The importance of promoting breast cancer awareness, by Dr. Lisa S. Pair

Assistant Professor Lisa S. Pair, DNP, WHNP-BC

October is Breast Cancer Awareness month.  Awareness campaigns are important to inform the public about important topics to increase knowledge and improve or change behavior . As a women’s health nurse practitioner (WHNP) with more than 20 years of clinical experience, I have performed many clinical breast exams and ordered many mammograms. As a result, I have diagnosed a few cases of breast cancers through the years.

While each patient’s experience is different, I feel that one particular experience provides a good example of why promoting awareness is so important. With this particular patient, I had seen her annually for many years. She came to see me for an annual exam in March, and I performed her clinical breast exam and ordered her screening mammogram, both of which were negative. Her only risk factors for breast cancer were the most common risk factors — the fact that she was female and her age (she was 60 years young). Six short months later, however, while exercising; she felt a lump in her breast.  She came in immediately to see me and her breast lump was over 2 centimeters in diameter. She had a diagnostic mammogram that day, which showed breast cancer.

I share this story because it emphasizes the importance of awareness and vigilance. If she had not performed self-screenings or had a baseline for her own health, this might have gone undiagnosed for longer. Annual breast cancer screening is just what it says — it is screening, not diagnostic.  Breast cancer screening helps with early breast cancer detection, but unfortunately, cannot prevent cancer.

As a WHNP, I encourage my patients to not only have their annual exams and begin screening mammograms at 40 years old, I also encourage them to perform routine self-screenings to help with early detection.

What we know

The most commonly diagnosed cancer in U.S. women is breast cancer. There are currently more than 3.1 million women in the U.S with a history of breast cancer, a statistic that includes women currently being treated and women who have finished treatment. About 1 in 8 U.S women (12%) will develop invasive breast cancer during our lifetime. In addition, men can develop breast cancer as well, with about 2,700 new cases of invasive breast cancer expected to be diagnosed in men in 2019. Though death rates for breast cancer are declining, currently around 42,000 U.S. women and men die from breast cancer annually.

The main risk factors for breast cancer are being female and age (growing older). There are also inherited genetic mutations, such as BRCA1 and BRCA2 genes, which are shown to increase risk. By identifying women with these inherited genetic mutations, we are able to provide them with additional options for breast cancer prevention. However, it is important to remember that currently about 85% of breast cancers occur in women who have NO family history of breast cancer.

Dr. Lisa Pair and Dr. Kelley Stallworth recently attended the National Organization of Nurse Practitioners in Women’s Health National Conference along with 4 graduates from the Women’s Health Nurse Practitioner Specialty Track. They celebrated Breast Cancer Awareness while attending the conference.

Debunking Myths

There are many myths concerning breast cancer. One is that annual mammograms guarantee that breast cancer can be found early. This, unfortunately, is not the case. Mammography is the best early detection tool we have in our toolkit, but it does not always find breast cancer at an early stage. Mammograms can report a false negative result, meaning that the mammogram images are normal and noncancerous when in fact cancer is present. It is estimated that mammograms can miss about 20% of breast cancers at the time of screening, especially in women that have dense breast tissue, which is breast tissue made up of more glandular and connective tissue than fatty tissue.

Another important myth is that breast cancers always present with a lump you can feel. The fact is that breast cancer might not cause a lump, especially when it first develops. In addition, there are cases where breast cancer develops and grows quickly even after a negative clinical breast exam and mammogram. That is why promoting breast self-awareness has become important screening component in our toolkit as well. Breast self- awareness is more than monthly self-breast exams. Most women do not perform monthly self-breast exams, so we also encourage self-breast awareness — becoming familiar with how your breasts normally look and feel. This way, when there is a change, the patient is the first to notice.

Why the importance of breast cancer awareness

Remember what we know from the statistics — death rates for breast cancer are declining. This month is an opportunity to share the latest evidence concerning breast cancer, which can inform decisions.  The current early detection recommendations include self-breast awareness strategies, regular screening mammograms, and provider-performed clinical breast exams. These three recommendations along with genetic counseling, if your risk factors are high, can promote early detection, which can result in cancers that are easier to treat and can decrease mortality. As for my patient with breast cancer, she underwent breast cancer treatment and is currently 5 years cancer free!

Additional resources:

• The American College of Obstetricians and Gynecologists: Did you know? Breast Self-Awareness.

• The American Cancer Society website offers information about cancers as well as information on support services available.  In addition, they have local offices you can visit to obtain information.

• The National Breast Cancer Foundation Inc. provides encouragement and support services to women battling breast cancer.  They also provide free mammograms through their network of hospitals across the U.S.

• The U.S. National Cancer Institute’s website includes information on everything from the various types of cancer, to the kinds of treatments, to the grants available that can help cover costs.

• The Pink Ribbon International is a nonprofit organization committed to creating a global community to support breast cancer patients and to promote breast cancer awareness.

• Susan G. Komen is the world’s largest nonprofit source of funding for the fight against breast cancer.  Their mission is to save lives by meeting the most critical needs of the community and invest in research to prevent and cure breast cancer.

Assistant Professor Lisa S. Pair, DNP, WHNP-BC, joined UAB School of Nursing in 2015 after more than 20 years of clinical experience as a women’s health nurse practitioner.  She is the co-coordinator of the UAB SON Graduate Program’s Women’s Health Nurse Practitioner Track mentoring future WHNPs in providing comprehensive care to women.