Cancer. It’s an ugly word, and not always easy to talk about with patients, even in a preventative context. As a clinician, however, developing the expertise to effectively hold those difficult conversations is critical not only to the patient’s immediate wellness, but to their long-term health as well.
Outside the bell curve
The difficulty in discussing cancer prevention strategies with patients doesn’t always directly relate to the physical aspects of the disease. Pre-existing stereotypes around certain cancers can significantly impact a patient’s understanding of what they should be looking for.
Breast cancer is a prime example. Though rare, this type of cancer does occur in the male population. While women are often encouraged to keep an eye out for potential indicators of breast cancer, however, men are not, and this can have serious consequences.
Related CE course: Communication in Health Care, 2nd Edition
Reducing potential risk
Age, naturally occurring genetic predispositions, previous cancer diagnoses, and certain environmental factors make the prevention of breast cancer increasingly challenging, especially among men, for whom the causes of most breast cancers remain unknown. But there are some general healthy practices that may help reduce risk for both men and women.
According to the National Institutes of Health (NIH), avoiding obesity, excessive alcohol consumption, smoking, a diet high in processed/red meats, a sedentary lifestyle, and stress may decrease the likelihood of developing cancer over the course of a lifetime.
Risk factors for women
The NIH has identified several additional factors that have been proven to pose a specific increase in breast cancer risk for women, such as:
- Reproductive history, including age of first pregnancy and delivery, resulting in greater exposure to estrogen,
- Taking hormone therapy for symptoms of menopause, and
- Radiation therapy to the breast or chest
Addressing risks
Given that increased exposure to estrogen has proven to be cancerous, the NIH recommends that women who’ve given birth breastfeed whenever possible in order to lower estrogen levels.
Additional early screening practices may improve the potential for early detection. Effective screening guidelines for women include:
- Women ages 40-44 should have the choice to begin annual breast cancer screening with mammograms
- Women ages 45-54 should receive mammograms annually
- Women ages 55 and older should receive mammograms every two years or continue annual screenings
- Screenings should continue if a woman is in good health and is expected to live 10 or more years
Among women who’ve undergone a hysterectomy, estrogen-only therapy after menopause may decrease the risk of breast cancer, although there is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy, according to the NIH.
Prescribed aromatase inhibitors decrease the amount of estrogen made by the woman’s body and block the action of the enzyme aromatase, which is used to produce estrogen. Aromatase inactivators stop the enzyme from working, but possible side effects include muscle and joint pain, osteoporosis, hot flashes, and extreme fatigue.
The NIH also suggests that some high-risk women may benefit from prophylactic mastectomy, while others with a breast cancer diagnosis may choose to have a contralateral prophylactic mastectomy. Before a patient makes any decisions regarding surgery, however, it’s critical to undergo a cancer risk assessment and counseling.
Related video course: Breast Cancer: Exploring Current Detection, Screening, and Treatment Strategies
Risk factors for men
For most men, mammography and ultrasound are conducted only when a lump is found, according to the American Cancer Society (ACS). While the effectiveness of screening men for breast cancer has not been fully studied, genetic testing has been proven to be helpful among men with a strong family history of breast cancer, ovarian cancer, pancreatic cancer, and/or prostate cancer that might be caused by a BRCA mutation (and/or if someone else in the family is known to have a BRCA mutation).
The U.S. Centers for Disease Control and Prevention (CDC) has also identified a few risk factors for men, including a lump or swelling in the breast, redness or flaky skin in the breast, irritation or dimpling of breast skin, nipple discharge, and pulling in of the nipple or pain in the nipple area.
Other risk factors for men include Klinefelter syndrome (a rare genetic condition that causes an extra X chromosome that can lead to the body making higher levels of estrogen and lower levels of androgens), certain conditions that affect the testicles, and liver disease.
Facilitating early detection
The CDC and NIH have collaborated through a National Program of Cancer Registries to collect data that can be utilized to learn more about which groups of people are most affected by cancer, determine how well cancer prevention programs work for specific populations, assess which communities require more assistance with cancer prevention and control, develop and improve cancer prevention programs, and develop resources to reach communities that have higher cancer rates.
Local registries can be found within 46 states, the District of Columbia, Puerto Rico, the U.S. Pacific Island Jurisdictions, and the U.S. Virgin Islands through an online resource tool.
The CDC also offers the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to assist healthcare professionals in helping those with low incomes who do not have adequate insurance to gain access to timely screening, diagnostic, and treatment services.
A case study in personalized cancer care
At Rutgers Cancer Institute of New Jersey and RWJBarnabas Health in New Brunswick, NJ, an ongoing clinical trial, “Cancer Treatment and Survivorship Experiences Among Southern New Jersey Residents,” is evaluating a more personalized treatment approach for patients diagnosed with locally advanced breast cancer (stage 2 or 3) by providing a unique platform to evaluate multiple treatments in the same study.
Following a genomic test taken of the tumor to determine its genomic profile, each study participant starts on the treatment regimen ideal for the tumor, including experimental agents. After several weeks of treatment, the participant undergoes a repeat scan to measure the level of disease remaining in the breast. If the clinical response is not evident, another medicine is used and assessed.
According to Michele Blackwood, MD, FACS, chief of the section of breast surgery, the trial is expected to serve as a template for how breast cancer is treated moving forward.
“It’s not just about curing breast cancer; it’s about helping each patient feel as whole as they can and having a full life afterward,” says Blackwood. “After a patient’s case is individually and anonymously presented, we have a vigorous discussion about what’s the best treatment strategy. This also helps ensure that the patient gets the best care that’s currently available. For every breast cancer patient, up to 20 healthcare providers and ancillary clinical staff become involved in the overall care process in some way – from surgeons, oncologists, geneticists and plastic surgeons to physician assistants, nurses, and social services.”
