One in Eight

by Amanda Boornazian and Abby Kappelman

Here’s the truth: one in eight US women will develop breast cancer in their lifetime. Statistically speaking, you absolutely know someone who will fight breast cancer. Personally speaking, you will be hurt, confused, devastated, and affected by this disease in some capacity in your life. So it’s time to learn about what you can do to educate and protect yourself, your family, and your friends, and how to make this fight more inclusive and empowering. Let’s get real about breast cancer and Breast Cancer Awareness Month.

Self-Exams

“Forty percent of diagnosed breast cancers are detected by women who feel a lump.” 

- Johns Hopkins Medical Center

You know your body better than anyone else, and while breast cancer might not be entirely preventable, your ability to reduce your risk by noticing changes early-on is your best attempt to avoid serious disease. The best way to remain aware of your breast health is to conduct self-exams, beginning ideally in your early 20s - so all you college women out there start now. Self-exams should be completed once a month, preferably the week after your period when your breasts are less tender and all that dense tissue that plagues that week is gone. Don’t know how to self-exam? First, start by looking in a mirror. Notice any color changes or moles or dimpling? Take note. Now, while either in the shower or lying down, do a physical exam. Whichever breast you examine first, left or right, take that same arm and put it behind your head. To examine, there are two recommended methods. With your opposite hand, either move in concentric circles, basically swirling in from the outside all the way to the center of your breast; or, zig-zag back and forth across your breast. Regardless, make sure you cover all of the area from just below your collarbone to about an inch underneath your breast -- including under your arms!

With your hand, make sure that you are pressing hard enough to feel any lumps or knots. Your breasts aren’t just what they seem at surface level, so while it may be significantly more comfortable just to run your fingers over the skin, you’re not going to pick up the important signs. You need to push your fingers to all different levels in your breast. So after you’re done feeling the surface, push a little harder. Then push even harder. Then get all the way down to the bottom so you leave no depth untouched. It’s not a walk in the park, and it can be uncomfortable - but trust us, it is worth it. You’re going to want to do these exams at the same time of your cycle every month, because hormone levels change the density and composition of the breast. In other words, what you’re feeling week three of your cycle may not be there week two.

Notice anything? What might be concerning are any lumps and inconsistencies that you notice multiple times, or any specific changes that you notice. If you’re worried about anything you feel or see, contact your primary care doctor, OB/GYN, or whoever you see for your yearly check ups. Here, it is always better safe than sorry, so ask questions!

However, the issue still remains that within our current healthcare system, we have limited access to physicians, resulting in shorter visits with doctors, long waiting lists, and less frequent visits. Be your own best advocate. Stay up to date on real scientific literature. No one knows your breasts better than you. A doctor feels them once a year along (if you even show up once a year) with 300+ other pairs of them from other patients. What's abnormal for you may not and is most likely not abnormal for anyone else. Feel them, know them, listen to them.

Read more about breast self-exams

Mammograms

Mammograms are considered the first course of action for women without preexisting conditions or familial histories of breast cancer. Mammograms are implemented a method of breast cancer screening for women beginning between the ages of 40-45. Of course, this type of preventative care is usually only implemented by those women with healthcare insurance approval or the financial capability to cover such costs -- for other women, who may be uninsured, preventative care is more of a luxury than they can afford. After the age of 40, it is recommended that women screen once a year with mammograms. After the age of 55, the recommendation is that women switch to two mammograms a year.

Breast cancer can progress slowly or quickly. There’s no telling where the disease goes. In theory, you could leave your yearly mammogram and develop a lump within the month (or the mammogram missed it). Should that lump go unnoticed and progress until your next yearly mammogram, you could be in a very different and dangerous situation. Diagnosis at Stage 0 and Stage I breast cancer boasts nearly 100% 5-year survival rates (meaning that five years after diagnosis, almost every woman that is diagnosed at this stage is still alive). On the other hand, Stage IV breast cancer has a 22% 5-year survival rate. Needless to say, that’s drastically lower. And that can be the difference between life and death. So, is there anything you can do? Luckily yes. Let’s learn about self-exams and get in that routine early so we all use it effectively throughout our lives. It’s not guaranteed to save you by any means, but it will lower your risk and increase your chance of an early diagnosis if your mammograms are irregularly timed or not frequent enough.

 

Family History

A family history refers to common instances of breast, ovarian, or prostate cancer in female relatives (mother, sister, daughter, aunt) or male relatives (father, brother, uncle). As the number of family relatives with cancer increases, so does your risk; also, the more closely related those family members are to you (your mother, say, rather than your aunt), so also increases your risk. If you do have a family history, you may be able to get covered by insurance for mammograms earlier in your life. It may also be a good to consider getting screened for genetic components of breast cancer, like BRCA, if you do have an extensive family history of breast cancer. Your primary care doctor can speak to you about those options.

Read more about family history.

Read more about BRCA.

 

Age & Time

Today, fewer than 5% of breast cancer patients are under the age of 40. Risk increases with age, so it makes sense that breast cancer occurs more frequently in older women. But here’s the catch. A lot of women put off the uncomfortable mammogram exams. Or after they start, mammograms may be irregular, occurring every few years. Even more, mammograms aren’t entirely accurate! And most women don’t complete self-exams either. Before you know it, you’re old enough to be at peak age for breast cancer -- and neither you nor your doctor have any idea how well you have tracked your body.

 

The Pink Issue

October has always been full of trick-or-treating, candy, and some spooky decorations. But in our generation, we’ve grown accustomed to seeing pink slathered against every surface and object that can change colors. It’s Breast Cancer Awareness Month! Football cleats, t-shirts, store banners, Facebook profile pictures, food, you name it. And that’s great, because it brings in a lot of money to foundations like Susan G. Komen that fund research and other noble efforts that really make a difference in the lives of women and their families. But this campaign is by no means inclusive. Pink is most commonly associated with femininity. It’s what we paint baby girl’s rooms, wear in powderpuff football games, and wear on Wednesdays. But there’s a few issues with what this color brings about for some women. Some afflicted breast cancer patients do not identify with their assumed femininity. Some men are diagnosed with this disease. People that are trans are diagnosed. People that are not cis-gender are diagnosed. Associating this disease with pink and femininity, while achieving a clear marketing goal, may leave many feeling excluded from the community that others can garner most of their support from.

Breast cancer can ravage femininity as well. Let’s think of some of the commonalities between womanhood and femininity: pregnancy, motherhood, ovaries, and breasts. But all four of those things can be taken away by this disease. Breast cancer isn’t keen on preserving womanhood. Many women lose their breasts. Many women lose their ovaries. Many women have hormone problems. Many women that get diagnosed at a young age may not be able to have children later in their lives. It’s not a pretty, beautiful, wrapped-in-a-pink-bow problem. It’s a disease and it’s awful and it’s destructive. Pink, though endearing, isn’t an accurate representation; it implies this disease is embodied these feminine traits that many patients not only lose but perhaps didn’t even claim as their own in the first place. So, yes, buy your pink shirt and pink ribbon and watch the NFL parade around in all pink everything because it does benefit research. It does raise awareness. But let’s focus on what this disease can actually do so you can best serve the community of patients, survivors, and grievers.

On this topic, how many have heard the phrase ‘Save the Tatas’? Maybe, ‘Save Second Base’? Any phrase that’s all about saving boobs? We all have. And yes, let’s save them. Maybe. Some women have significantly higher chances at surviving breast cancer if they undergo mastectomies, the removal of one’s breasts). On the other hand, many women opt to preserve their breasts and fight the disease in other ways. Doctors can go either way, but we definitely see a lot of doctors encourage fighting in those other ways - keep your breasts and we’ll see what we can do. And society definitely advocates for keeping your breasts too, evidence being the ‘Save the Tatas’ bracelets that everyone had in middle school. But they are your breasts.

This idea of society deciding that even when faced with cancer, your breasts may be more important than your life, is representative of how perverted version of femininity permeates breast cancer. There’s a push to pursue treatments other than mastectomies. Yes, we admit that mastectomies are a drastic treatment option, but women should feel comfortable to pursue such a procedure for their own safety, and should feel comfortable to pursue such an option without the pressure to then reconstruct their breasts. We fully believe in the empowerment that many women receive through physical traits like their breasts. It’s not an easy choice to undergo an elective procedure to remove part of your own body. And if you do undergo a mastectomy, there is nothing wrong with then undergoing reconstructive plastic surgery. But that’s not for everyone. And losing your breasts shouldn’t be an outcasting move. Let’s learn to respect personal decisions and let’s draw empowerment from one another and non-physical traits as well. Breast cancer attacks the physical aspect that makes us women. It tries to destroy it. But there is so much else to who we are. So in the month of October, to support all women everywhere, let’s focus on what makes us women in our day-to-day lives, something that cancer cannot attack.

So save the tatas, sure. But let’s also say save the lungs, the brain, the heart, the liver, the prostate. For women, your breasts are just as much a part of you as your brain or your heart. They are something as unique to you as birthmarks, neural networks, and your eyes. So, yes let’s save them. Because saving them means saving a person. Let’s save you. And for everyone else, at risk of breast cancer or concerned for those who are, let’s focus on the disease. And let’s focus on the victims. And let’s celebrate what we have, with or without breasts.

Let’s save you in whatever ways you see fit, and rally around your decisions to fight this disease with your entire being. Let’s put femininity and pink aside and draw empowerment for our ability to conduct research, donate to families, and sit by each other’s side in exam rooms, surgical suites, and in chemotherapy chairs. This disease is unique. People’s fights with it are going to be unique. So do your best to protect yourself, share your new wealth of knowledge about preventative care with everyone you know, and let’s focus on each other and keep fighting the good fight.

Amanda + Abby