More women than ever before are surviving breast cancer. The National Breast Cancer Foundation (NBCF) reports that breast cancer death rates have declined by 40% in women from 1989 through 2016. Given that breast cancer is the second-most common cancer among women, surpassed only by some skin cancers, having such a large decline is encouraging.
Because the U.S. population is growing and aging, the numbers of new breast cancer cases and deaths are increasing. The CDC reports 254,744 cases in 2018 — the latest year for which incidence data is available — compared to 196,684 new cases in 1999.
The American Cancer Society (ACS) largely attributes the lower death rate to improvements in early detection.
“On average one out of eight women will be diagnosed with breast cancer,” says Dr. Tracy Carmellini, director of imaging at Jennersville Hospital-Tower Health Medical. “The goal is to reduce mortality and mammography is the only test proven to reduce mortality.”
Since 2015, women 20 and older get a breast exam as part of their clinical wellness checkups every three years. Women older than 40 receive a clinical exam with their checkup every year, in addition to an annual mammogram. Women older than 45 are asked to get a mammogram every year until age 55, at which point they can decide if they are more comfortable with an annual or biannual mammogram.
That biannual recommendation has led some women to think there is a risk associated with mammography starting at age 55, or that they are at reduced risk of breast cancer.
“The risk is anxiety of women getting called back for additional studies or a false alarm with a breast cancer detection, Carmellini explains. “The goal is to find cancers when they are smaller and more treatable, which leads to less extensive surgeries. There will be some anxiety with false positives, but the benefits far outweigh the costs.”
A breast cancer diagnosis is not limited to the patient. Carmellini says the impact on the family, disruption to careers and the number of years lost are all tragic.
“There are so many factors dealing with late-stage breast cancer other than mortalities,” she adds. “Medical societies recommend getting screened annually as long as you’re in good health.”
Advancements in medical technology have enabled medical professionals to provide a greater array of tools for early detection. The most popular screening tests are mammograms and breast MRI. A diagnostic mammogram and ultrasound may be scheduled if the screening reveals changes or other causes for concern.
Women should not be concerned about radiation exposure during a mammogram.
“The amount of radiation is very small,” Carmellini says. “It’s the same as natural exposure of background radiation that you get from regular soil.”
There are also emerging screening technologies. Many of these are variations of injecting a substance into the bloodstream and taking images of the substance to reveal details about the breast tissue. Positron emission mammography differs in that it uses a radioactive particle to detect cancer cells.
Other tests are also being developed, including optical imaging tests that measure light sent through the breast tissue; electrical impedance imaging, which scans the breast for electrical conductivity; and elastography, which is done in conjunction with an ultrasound and looks for suspiciously firmer tissue.
In conjunction with advanced imaging technology, screening recommendations reflect a growing trend of shared decision-making between physicians and their patients. Decisions may be influenced by whether a woman is considered high risk for breast cancer. The CDC has a list of red flags for high risk. These include family history, being a carrier of gene mutations such as the BRCA1 or BRCA2, radiation therapy to the chest between ages 10-30, and a diagnosis of Li-Fraumeni Syndrome, Cowden Syndrome or Bannayan-Riley-Ruvalcaba Syndrome.
Lifestyle choices can also affect a woman’s level of risk. Maintaining an ideal weight, not smoking, eating healthy foods and staying active are all behaviors a person can control to reduce the risk.
Carmellini notes 75% of breast cancers develop in women with no risk factors.
“The No. 1 risk is being a woman,” Carmellini says. “I hear this so frequently from newly diagnosed women, ‘Well, I’ve never had any problems with breast cancer and no one in my family has had cancer.’”
Carmellini emphasizes that the most important thing a woman can do is to have a conversation with her physician at age 30 to determine her risk.
Hed: Diligence and a diagnosis
When Herr Foods Quality Assurance Lab Tech Laura Spangler was diagnosed with breast cancer, her tumor was about the size of the period that ends this sentence.
Spangler’s journey is a tale about the importance of annual screenings, early detection and the capabilities of modern medical technology to save lives.
When she was 40 years old, Spangler began getting an annual mammogram, as is recommended for women ages 40 to 55. She sets up her appointment each October, and typically gets a mammogram and an ultrasound.
“When everyone starts talking about breast cancer for Breast Cancer Awareness Month, I know it’s time to get my mammogram,” Spangler says.
When the pandemic hit, Spangler’s mammogram was delayed four months. She was screened in February and shortly afterward received a call from her doctor. When she went in for the diagnostic screening, she took advantage of an opening to get her biopsy done that day. The results came back positive.
Being adopted, Spangler has no idea about her biological family’s medical history. She opted for genetic testing, which came back negative.
“I’m a fluke cancer,” Spangler says.
In reality, her diagnosis is not unusual. Tracy Carmellini, director of imaging at Jennersville Hospital-Tower Health Medical, says 75% of breast cancers develop in women with no risk factors.
Spangler diligence regarding being screened enabled her cancer to be diagnosed early and classified as 1A, about as low a rating a cancer can have.
In May, Spangler had surgery. Her lump and three lymph nodes were removed. All lymph nodes tested negative. As of July 2021, she was undergoing radiation treatments that left her feeling tired.
“Because they found my lump so soon and the lymph nodes tested negative, I just need radiation in a local area,” Spangler says. “No chemo or nasty, radical stuff.”
Spangler had the lowest dose of radiation for the shortest amount of time. Her cancer journey will be about four months.
As far as Spangler is concerned, getting all her recommended screenings is the best way to keep her life enjoyable and smooth. She’s had two colonoscopies, gets her flu shot each year and been vaccinated against COVID-19.
“I have a science background,” Spangler says. “When they say this is what’s needed, I get it. They aren’t giving you these recommendations for personal gains. It works.”
Spangler is part of the crew on a 17th century tall ship, a traditionally-rigged sailing vessel on which she teaches people about Delaware’s history and how to sail.
“I’m just waiting to be cleared from my doctor so I can sail again,” she says.