You've heard it before, and you'll hear it again: Early detection is so important with breast cancer. It certainly is useful in the sense that, the sooner you catch breast cancer, the more treatable it probably is. But there can also be a serious downside: If you end up being one of the eight American women will get cancer in their lifetimes, your fear may lead you to preemptively opt for the most aggressive treatment possible.
First, a little background: If breast cancer is caught in Stage 0, 1, or 2, that counts as early detection. Stage 0 cancer, also known as pre-cancer, is what doctors often call non-invasive, meaning the cancer cells are strictly located in the breast’s milk ducts. “Stage 1 is when there’s an actual tumor of less than an inch in the breast only,” says Dennis Citrin, Ph.D., an oncologist at Cancer Treatment Centers of America and author of Knowledge is Power: What Every Woman Should Know about Breast Cancer. “In Stage 2, the lump may be a bit bigger and the cancer may have spread to the lymph nodes.”
Most women with early-stage breast cancer do as well with a lumpectomy as they would a mastectomy, which removes the entire breast, says Citirin. Medical progress in approaches like radiation or drug treatment keeps breast cancer deaths around 40,000 per year, according to the American Cancer Society. But the thing is, when you’re afraid of cancer spreading, conservative measures may not seem like the most judicious approach. “Sometimes women get scared and want to have something drastic done, even if it’s not necessary,” says Beatriz Amendola, M.D., a radiation oncologist at the Innovative Cancer Institute. Research backs this up.
In fact, up to 70 percent of women who underwent a double mastectomy didn’t have a medical reason to do so, according to a June 2014 study published in JAMA Surgery. Researchers interested in studying potential overtreatment of breast cancer evaluated 1,447 cases of women who’d had the disease and hadn’t had a recurrence. While 19 percent of the women strongly considered contralateral prophylactic mastectomy (CPM), or the removal of both the cancerous and non-cancerous breasts, just under 8 percent actually went through with it. After analyzing the patients’ medical and family histories, researchers concluded that 69 percent had no science-based reason for undergoing the procedure. The study authors posit that anxiety about cancer recurrence is a driving force behind the decision to remove both breasts, even when doctors don’t see a need for it.
"Sometimes women get scared and want to have something drastic done, even if it's not necessary."
Although the study authors write that “removal of the unaffected breast in most patients diagnosed as having breast cancer has not been shown to prolong survival,” doctors are still seeing women request more treatment than they’d medically deem necessary. “Women tend to overestimate their risk and think that removing their breasts means the cancer can’t come back,” says Rosemary Leeming, M.D., director of the Comprehensive Breast Program at Geisinger Health System. “The takeaway from this research shows women wanted to take control of cancer and manage their fear.”
Another analysis of more than 108,196 women suggests that those diagnosed with Stage 0 breast cancer had about the same probability of dying from breast cancer as the average woman. The August 2015 JAMA Oncology study checked on women 10 and 20 years after their diagnosis of ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer. They found no matter what kind of treatment the patients got, they had a 3.3 percent chance of dying in the 20 years after the study, about the same as the average woman’s risk of dying from breast cancer.
Two major takeaways are that extreme measures after an early diagnosis aren’t necessarily guaranteed to prolong a woman’s life and that anxiety about an early diagnosis isn't always productive. “This research isn’t enough to immediately change what we’re doing, but it does raise very good questions about treatment,” says Leeming. “Hopefully, we will design good studies to look at novel approaches.”
And fear often wins out in the face of research or doctors’ opinions, says Amendola. “I’ve seen many patients with early-stage breast cancer who have great anxiety,” she says. “This happens many times because they are not fully educated on the issue. Patients can be scared that death is imminent, even when that’s not the case.”
If you do wind up being diagnosed, it’s important to weigh your choices and get input from multiple sources. “Every woman who is newly diagnosed should see both a surgeon and a medical oncologist who specializes in breast cancer,” says Citrin. Instead of the go-to being immediate surgery, doctors often use drug treatment to shrink the cancer first. “We can take very large tumors that would have once required mastectomy and convert them into small ones that can be managed with limited surgery,” says Citrin.
"Patients can be scared that death is imminent, even when that’s not the case."
While things like your family history of the BRCA gene, your weight, and your race can affect your chances of getting breast cancer, a diagnosis doesn’t equal a death sentence. And although you can’t fully control whether you get breast cancer, you can do your best to keep your risk low. “If you’re at no more risk than the average person, live a healthy lifestyle,” says Leeming. That means incorporating plenty of diet and exercise since obesity can drive up your risk factor, she says. It also involves keeping eye on your vino habit. “Studies show women who are heavy drinkers, as in more than one drink a day, have an increased risk of developing breast cancer,” says Leeming.
Beyond that, you should be doing a breast self-exam once per month. Watch this video to find out exactly how to give yourself a self-exam:
If you’re still menstruating, Leeming recommends doing it right after your period since that’s when your breasts are least swollen. If you’re no longer getting your period, pick one day a month and stick to it. In addition to feeling for any changes, it’s about familiarizing yourself with your chest in general. “You may not know exactly what you’re feeling if you find something, but you’ll know it represents a change from your norm,” says Leeming. If you do feel a lump, you can wait it out for a couple of menstrual cycles. If it sticks around for more than one or two, make an appointment with your doctor for a professional opinion. And it’s important to remember: “If we detect breast cancer early enough, we can treat it with conservative measures,” says Amendola.