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Breast Cancer Awareness

Volume 1, Number 8 - September/October, 1997

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Inside HealthHints....

• Breast Cancer Awareness
• What is Cancer?
• Benign Tumors
• Malignant Tumors
• Risk Factors
• What Can You Do: Methods for Early Detection
• American Cancer Society Recommendations for Early Detection
• Breast Self-exam
• Clinical Breast Exam
• Mammogram
• Risk Factors You Can Control
• Cutting Down on High Fat Foods: Substitutes for an Easier Transition
• Activity Ideas
• Fibrocystic Breasts
• Extension Resources
• Other Upcoming Health Observances
• Websites with Reliable Information
• References

Breast Cancer Awareness

National Breast Cancer Awareness Month will be held in October, 1997. October 17th is National Mammography Day.

Breast cancer is the leading cancer diagnosed in women in the United States. It is also the leading cause of cancer deaths among women aged 40 to 55 years (Kemper, 1997). This year, more than 180,000 women will learn that they have breast cancer for the first time, and more than 40,000 women will lose their lives because of breast cancer (National Breast Cancer Awareness Month [NBCAM] Board, 1997).

Fortunately, breast cancer is highly treatable if detected early. With early detection and proper treatment, suffering and ultimately the loss of life can be reduced significantly.

What is Cancer?

Cancer is a group of diseases that occur when cells become abnormal and divide without control or order (National Cancer Institute, 1993).

Every organ in the body is made up of various types of cells. Normally, the cells in the body reproduce in a controlled and orderly fashion. This controlled and orderly reproduction allows us to grow, replace worn-out tissue, and repair injuries. Normally, our bodies only produce new cells when needed, thus, keeping our bodies healthy. If cells divide when new cells are not needed, however, they form too much tissue. This extra tissue is called a tumor. There are two types of tumors: 1) benign, and 2) malignant.

Benign Tumors

Of all breast tumors, 80% are benign. Benign tumors are not cancer (NBCAM Board, 1997, National Cancer Institute, 1993). Tumors that are benign can usually be removed, and in most cases, they do not come back. Most importantly, the cells in a benign tumor do not invade other tissues or spread to other parts of the body (NBCAM Board, 1997, National Cancer Institute, 1993). Therefore, benign breast tumors are not a threat to life.

Malignant Tumors

Malignant tumors are cancer (NBCAM Board, 1997, National Cancer Institute, 1993). Cancer cells can invade and damage nearby tissue and organs. The cancer cells can also break away from the malignant tumor and enter the bloodstream or lymphatic system. This is the process by which breast cancer spreads and forms secondary tumors in other parts of the body. This spread of cancer is called metastasis.

Risk Factors

Research has demonstrated that there are several factors which may put you at risk for developing breast cancer, including the following:

• Age
  Breast cancer risk increases with age. You may be at risk for breast cancer if you:
  • are aged 40 or older, however, breast cancer can occur at an earlier age.
• Family history
  Breast cancer risk increases for women whose close female relatives have had breast cancer. You may be at risk for breast cancer if you:
  • have a mother, sister, daughter, or two or more close relatives, such as cousins, who have had breast cancer.
• Personal history
  A woman's personal menstrual history and other breast symptom history may put her at higher risk. You may be at risk for breast cancer if you:
  • have had cancer of the breast, ovary, colon, or endometrium (part of the womb) previously
  • have had a growth on your breast that was not cancer
  • started your period before age 12
  • ended your period after age 50
  • have never been pregnant or had your first pregnancy after age 30.
• Other
  Current research is continuing to study other breast cancer risk factors. You may be at risk for breast cancer if you:
  • are obese
  • eat too many foods high in fat, such as whole milk, fried foods, lard, and fatty meats
  • regularly drink alcoholic beverages
  • have been on hormone replacement therapy 5 years or longer (Texas Department of Health, Health, 1997; NBCAM Board, 1997).

Note: Having none of these risk factors does not make you exempt from getting breast cancer. It is essential that all women do regular breast self-exam (BSE) and clinical breast exams.

What You Can Do: Methods for Early Detection

Breast cancer is highly treatable if detected early. There are three methods for early detection:

• breast self-exam
• clinical breast exam
• mammogram.

American Cancer Society Recommendations for Early Detection of Breast Cancer

 

Age Group	Examination	Frequency
20-40	Breast self-exam	Every month
20-40	Clinical breast exam	Every 3 years
40-49	Breast self-exam	Every month
40-49	Clinical breast exam	Every year
40-49	Mammography	Every year
50+	Breast self-exam	Every month
50+	Clinical breast exam	Every year
50+	Mammography	Every year

Adapted from American Cancer Society (1997). Breast Health Awareness Flipchart.

Breast Self-exam

Women discover more than 80% of breast lumps through self-examination. Breast self-exam (BSE) takes no more than 10 minutes, but many women are reluctant to examine their breasts because they don't know what to look or feel for. The most important thing to look for is a change in the breast. Because a woman lives with her breasts every day, she is most often the best judge of change.

Some changes to look for include the following:

• Change in color
• Change in shape or size of either breast
• Presence of a lump or thickening in the breast
• A lump or knot in the underarm area, or above or below the collarbone
• Persistent discomfort or pain in the breast
• Discharge from the nipple
• Change in the skin on and around the nipple (thickening, scaling, crusting)
• Dimpling, puckering, or pulling-in of the skin
• Raised area on breast
• Sores or ulcerations not caused from injury, or sores that don't heal
• Veins which protrude or are noticeably larger or more prominent in one breast
• Change in the direction of the nipple
• Change in the appearance of moles or skin (American Cancer Society,1995).

Keep in mind, only you know what is normal for you. Regular BSE can help you to know what is normal and if there is a change. The American Cancer Society recommends doing BSE every month, beginning at age 20. The best time for BSE is 2 days to a week after menstruation.

Clinical Breast Exam

A second method for early detection of breast cancer is the clinical breast exam. This is a physical exam much like the breast self-exam, but it is done by your health care provider.

This exam is important for identifying changes in the breast that you may not have found in your BSE. It is also a good way to help you understand how to do part of your own BSE.

Mammogram

A third method for early detection of breast cancer is mammography. Mammography is an x-ray that creates an image of the breast. The x-ray picture is called a mammogram. Two x-rays of each breast are usually taken -- one from the top and one from the side. Mammograms are typically done for the first time at age 40. This serves as a baseline for comparison in identifying any changes.

Mammography is especially important because it can reveal tumors in the breast that cannot be felt. A mammogram may reveal tumors when a woman has no visible signs or symptoms.

To find out where you can get a mammogram, contact your health care provider or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Keep in mind, mammography is not a substitute for breast self exam. Since no diagnostic test is 100 percent accurate, it is essential to continue BSE.

Risk Factors You Can Control

In addition to methods for early detection, you can reduce your risk by controlling your diet, your eating behaviors, and your alcohol consumption.

Diet

Replace high fat foods with lower fat choices. Choose fruits, vegetables, and whole grains, which are not only low in fat, but rich in nutrients such as beta-carotene, vitamin C, and dietary fiber. These nutrients may actually protect against certain forms of cancer.

Eating Behavior

Avoid overeating. High calorie diets can often lead to obesity -- another risk factor for breast cancer. It is difficult to consume too many calories if you stock up on fruits, vegetable, and whole grains -- rather than high fat meats, fried foods, and desserts.

Alcohol consumption

Drink alcohol in moderation, if at all. For women, moderation is usually defined as no more than one drink per day. One drink is defined as one 12 ounce bottle of beer, one 5 ounce glass of wine, or one 1.5 ounce shot of distilled liquor (American Institute for Cancer Research, 1993).

Cutting Down on High Fat Foods: Substitutes for an Easier Transition

 

High fat foods	Substitutes	Calories saved	Fat saved (grams)
3.5oz broiled beef tenderloin (choice grade, untrimmed)	3.5 oz broiled beef tenderloin (select grade, trimmed)	75	9
3.5oz ground beef, regular, broiled	3.5oz ground turkey, broiled	75	7
1oz regular bacon, broiled or pan fried	1oz canadian bacon, grilled	112	12
2oz chunk light tuna, canned in oil	2oz chunk light tuna, canned in water	110	12
1oz cheddar cheese	1oz part skim mozzarella	42	5
1oz cream cheese	1oz light cream cheese	36	5
1 cup premium ice cream	1 cup fruit frozen yogurt	130	22
1 whole egg	1 egg white	60	5
1Tbsp regular mayonnaise	1Tbsp mustard	85	10
1oz potato chips	1oz thin pretzels	44	9
1 regular-sized fast-food french fries	3.5oz baked potato with skin	127	12
2oz piece of white cake	2oz piece of angel food cake	48	8

(Margolis, 1996)

Activity Ideas

The Weed and the Seed

Materials: flower pot (any size), potting soil, bag of seeds (any kind), plastic plant that looks like a weed, cup of water.

Preparation: Before your meeting fill the pot with soil. Have seeds and water at hand.

Demonstration 1: Plant one seed in the soil. Explain that this is what you are doing as you plant the seed. Ask someone from the audience to come up and feel the top of the soil. Ask this participant if he/she can feel the seed. (The participant should not be able to feel the seed without digging into the soil).

Demonstration 2: Pour or pretend to pour water into the pot. Turn your back to the audience and place the plastic weed in the pot. Ask the audience what happens when you add water and sunlight. Ask them what grows in their gardens. Inevitably, someone will say weeds.

Demonstration 3: Reveal the weed you've planted. Tell the participants that a weed has come up in your pot instead of a flower. Ask how many of them would rather have removed the seed than to be pulling up a big weed. (Most will say "I would rather have removed the seed.")

Discussion: Ask participants how this demonstration is like breast cancer. Ask if they would prefer to find a large or small lump in the breast. (Most will say small.) Explain that there is a test called a mammogram -- a special x-ray of the breast that can find cancer from 3 to 5 years before it could be detected by touch. Explain that these small cancers can usually be removed without having to remove the entire breast. The cure rate is 95%.

Handouts: Be sure to handout materials with further details on what a mammogram is, what it does, and where to get one.

Adapted from American Cancer Society (1996). Cancer Concerns: Health Breaks for Cancer Control. Code 1107.

A Picture is Worth a Thousand Words

Materials: series of photos of a family member at different ages (e.g., age 2,3,5,8, or 12,20,42); sample mammogram (ask your doctor, clinic, health department, or American Cancer Society).

Preparation: Display the earliest age photo alone. Display the remainder of photos from youngest to oldest. Display photos so they can be easily seen by participants later in the activity.

Discussion: Ask participants if they have pictures of family members with them. Are they recent?

Demonstration 1: Show your earliest age photo. Tell participants the year it was taken. Ask participants if they think the person looks the same today.

Demonstration 2: Show the series of photos of the person you have displayed from youngest to oldest. Highlight that this series of photos captures how the person has changed over time.

Demonstration 3: Show the sample mammogram.

Discussion: Explain that in the same way you compared photos to see changes in your loved one from year to year, a mammogram enables doctors to see the changes in a woman's breasts from year to year. A mammogram is an x-ray picture of the breast. As one photo cannot capture changes in your loved one over a whole lifetime, neither can a mammogram capture a lifetime of changes in the breast without regular yearly mammography. Additionally, like the changes seen in the photos, a woman can detect changes in her breast by doing a monthly breast self-exam. Again, this must be done monthly (regularly) to be sure the woman detects any changes in what is normal for her breasts.

Adapted from American Cancer Society (1996). Cancer Concerns: Health Breaks for Cancer Control. Code 1107.

Fibrocystic Breasts

Fibrocystic changes are the most common cause of breast lumps among women 30 to 50 years old. This condition is not cancerous. At least 50% of women have lumpy breasts in their reproductive years as a result of these non-cancerous conditions.

A fibrocystic change is when, as a result of repeated hormone stimulation, there is an increase in the firmness of the breast tissue. Pockets of fluid called cysts may also form in the milk ducts. The breast may feel irregularly-shaped, lumpy, or like tiny beads scattered over the surface of the breast.

It is important to understand that fibrocystic changes are related to the way the breast tissue responds to your regular, monthly changes in estrogen and progestin. Hormonal stimulation may cause the breast tissue to swell, milk glands and ducts to enlarge, and the breast to retain water. The breasts will often feel swollen, tender, painful, or lumpy at this time. After menstruation, these feelings tend to subside. That's why doing a breast self-exam right after the menstrual period is the best time.

Remember, having fibrocystic breasts is not a disease. By performing regular, monthly breast self-exams, you can know what is normal for you, and detect any changes in your breasts (American Cancer Society,1992).

Extension Resources

Videos

• Personal Risks for Cancer (VHS 846, 7:51 minutes, Educational Resource Library -- Addresses the risks of cancer we all face based on age, gender, family history, life practices, and environment.)
• Breast Self-Exam Techniques (VHS, 10 minutes, Educational Resource Library -- Importance of 10 minute self-exam, clinical breast exam, and regular mammography. Shows step by step BSE and important changes to look for.)
• Breast Self Examination: A Special Touch (ACS) (Code P5, 8 minutes, Educational Resource Library and District Extension Office -- Importance of 3 exams: self-exam, clinical breast exam, and mammography. Instructions on BSE.)
• Keep in Touch (VHS 1120 or Code P33, 11 minutes, Educational Resource Library -- African-American mother and daughter team discuss unique breast health needs of this target audience. Mammography, clinical breast exam and BSE discussed and demonstrated.)
• Fibrocystic Breasts: A Non-Disease (Code P167, 8 minutes, Educational Resource Library -- Describes fibrocystic breast changes and the importance of BSE, mammography, and breast health care.)
• Mammography: What Every Woman Should Know (Code P99, 5:45 minutes, Educational Resource Library -- Importance of mammography for breast health. American Cancer Society guidelines.)
• Something Very Special (Code P196, 12:25 minutes, Educational Resource Library -- Designed for use in schools to promote BSE as a lifetime health habit. BSE illustrated by a young girl.)
• Once a Year for a Lifetime (VHS, 26 minutes, Educational Resource Library -- Jane Pauly and Phylicia Rashad tell story of 5 women whose lives are touched in different ways by breast cancer. Purpose to serve as tool to educate women about the need for regular health maintenance, appropriate medical testing, and detection and treatment of breast cancer.)
• Diet and Cancer Prevention (VHS 1195, 15 minutes, Educational Resource Library -- Six guidelines for diet and cancer: healthy weight, reduced fat, increased fruits and vegetables, high fiber, limited alcohol, limited smoked, salt cured, and nitrite cured foods. Creating a healthy menu and how to make changes.)
• Una vez al año...Para toda una vida (Spanish only, Educational Resource Library -- Video on breast cancer.)

Exhibits/Models

• Breast Cancer (District Extension Office -- Includes breast model. Also bilingual [1995]).
• Multi-type Breast Models (#X-1082, Educational Resource Library and District Extension Office, 50 counties received their own models at the 1996 Institute in Austin, English and Spanish available. -- An average breast with no lumps, an average breast with lumps, a dense-tissue breast with no lumps, a fibrocystic breast with lumps. All are mounted on a heavy piece of plastic for women to feel the difference in breasts for themselves. (1996).
• Breast Lump Size display (12"x 9") (#X-1084, Educational Resource Library -- Shows women the difference early detection can make. Makes comparisons in size of breast lumps with ordinary objects (e.g., ping pong ball, eraser, button, dime, etc.).
• Food Models (#X-1083, Educational Resource Library -- These models are available for use with cancer and diet programs as well as other nutrition programming for which you may need food models.

Flipchart

• Breast Self Exam Notebook Flipchart (English and Spanish available), County Extension Office, Distributed during the 1997 update training.

Healthy, Wealthy, and Wise Resource for Worksite Wellness

To attain your copy of Healthy, Wealthy, and Wise at a reduced cost of $45.00 (+8% S&H) contact:

Jean Ristow
Wellness Councils of America
7101 Newport Avenue, Suite 311
Omaha, Nebraska 68152
phone: (402) 572-3590
fax: (402) 572-3594

Be sure to identify that you work for the Texas AgriLife Extension Service and contact or send inquiries only to Jean Ristow. She will accept check, credit card, or purchase orders only. This is a cost savings to you of over $50!

Other Upcoming Health Observances

September

Baby Safety Month
Juvenile Products Manufacturers Association
236 Route 38-West, Suite 100
Moorestown, NJ 08057
Materials: Safe and Sound for Baby, a 16 page guide to safe selection and use of baby products (English and Spanish available). Send self-address, stamped envelope to JMPA Safety Brochure at above address for your free copy. Specify English and/or Spanish.

National 5 a Day Week
September 7-13
Produce for Better Health Foundation
1500 Casho Mill Road
P.O. Box 6035
Newark, DE 19714-6035
(800) CANCER
(302) 738-7100
Materials: Promotional kit
Contact: Cancer Information Service

October

Child Health Month
American Academy of Pediatrics
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
(847) 981-VILLAGE
Materials: fact sheets, camera ready information, posters, and product catalog
Contact: Division of Member Communications

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References

• American Cancer Society (1997). Breast Health Awareness Flipchart.
• American Cancer Society (ACS) (1995). Breast Health Awareness Manual for Lay Audience Presenters. ACS, Texas Division, Inc. Code 501.01.
• American Cancer Society (ACS) (1996). Cancer Concerns: Health Breaks for Cancer Control. ACS, Texas Division, Inc. Code 1107.
• American Cancer Society (ACS)(1992). Fibrocystic Breasts: A Non-Disease [brochure]. ACS, Texas Division, inc. Code 534.
• American Institute for Cancer Research (1993). Reducing Your Risk of Breast Cancer [brochure]. Washington, DC. No. E3C-BHB/E05.
• Kemper, D.W. (1997). Healthwise Handbook: A Self-Care Manual for You. Boise, ID: Healthwise, Incorporated.
• Margolis, S. , Samet, J.M. (1996). The John's Hopkins White Papers: Cancer Prevention. The Johns Hopkins Medical Institute: Baltimore, MD.
• National Breast Cancer Awareness Month (NBCAM) (1997). Promotional Kit. Zeneca HealthCare Foundation.
• National Cancer Institute (1993). What You Need to Know bout Breast Cancer [booklet]. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 93-1556.
• Texas Department of Health, Public Health Promotion Division, Health Education Risk Reduction (1992). Health Risk Appraisal: Breast Exam. Stock No. 10-15b.

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