Breast Cancer Awareness

Breast Cancer Awareness
By Amy St. George, PharmD Candidate 2011
University of Illinois at Chicago College of Pharmacy

UIC Pharmacy

Every year in October we celebrate National Breast Cancer Awareness Month (NBCAM). 1 The NBCAM organization has been a leader in promoting awareness of breast cancer, and in 2009 they celebrated 25 years of awareness, education, and empowerment. According to the Center for Disease Control (CDC), after non-melanoma skin cancer, breast cancer is the most common form of cancer in women.2 Breast cancer is the number one cause of cancer death in Hispanic women and the second most common cause of cancer death in white, African-American, Asian/Pacific Islander, and American Indian/Alaska Native women. The American Cancer Society estimates that in the United States in 2010 there will be about 207,090 new cases of invasive breast cancer in women, and about 54,010 new cases of carcinoma in situ.3 They also estimate that about 39,840 women will die from breast cancer.

The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. Breast cancer does not just affect women; men can also get this devastating disease. According to the American Cancer Society, about 1,970 new cases of invasive breast cancer will be diagnosed in men, and about 390 men will die from breast cancer this year. The outlook for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment. Currently, there are more than 2.5 million breast cancer survivors in the United States.

Risk factors for breast cancer

There are many risk factors for breast cancer that you may be able to control to decrease the chance of developing breast cancer; however, there are also some factors that you are not able to control.5 Table 1 describes both controllable and non-controllable breast cancer risk factors.

Table 1. Risk factors for breast cancer.5

Risk factors you CAN control

• Weight and diet
• Exercise
• Alcohol consumption
• Smoking
• Use of hormone replacement therapy
• Recent oral contraceptive use
• Stress and anxiety

Risk factors you CAN’T control

• Gender
• Age
• Race
• Family/personal history of breast cancer
• Radiation therapy to the chest
• Exposure to estrogen (ages at menarche and menopause or environmental exposure)
• Pregnancy and breastfeeding
• Diethylstilbestrol exposure-an estrogen-like hormone given to women to prevent miscarriages; daughters born to women who took this medication during pregnancy may be at a higher risk for breast cancer.

Early detection through screening

Screening for breast cancer is crucial for early detection. The earlier that breast cancer is detected the easier it is to treat.2 There is no such thing as a “normal” breast and lumps can be a normal occurrence in some women due to menstruation, changes in weight, having had children, or changes in breast tissue associated with age.

When screening for breast cancer, there are 3 main tests that can be performed: a self breast exam, a clinical breast exam by a physician or nurse, and a mammogram.2 Scheduled mammogram screenings should be done every 1 to 2 years after the age of 40. Although clinical breast exams are not as effective as a mammogram at detecting breast cancer, they do provide some benefit in detecting changes in breast tissue. These exams should be done as part of a routine health examination for all women, starting in their 20s and 30s.3 Monthly self breast exams are also important for all women, starting in their 20s, to determine what is normal for each woman. If you have a strong family history of breast cancer (eg, mother or sister) or had chest radiation therapy at a young age, regular mammogram screenings may need to begin earlier, before 40 years of age.

Diagnosis and Treatment Options

If a diagnostic test is needed, several options are available: breast ultrasound, diagnostic mammogram, magnetic resonance imaging (MRI), or a biopsy. If a breast cancer diagnosis is made, a health care professional will diagnose the stage of cancer based on the spread of the cancer cells within the breast or to various parts of the body.2 Treatment of breast cancer is based on the stage and type of the breast cancer. Possible treatment options include surgery, chemotherapy, and radiation. There are 5 stages of breast cancer and some stages are divided into classes within the stage. The 5 stages are 0 to IV, with I to III having stage rankings of A, B, or C within the stage. Table 2 describes breast cancer stages; the earlier the stage of cancer at detection, the greater chances of successful treatment.4

Table 2. Breast cancer stages.4

Stage 0 Class None Description Abnormal cells in the lining of the breast (ductal) or in the lobules of the breast (lobular). Referred to as carcinoma in situ.

Stage 1 Class A Description Cancer has formed and the tumor is 20 mm or smaller and confined to the breast.

Stage 1 Class B Description Either a cluster of cancer cells (0.3 to 2 mm) found in the lymph nodes or a tumor 20 mm or less and a cluster of cells found in the lymph nodes.

Stage 2 Class A Description A large tumor (20 to 50 mm) hat has not spread to the lymph nodes or a tumor less than 20 mm that has spread to the lymph nodes.

Stage 2 Class B Description A large tumor (20 to 50 mm) that has spread to the lymph nodes or a tumor greater than 50 mm that has not spread to the axillary lymph nodes

Stage 3 Class A Description Cancer is found in the axillary lymph nodes or lymph nodes near the breastbone

Stage 3 Class B Description Any size tumor that spread to the chest wall or skin of the breast

Stage 3 Class C Description Any size tumor that spread to chest wall and lymph nodes above or below the collarbone

Stage 4 Class None Description Cancer that has spread to other organs of the body

How to be involved

Being involved in education and awareness for breast cancer should not stop at the end of October. There are many ways to get involved and help spread the word all year long. The NBCAM website (http://www.nbcam.org/help_promote_nbcam.cfm) lists ways to be involved in your community or workplace to promote awareness of breast cancer. More ways to contribute to breast cancer awareness and a search for a cure can be found at the Susan G. Komen for the Cure website (http://ww5.komen.org/MakeADifference/ImHeretoMakeaDifference.html?itc=emoentpnt:3). Get out, get involved, and support the thousands of people that are affected each year by breast cancer.

References

1. National Breast Cancer Awareness Month. NBCAM 25 years. http://nbcam.org/index.cfm. Accessed August 3rd, 2010.
2. Centers for Disease Control and Prevention. Breast Cancer. http://www.cdc.gov/cancer/breast/basic_info/index.htm. Accessed August 3rd, 2010.
3. American Cancer Society. Breast Cancer. http://www.cancer.org/Cancer/BreastCancer/index. Accessed August 3rd, 2010.
4. National Cancer Institute. Breast Cancer Treatment (PDQ). http://www.cancer.gov/cancertopics/pdq/treatment/breast/patient. Accessed August 3rd, 2010.
5. Breastcancer.org. Lowering Risk for Everyone. http://www.breastcancer.org/risk/everyone/. Accessed August 3rd, 2010.

Let's Talk About Prescriptions!

October is Talk About Prescriptions Month, focusing on safe medicine use messages for consumers and healthcare providers.

Did you know that 2 out of every 3 office visits to the doctor end with
a prescription being given? This adds up to over 3.5 billion prescriptions
dispensed from pharmacies each year, which means that if you go to the doctor
this year, you will more than likely be given a prescription. Since it
has become so common to prescribe medication, it is important
to make sure you understand why you’re getting the
medication and what it will do for you.

Your UIC pharmacists are there to help you! You can call them and ask
them questions or ask them in person when picking up your prescriptions.

Here is a list of questions you can ask the pharmacist to better understand your medication and how it will affect you:

•What is this medication and what is it used for? If there is an
addition or change to your usual regimen, ask about the reason for the change.

•How and when do I take this medication? And for how long?

•Do I need to take it on an empty stomach or with food? Can I take this
with my other medications and over-the-counter and herbal supplements?

•What should I do if I miss a dose?

•What does “as needed” mean?

•What side effects can occur from taking this medication?

•How will I know if it’s working?

•How come the name on this medication is different from what the doctor
prescribed?

This happens often. Brand name drugs are commonly seen written on prescriptions, but in the pharmacy they may be dispensed as a generic equivalent.

•How and where should I store this medication?

•May I have written information about my prescription? If you prefer
large print or a language other than English, let the pharmacist know.

•Can I fill out a patient profile form that includes over-the–counter
and herbal medications as well as my prescription medications to keep on
file?

This is a great way to provide all necessary information to ensure
you get the best care.

So now that you have asked all the questions and you have your
prescription, here are some tips for the future:

•Read the label and take the medication exactly as prescribed for the
entire time you are supposed to take it.

•If you take more than one medication, it is important to be organized.
Know what your medications look like, what each one is for, and be able to
tell them apart. Pill containers available at the pharmacy make it much
easier to organize your medications by day and time of administration.

•When you need a refill, it is better to get it while you still have a
few pills left so that way you remain on schedule and don’t miss doses.

•If you have children in your home do not take medications in front of
them and store medications out of their reach and sight.

•If you are traveling ask your doctor or pharmacist to adjust your
schedule to accommodate your change in schedule. Also, carry your
medications with you and do not keep them in checked luggage.

•If you need to buy your medications online, make sure the pharmacy is
state-licensed with licensed pharmacists answering questions and
overseeing the pharmacy. Also, look for a Verified Internet Pharmacy
Practice Site (VIPPS) seal on the website so you know it is accredited.

•If you are required to have blood work or lab tests done while taking your medication make sure you know where you can go and how often the tests should be done.

•Keep notice of expiration dates on your medications.

If they are expired, almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a bag or other container. Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine.
.
For more information on how to use medications safely, these sites can help:

www.talkaboutrx.org/
www.fda.gov
www.bemedwise.org
www.consumermedsafety.com


Written by: Amanda Hodges, Pharm.D. candidate (P3)
University of Illinois, College of Pharmacy