After the Susan G. Komen’s MORE THAN PINK Walk® in Colorado, the community was reminded of the prevalence of breast cancer. Information circulated by Susan G. Komen leading up to the race stated that “every two minutes someone is diagnosed with breast cancer” and “every sixty seconds, someone in the world dies of breast cancer” (Susan B. Komen, August 24, 2019). Websites like the Center for Disease Control [CDC] further explain what this means for Colorado residents. For instance, between the years of 2012 – 2016, breast cancer had the highest incidence rate compared to all other cancers for women in Colorado (CDC, 2019). Furthermore, it was the second highest ranked cancer responsible for cancer related deaths in the state. Interestingly, Colorado’s trends also mirror those of the nation (CDC, 2019).
Many people are unaware that medical professionals were essentially mystified by breast cancer until the 19th century (Freeman et al, 2018). In addition, not until the 20th century did surgeons begin to operate in a far less invasive manner (Freeman et al., 2018). Instead of removing all underlying muscle and breast tissue from the afflicted area, surgeons were finally able to keep the underlying muscle intact. Not too long after, the alternative surgical option of lumpectomy was developed. Lumpectomy allowed for the cancer to be removed with little extra tissue, and thus more breast tissue was preserved. Furthermore, in the same time frame, chemotherapies and other supplemental therapies such as radiation were shown to reduce the rate of reoccurrence of the breast cancer and prolong survival (Sakorafas & Safioleas, 2018).
Even with these scientific and medical advances, several questions are still left unanswered regarding both the causes of the onset of breast cancer and the best treatment options. However, research has shown that the earlier breast cancer is detected, the more likely treatment will be successful (Qaseem et al., 2019). Knowing this, medical professionals highly recommend women get screened by a mammogram. While some practitioners argue that women should begin screening in their 50’s (Qaseem et al., 2019), the National Comprehensive Cancer Network [NCCN] along with the American Cancer society [ACS] recommend that women who are at “average risk” begin getting screened in their 40’s (NCCN, 2019; ACS, 2017). Average risk includes: no previous history of breast cancer, absence of the BRCA1/2 gene mutation, and no history of radiation therapy on the chest as a child (Qaseem et al., 2019). Due to the shared recommendation of the NCCN and the ACS, insurance companies like Medicare and Medicaid cover women’s mammograms starting at the age of 40. However, if a woman has an increased chance of breast cancer, screenings at a younger age might additionally be covered by insurance (NCCN, 2019). An elevated risk would be a family history of breast cancer or the presence of the BRCA1/2 gene mutation. Nonetheless, it is important to talk with your insurance company or doctor to find out if a mammogram would be covered at your age.
When considering African American women’s health, breast cancer becomes a greater concern. While overall there is a slightly lower prevalence of breast cancer within the Black community, death for African American women, as opposed to their White counterparts, occurs at a much higher rate (Daly et al., 2015). Several factors that contribute to this mortality(death) gap are suggested:
- A larger population of younger African American women being diagnosed with cancer (33% being diagnosed under 50 as opposed to 21.9% of white women).
- A higher rate of triple negative breast cancer within that same population (a breast cancer that is not easily targeted with chemotherapy).
- A higher degree of African American women do not follow up after an abnormal mammogram (Daly et al., 2015).
In the past, the predominant concern was the reduced rate of African American women getting mammograms. In comparison to European Americans “African American women were less likely to know their lifetime risk for getting breast cancer or to understand that older women were more likely to get breast cancer” (Champion & Springston, 1999). Over time, the rate of African American women getting screened has substantially increased (Peek et al., 2004; Daly et al., 2015). The current concern is that African American women are not following-up after their screening. The patient provider relationship then, is thought to contribute to whether or not a woman will follow up after her initial screening. A study conducted by Mayne and colleagues found that more women were screened when they had relatively easier access to a provider, and more women followed up when their providers gave them a direct referral (Mayne et al, 2003). Without such referral, the medical necessity to follow up was less understood (Mayne et al., 2003). Follow up appointments and diagnostic evaluations are often not covered by insurance. In the event that evaluations and follow ups are recommended, they can potentially be lifesaving.
During October (Breast Cancer Awareness month) take the opportunity to encourage the women you love and care about to get screened and follow up as recommended. Insurance will cover breast cancer screening for women above 40 years of age. For women who are uninsured, resources exist:
- The Colorado Department of Public Health and Environment
- The Colorado Department of Public Health provides women who are eligible for their Woman’s Wellness Connection (WWC) program with access to free mammograms, and if applicable, the financial assistance needed for relevant follow-ups. Their website is: https://www.colorado.gov/pacific/cdphe/womens-wellness-connection-wisewoman.
- Susan G. Komen’s Helpline at 1-877-GO KOMEN (1-877- 465-6636).
- Susan G. Komen’s Helpline is able to put women in contact with mission and care coordinators here in Colorado. These care coordinators connect those who are ineligible for the WWC program to community health care clinics close to them that are able to provide adequate care at a sliding scale fee.
Together we can spread awareness! We are women! We are strong!
By Paige Petrone
Professional Master’s in Biomedical Science 2019
(2019, August 24th). Komen Website Reference Materials. Retrieved from https://ww5.komen.org/BreastCancer/BreastFactsReference.html
ACS Breast Cancer Early Detection Recommendations. (2017, September 1). Retrieved from https:www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/American-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
Champion, V. L., & Springston, J. (1999). Mammography adherence and beliefs in a sample of low-income African American women. International Journal of Behavioral Medicine, 6(3), 228–240. https://doi.org/10.1207/s15327558ijbm0603_2
Daly, B., & Olopade, O. I. (2015). A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA: A Cancer Journal for Clinicians, 65(3), 221–238. https://doi.org/10.3322/caac.21271
Freeman, M. D., Gopman, J. M., & Salzberg, A. C. (2018). The evolution of mastectomy surgical technique: from mutilation to medicine. Gland Surgery, 7(3), 308–315.
Mayne, L., & Earp, J. A. (2003). Initial and repeat mammography screening: Different behaviors/different predictors. Journal of Rural Health, 19(1), 63–71. https://doi.org/10.1111/j.1748-0361.2003.tb00543.x
National Comprehensive Cancer Network (2019, May 17).Retrieved from https://di.org/10/1111/j.1748-0361.2003.tb00543.x
Peek, M. E., & Han, J. H. (2004). Disparities in screening mammography: Current status, interventions, and implications. Journal of General Internal Medicine, 19(2), 184–194. https://doi.org/10.1111/j.1525-1497.2004.30254.x
Qaseem, A., Lin, J. S., Mustafa, R. A., & Horwitch, C. A. (2019). Screening for Breast Cancer in Average-Risk Women : A Guidance Statement From the American College of Physicians. American College of Physicians, (2019), 547–560. https://doi.org/10.7326/M18-2147
Sakorafas, G. ., & Safioleas, M. (2010). Breast cancer surgery: an historical narrative. Part III. From the onset of the 19th to the dawn of the 21st century. European Journal of Cancer Care, 19, 144–166.