Breast CancerClinical TopicsEditorialOncologyUncategorized

The elusive cure


October is Breast Cancer Awareness month. To urge you to focus on early detection, we’ve devoted our cover article and continuing education module to breast cancer.

We all have our stories—friends, family, neighbors, and coworkers who have survived or succumbed to breast cancer. The disease first touched my family almost 40 years ago when my maternal grandmother underwent a radical mastectomy and radiation therapy. Several years later, my cousin died at age 25 from metastatic breast cancer.

Breast cancer is the second leading cause of cancer deaths for women overall in the United States—but the leading cause in American women ages 20 to 59, as well as in women worldwide. In the United States, the risk of developing breast cancer in 1975 was 1 in 11, or 9%; today, it’s 1 in 8, or 12.6%. The risk increases with age; nearly 80% of affected women are older than age 50. Known risk factors account for less than one-third of cases, and more than 90% of women with breast cancer have no family history. What’s more, interventions that reduce the risk or development of the disease have seen little success.

The good news: Mortality is declining. Since the mid-1990s, it has dropped approximately 2.4% annually, with greater decreases in white non-Hispanic women. Also, mortality for women younger than age 50 has declined by more than 3% per year, regardless of race or ethnicity. However, mortality for black women lags behind that of white women. Survival at 5 years after invasive breast cancer is almost 90% for white women but just 77% for black women.

The earlier breast cancer is found, the greater the likelihood that treatment will succeed. The American Cancer Society (ACS) and other advocacy groups are longtime proponents of early detection. Current ACS recommendations are generally accepted as the guide for screening mammograms and clinical breast examinations. (See “What every nurse needs to know about breast cancer,” pages 32-38.)

Breast cancer research has brought an interesting discovery: Breast self-exams (BSEs) don’t contribute meaningfully to earlier detection or reduced mortality. The benefit of BSE is that it familiarizes women with their normal breast appearance and structure, making changes easier to detect. The most often-cited risk of BSE is the increased anxiety a woman may experience after discovering a lump that later turns out to be benign, leading to more physician visits and a potential for unnecessary biopsy. Thus, with insufficient evidence that BSE is effective, its routine use is no longer recommended.

The high toll of breast cancer has led to a national grassroots volunteer movement to help raise both awareness and funds for research to find a cure. Groups such as the Susan G. Komen Breast Cancer Foundation and the Breast Cancer Research Foundation were established to find out why young women die from breast cancer and how others can be spared. Volunteer activists have invaded boardrooms seeking resources to fight breast cancer. Well-known retailers have given millions of dollars to support foundation fundraising efforts. One of the best-known fundraising campaigns is the Komen Foundation’s Race for the Cure, with events occurring in more than 120 cities each year. Lee Jeans holds Lee National Denim Day, perhaps the world’s largest single-day fundraiser for breast cancer.

The federal government also funds breast cancer research. This year, estimated federal spending on such research will include $551 million at the National Cancer Institute and $127.5 million at the Department of Defense. Also, the National Breast and Cervical Cancer Early Detection Program of the Centers for Disease Control and Prevention provides mammograms and Pap smears to underserved women throughout all 50 states, the District of Columbia, six U.S. territories, and 12 American Indian/Alaska Native organizations.

Remember—promoting breast cancer screening is more than a once-a-year event. Be sure to follow the screening guidelines for yourself, and encourage your friends and family to do the same. If you’re not already involved in efforts to support breast cancer research, consider doing so. Help us get another step closer to the cure.
Pamela F. Cipriano, PhD, RN, FAAN

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