
shown to have a strong
inhibitory effect on
human breast tumors
growing in rats.
The theory is easy to
state but dificult to test in a rigorous manner.
Studies have shown that
night-working women
are at higher risk than
day-working women,
which was the irst pre-
diction of the theory.
Other predictions are
that blind women would
be at lower risk, short
sleepers would be at
higher risk, and more
highly lighted communi-
ties at night would have
higher breast cancer
incidence.
Each of these has
some modest support
though none are conclu-
sive. What we do know
is that electric light in
the evening or at night
can disrupt our circadi-
an rhythms, and wheth-
er this harms our long
term health, including
risk of breast cancer, is
not yet clear.
Whatever is going on,
it’s important to ind answers because breast
cancer has become
a scourge that now
aflicts women all over the world in very large
numbers, at almost two
million new cases this
year alone.
Richard Stevens has
received funding from
the National Institute for
Environmental Health
Sciences.
Breast cancer is a
disease that claims
the lives of so many
people. Although
many deaths cannot be
prevented due to the
severity and late stage
of the breast cancer,
early diagnosis goes a
long way to improving
mortality rates and
sending individuals
into remission faster.
Knowing the symptoms
of breast cancer can
help women and men
improve their chances
of surviving the disease
after diagnosis, as the
earlier the disease is
diagnosed, the better
a person’s chance at
survival.
Not every person
experiences symptoms
of breast cancer. That’s
because, in its very
early stages, breast
cancer may not exhibit
any symptoms or, if
a tumor is present, it
may be too small to
detect during a breast
self-exam. Furthermore,
there are different
types of breast cancer,
each of which may have
its own distinct symp-
toms. Some of these
symptoms may mimic
symptoms of more be-
nign conditions as well,
making it dificult to determine if symptoms
are indicative of breast
cancer or another ail-
ment.
But even though the
following symptoms
will not necessarily
lead to a breast can-
cer diagnosis, it’s still
important to visit your
doctor for further clar-
iication if any of them appear.
• swelling of all or
part of the breast
• skin irritation or
dimpling
• breast pain
• nipple pain or the
nipple turning inward
• redness, scaliness
or thickening of the
nipple or breast skin
• a nipple discharge
other than breast milk
• a lump in the un-
derarm area
• changes in the size
or symmetry of breasts
• presence of unusual
lumps
Common breast cancer symptomsDid you know?
When a person is diagnosed with breast
cancer, tests are then conducted to study the
cancer cells.
According to the National Cancer Institute,
such tests are used to determine how quickly
the cancer may grow and the likelihood that
the cancer will spread throughout the body.
These tests also may help doctors deter-
mine a course of treatment and if a patient is
likely to experience a recurrence of the cancer
down the road.
One such test is the estrogen and progester-
one receptor test, which measures the amount
of estrogen and progesterone receptors in
cancer tissue.
The cancer may grow more quickly in pa-
tients who have more of these receptors than
normal. In addition to measuring the amount
of these hormones in the cancer tissue, an
estrogen and progesterone test can determine
if a treatment aimed at blocking estrogen and
progesterone may prevent the cancer from
growing.
Many abnormalities
found on a mammo-
gram are not cancer,
but rather are benign
conditions like calci-
um deposits or dense
areas in the breast. If
the radiologist or a
doctor notes areas of
concern on a mammo-
gram, The Mayo Clinic
says further testing
may be needed. This
can include additional
mammograms known
as compression or
magniication views, as
well as ultrasound im-
aging. A biopsy could
be taken and be sent to
a laboratory for test-
ing. In some instances
results are negative
and it is still not clear
what’s causing the
abnormality.
Abnormalities not necessarily cancer
12 — Breast Cancer Awareness Star Beacon, Wednesday, October 5, 2016
