Are we making progress?
A look at the current state of breast cancer in Manitoba
BY ANDREA BODIE
Winnipeg Health Region
Published Wednesday October 5, 2011
Over the years, millions of donated dollars have supported breast cancer education, research and programs. The pink ribbon is a readily identified symbol. Yet the fact remains: breast cancer is the most common cancer diagnosed in Manitoba women and the second leading cause of death for Manitoba women.
With no cure to date, the question most people can't help but ask is "are we making progress here?"
Yes, say health experts. Here in Manitoba, we have a very vocal lobby group - primarily comprised of breast cancer survivors - to thank. We also have a health-care system that continually strives to improve itself.
Cancer is a complex disease. Despite this, hundreds of people in this province wake up every morning in this province and dedicate their time, energy and efforts to finding answers about this disease, and working with people whose lives have been touched by breast cancer or raising awareness to help prevent further diagnoses. With every question that's asked and answered, progress is made that impacts how we view this disease, treat this disease and care for the people diagnosed with this disease.
"The key treatments - surgery, radiation and chemotherapy - have been refined and improved, which contributes to lowering cancer death rates," says Dr. Donna Turner, an Epidemiologist and Provincial Director, Population Oncology for CancerCare Manitoba. "Treatments have improved dramatically over the last several decades so women today are looking at survival rates better than ever."
Gone are the days when a breast cancer diagnosis meant a mastectomy. Today, when a woman is diagnosed with breast cancer at an early stage, wherever possible the option of a lumpectomy (a breast conserving surgery) coupled with radiation is considered.
In fact, in Manitoba 80 per cent of women are diagnosed with early stage cancer, and for many of these women, lumpectomy with radiation is an option to mastectomy. For women who fear a breast cancer diagnosis because they may lose their breasts, this is encouraging news. It's also encouraging because this more focused surgery has equivalent outcomes to mastectomy when it's combined with radiation.
Advances in chemotherapy have significantly reduced the risk of disease recurrence and breast cancer prevention clinical trials are shedding new light on preventing the disease or lowering the chances that people will get it.
Social supports - encouraging women and their families to work through the complex emotions associated with a cancer diagnosis and treatment - are also at the forefront. Realizing the health of a person includes their emotional, spiritual and psychological health as well as their physical health is having a positive impact on people's lives.
Services and programs are designed specifically for those affected by breast cancer. There are programs for those diagnosed, as well as those close to them. Programs can be accessed to help individuals during treatment, to help recover from treatments and improve their physical and emotional strength. Support services are available at:
There are also activity based self help groups - everything from singing groups, to dragon boating and more.
We've also seen progress in lymphedema treatment. (When a woman's lymph nodes are removed in surgery, she is at risk for a condition called lymphedema which can cause swelling of the arm, breast, and chest wall.) That means women living with lymphedema are managing it better, which improves their health and wellbeing.
General awareness of breast cancer is on the rise. In the past 30 years, women and the public in general have become more comfortable talking about breast cancer and breast health.
It wasn't always that way. The words ‘breast cancer' were whispered. Many women suffered in isolation. If breast cancer was talked about at all, it certainly didn't resemble the frank conversations about body awareness, breast health and breast cancer we are now having.
That's good. These frank conversations about tough topics have the potential to save lives.
"Before people didn't want to talk about breast cancer because breasts were considered a taboo subject: nice people don't talk about breasts. Now people realize that by not talking about it, you could put yourself in a position of dying from a condition that you could possibly avoid," says Turner. "We're in a much better place to be able to talk about it. We've come a long way."
Reducing the impact
How do we reduce mortality from breast cancer? How do we improve survival?
"By preventing it when we can and finding it early when we can't prevent it, we can reduce the number of women being diagnosed and ultimately, the number of deaths due to breast cancer," she says.
We can reduce the number of people diagnosed with breast cancer by reducing our risk factors. Healthy living can go a long way to reducing your risk for developing breast cancer - or any other type, for that matter.
There's not much we can do about aging, which along with a family history is what health experts call an unmodifiable risk. Our power lies in the factors we can control: maintaining a healthy weight, getting active and reducing alcohol use.
For post-menopausal women, obesity puts us at greater risk for breast cancer. Current scientific thinking is that this is because of increased levels of estrogen in obese women. Although ovaries are the main source of estrogen in women before menopause, estrogen is also produced in fatty tissue. This becomes a major source of estrogen in women after menopause. The estrogen-sensitive breast tissue is therefore exposed to more of this hormone in overweight women, resulting in faster growth of estrogen-responsive breast cancers.
The way hormones interact with our body change the heavier our body weight. On top of this, experts have been concerned that obese women find or detect breast cancer at a later stage, when treatment may be less effective. If we're at a healthy weight, we reduce the risk.
Choosing to eat healthy, nourishing foods - using Canada's Food Guide as a basis - is a good start in maintaining a healthy weight.
Being physically active has also been shown to reduce breast cancer risk. Most research has shown that 30 to 60 minutes of moderate to vigorous exercise a day for women of any age is the key. So do something for at least half an hour everyday that makes you sweat. Consistent, daily exercise is a choice you can make to reduce your risk of breast cancer.
Most people don't readily associate alcohol with increased risk of breast cancer, but it's something we all need to be aware of.
"There is consistent evidence that alcohol consumption will increase your risk for breast cancer," says Turner.
Alcohol has been listed as carcinogenic for humans (a Class 1 carcinogen) by the World Health Organization. This makes it imperative for us to examine our alcohol use. Drink less - or not at all - and reduce your risk.
Early detection - through regular mammograms - is key to reducing deaths associated with breast cancer.
"We've seen a gradual increase in screening participation from when CancerCare Manitoba's program was introduced in 1995. More and more women in the target age ranges are getting tested with mammography," she says. "That allows us to find the cancer much earlier. The key to early detection is being checked before you have symptoms."
BreastCheck, the provincial breast screening program, detects cancers early. Roughly 95 per cent of cancers diagnosed through the program are Stage One and Two, which means a woman's outlook is really good. If the cancer is contained and small, there is an excellent chance for successful treatment. In fact, mortality from breast cancer has been reduced by 23 per cent in women who attended the program.
The frank conversation about knowing your breasts and becoming familiar with how they look and feel at different points in your cycle is one that is necessary to help raise awareness.
Knowing your body is essential. But the simple truth remains: mammograms can save lives. An x-ray of the breast can detect breast cancer before you may see signs or symptoms. For more information on mammograms, visit www.breastcheckmb.ca.
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Physical activity and cancer
World Health Organization - Cancer prevention