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Editorial OCTOBER
2007
October Is Breast Cancer Awareness Month, However…
J. K. Williams, MD
For the 20th year, October has been designated as National
Breast Cancer Awareness Month. This is a noble effort
insofar as the American Cancer Society (ACS) estimates
that more than 40,000 women will die of this disease
in 2007, making it the second leading cause of cancer
deaths in women, second only to lung cancer. The ACS
also estimates that approximately 180,000 new cases will
be diagnosed this year. But although heightened public
awareness is generally such a positive force, I am often
reminded of the potential pitfalls.
First, many “awareness” programs fail
to emphasize the number one independent risk factor
for breast cancer—age.
In fact, in one of the more commonly used prescreening
assessments for breast cancer risk, age (other than
being older than age 35 years), is not even mentioned.
Breast cancer is one of the only cancers that does
not have a specific age of peak incidence; it just
gets more common the older one gets (as does prostate
cancer). But since age is an uncontrollable risk factor,
and the only alternative to aging is dying, it is often
neglected. Nonetheless, awareness of the age factor
would really help patients to understand why breast
cancer appears to be so much more common than before.
Realistically, as our population ages—especially as
the “baby boomers” pass into their 60s—there
will inevitably be an increase in all age-related diseases.
This simple truth must be acknowledged, rather than
pursuing the natural impulse to look for someone or
something to blame—eg, power lines, electromagnetic
waves.
I will never forget one of my medical school professors
telling us of a study (which I have never been able
to find) by an epidemiologist who claimed that the
primary cause for the increasing incidence of breast
cancer was the wearing of automobile seat belts. After
letting us guffaw for a minute, he explained that because
motor vehicle accidents were the leading cause of death
for US women, wearing seat belts has substantially
reduced that risk, leading to a statistically significant
increase in life expectancy and hence an increase in
breast cancer incidence.
Another downside of awareness programs is the potential guilt a patient may feel—guilt
that she was not “aware” enough. This is
addressed to those less-than-obsessive/compulsive people
who do not, or are not able to, adhere in the strictest
sense to all of the guidelines for prevention. (Don’t
ask me when I had my last colonoscopy.) How often does
a patient come to the office 13 months since her last
Papanicolaou test and apologize for being a month late?
This self-blame will likely carry over to breast cancer
screening. At face value, keeping up with timely screening
is a positive factor, until the woman with a newly
diagnosed breast cancer blames herself
for forgetting to do her breast self-examination in
the shower last month.
The other potential negative consequence of screening vis-ˆ-vis awareness is unrealistic expectations. A popular Web site for breast cancer information states, ÒAll women can protect themselves from breast cancerÓ and follows with a discussion of monthly self-examination, clinical breast examination, and screening mammography. Physicians can perform timely, high-quality screening of all women and still not catch every breast cancer in its earliest stage. And even if this were possible, breast cancer screening programs are designed for early detection—not prevention, as implied on that Web site. Here is where breast and cervical cancer screening programs diverge: the former is for early detection, and the latter for prevention. This may be confusing to the public. Every plaintiffÕs attorney holds dear the concept that with strict adherence to a screening program, no one will ever get a disease without it being some physicianÕs fault. In the state of Florida failure to diagnose breast cancer in a timely manner has replaced obstetric problems as the most common type of lawsuit filed against
an OB/GYN.
So this year, letÕs take breast cancer awareness one step further and be sure that the women for whom we care have sufficient information to understand these basic issues regarding this Òall-too-commonÓ disease. For starters, I would recommend that patients visit the Susan G. Komen for the Cure Web site (www.komen.org). I disagree with their interpretation of the evidence that
5 years of oral contraceptive
use increases breast cancer risk, but otherwise this is an excellent, reader-friendly resource for a common-sense approach to risk awareness.
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J. Kell Williams, MD, Board Member
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