We know for sure that there is hope for prevention of breast cancer.

Look at what happened in 2002 after the Women’s Health Initiative Study became known to the public when it made the 6 o’clock news. Women found out that hormone replacement therapy, Pempro, increased breast cancer risk by 26%.  That summer 15 million or half of the 30 million women that were on HRT abruptly stopped.  As one of my patients said, “I’d rather have hot flashes than cancer.” 

Just a few years later in 2007, it was reported that there was an 11% decline in breast cancer rates in women over 50 with estrogen receptor positive cancers. After much scientific debate, those in the medical field conceded that the decline in rates was attributable to the reduction in the use of HRT. 

Information that these hormones could cause breast cancer was in the medical literature for over 20 years.  But when that knowledge was put in the hands of women who needed and considered it, many acted upon it and breast cancer rates fell. 

What do you think will happen when women learn that these same hormones are in oral contraceptives but in much higher doses?  Will half of the 75% of premenopausal women in theUnited Stateswho take hormonal contraceptives stop these hormones like their mothers did after menopause? 

Since 1975, according to the National Cancer Institute SEER data, non invasive breast cancers have increased in women less than 50 by 400%.  What if they learn that in 2005 the UN’s World Health Organization listed oral contraceptives as Group 1 carcinogens, the same group that contains asbestos and cigarettes?  I bet that they will learn about the safer methods of fertility control, especially if they have a family history of breast cancer. 

Breast cancer rates would fall for premenopausal women too. 

What if women knew that having children and breastfeeding decreased breast cancer risk substantially?  Would we wait so long to have our children if we knew that a woman who waits to have her first child at 30 has a 90% higher risk of breast cancer than the woman who has her first child at 20?  I wouldn’t have waited until I was 41 to have my first and only child if I had known. Unplanned pregnancies could bring unplanned joy and adoption could be a better option. 

It is often said by cancer organizations that 70% of women with breast cancer have no identifiable risk factors and that we should give them money to find a cure.  It is simply untrue that 70% of all breast cancer patients have no identifiable risk factors.   If 75% of women of reproductive age have taken oral contraceptives they are at increased risk.  If 20% of the women in this country remain childless, they are at increased risk.  If 50% of post menopausal women have taken hormone replacement therapy, they are at increased risk. 

Let’s be more than “aware” regarding breast cancer.  You’d have to be deaf, dumb and blind not to be aware that breast cancer exists and is a threat to many women.  It’s on the TV news and cable channels, radio, the internet, magazines, newspapers, and even the shopping channel as a patient once told me.  You can’t even go to the grocery store during “awareness” month without being faced with pink ribbons on food containers to benefit one organization or another. 

Let’s be proactive and not just aware. Let’s be proactive make women aware that breast cancer is curable in many cases if not in at least half those diagnosed with screening mammograms. 

We already know lots about what causes breast cancer and what can increase a woman’s risk.  Breast cancer is not the fickle finger of fate randomly pointed at women.  There are many other avoidable risks. We can hope and expect to reduce breast cancer rates with prevention. 

And what of the hope in survivorship? 

There are 2.5 million survivors of breast cancer in our country right now.  Wouldn’t it be a shame if they worried everyday that their cancer might come back, waiting for the other shoe to drop or with the sword of Damocles over their head?  Not able to enjoy life to the fullest?   Or didn’t do the things that would reduce the risk of it coming back?

They need to know that there is a wonderful survivorship programs around the country. The name of one program is Transitions.  It is a national Wellness Community program that helps women to overcome the challenges of survivorship.  There is also a Kids Connect program that helps children to overcome the challenges of having a parent with a cancer diagnosis. 

In a nutshell, hope comes through knowledge and the gift of faith. Both are free for the asking. Visit www.bcpinstitute.org. 

(This two part post was adapted from a speech given by Dr. Angela Lanfranchi, MD FACS during the 7^th Annual Shades of Pink Celebration Proclaiming Breast Cancer Awareness Month.)

Breast cancer not only affects a woman, it affects her spouse, family, friends and most especially her children.  What better way to conquer fear than the grace of hope.  Hope in a cure.  Hope in prevention.  Hope that whatever it is they will be challenged with, that they will be able to surmount it and live their lives to fullest each day into their survivorship. 

This is part 1 of a two part post on breast cancer.  Today, I focus on the hope in a cure.   

We all hear that 1 in 8 women, or 12.5% of women, will develop breast cancer in their lifetime. That is the cumulative lifetime risk for breast cancer. It is a statistically derived number that assumes all women will live to be the age of 82 and not die of something else first. Many times, women hear that number 1 in 8 and they look about the room and start counting off: “1, 2, 3” and they believe that someone in that room will get breast cancer if there are more than 8 of them. 

But we also need to know that if a women has no risks for breast cancer (other than that she is a woman, living in this country and getting older) her risk of getting breast cancer is only 3.3%.

Unfortunately few women have no risk factors.  But even if she has a risk factor that increases her risk 100%, or doubles her breast cancer risk, her risk is now only 6.6%.  That’s a lot different from one in eight. 

We also need to hear that a woman’s chance of dying from breast cancer in this country is 1 in 35, or less than 3%. 

So can we really hope for a cure?

 Most women are unaware that it’s already happening.  Lots of women are being cured without great fanfare. You see, one is only officially cured of breast cancer when one dies of something else first, like a heart attack in old age. That’s just how statistics are done and reported.  We hear about 5 and 10 year survival rates.  Maybe some 10 year survivors will have a relapse of cancer.  So we have to wait until they die of something else first before we say they were cured.

But what about women who have stage 0 breast cancer, also known as ductal carcinoma in situ or DCIS? With a partial mastectomy and radiation, they have a 97% cure rate.  With mastectomy they have a 99.9% cure rate.  No chemotherapy is needed to cure them. According to the American Cancer Society, there were 62,280 women diagnosed with in-situ breast cancer in 2009. We can expect that a minimum of 60,411 to be cured!  We just can’t know who they are until they die of something else first.

What about women with Stage 1 invasive breast cancers? Those are the women with small tumors, less than ¾ of an inch, which have not spread to the lymph nodes under the arm. Those women have a 95% cure rate. Since there are many patients with Stage 1 breast cancer treated at my clinic, I would expect the vast majority to be cured with present treatment regimens.

At the Steeplechase Cancer Center where I work, 53% of all patients who are found to have cancer were detected just because they went for a screening mammogram – nobody thought they had cancer when they were screened.  Slightly over half, 53%, were Stage 0 and Stage 1.  That’s why mammograms are so important.  They give women excellent odds for a cure and no bookie would take a bet against them. 

Based upon data when treatment wasn’t as sophisticated and effective as it is now, the 5 year survival rate for tumors up to 2 inches and which had already spread to local lymph nodes, or Stage 2 breast cancers, is 86%.  So I do believe there will be even higher cure rates in the future. 

Tomorrow, we will take a look at the hope in prevention of breast cancer.

Lost in the media frenzy concerning Susan G. Komen’s grants to Planned Parenthood was the fact that Planned Parenthood is an enormous national provider of two causes of breast cancer: induced abortion and oral contraceptives.

Assumed in the many reports in the media was that Komen, as the country’s largest breast cancer advocacy group, is a wonderful icon serving the needs of breast cancer survivors and providing needed information  and money for breast cancer research.

Nothing could be further from the truth. 

Up until 2005, according to Komen’s STEP Grants information published on the internet, less than 1% of the nearly billion dollars they had raised since 1984 was given to entities that did breast cancer research to find a cure. Shocking I’m sure to its many donors. 

It makes women feel great to gather in pink sweats and running shoes to raise money for a cure. The camaraderie is exhilarating. The mutual support is gratifying.  Doing something that matters to conquer that dreaded cancer that has taken so many women, mothers, sisters, and friends is empowering to women. But is all the “feel good” that the many races engender in the participants just an incredibly successful Pink Money marketing device? 

As a breast cancer surgeon, I see Komen as a purveyor of misinformation to the women who look to them as a reliable source.  Komen states on its web site that although oral contraceptives slightly raise the risk for breast cancer, a women’s risk will go back to normal after she goes off the pill for ten years, as if no harm has been done. 

The truth is that since 2005, the World Health Organization’s International Agency on Research of Cancer listed oral contraceptives as a Group 1 carcinogen for breast, cervical and liver cancer. Group 1 is also where cigarettes are listed as a cause for lung cancer. The truth is that if you are unlucky and the Pill caused a breast cancer cell to start growing in your breast, it would take about 10 years for the cancer to get big enough for your doctor to detect.  Hence, if it hasn’t shown up by 10 years, you were lucky and your risk is no longer increased. You’re normal risk again. Komen has not done anything to protect women and reduce their risk by avoiding known carcinogens. When 15 million women stopped their hormone replacement therapy in 2002 after they learned it increased their breast cancer risk, by 2007 the number of postmenopausal breast cancers decreased 11%. 

In 2010, 88% of young women take the Pill, a known carcinogen. Yet there is no awareness campaign for these women. The Pill contains the same drugs as hormone replacement therapy but in doses that are nearly 10 times higher! Imagine all the breast cancers that could be prevented in young women if half of them stopped the Pill.

Komen also denies the abortion breast cancer link.  It does this by not only citing the findings of the National Cancer Institute – which denies the link – but also by stating that the studies that show a positive correlation (there are 50) and those that are statistically significant (there are 31) are tainted by “recall bias.”  Recall bias assumes that a significant number of women will not report their abortion history accurately:  that they will not admit their abortions to researchers thereby by skewing the study’s results. This is despite the facts that 1) there are studies that have internally controlled for recall bias and have found no bias;  2) other studies state that, because induced abortion is so common in some countries, investigators report that recall bias is not an issue;  3) that a study specifically looking for recall bias by comparing computer records and interview data did not find a significant result (except that women recalled abortions that had not been recorded in the computer).

If an organization respected women, it would give them the truth so that they could make an informed choice.  For more information on risk go to the Breast Cancer Prevention Institute at www.bcpinstitute.org.

By way of introduction, I look forward to sharing what I’ve learned, as a breast surgeon, physician, mother and wife in this New Feminism blog. Before “New” was attached to it, I was always a “New Feminist” at heart. I was pre-med in college from 1967-1971 at a Long Island university noted for its science programs and for being the first college with a campus wide drug bust that made the national news. The Vietnam War sent some of my friends to ‘Nam and changed them forever. The sexual revolution was in full swing and regretfully I participated with enthusiasm. Medical school in D.C. was difficult in a hostile environment. Male students would tell me I would be the cause of their roommate’s death because they had been drafted after I had taken their “spot” in medical school. There were too many women in the class (21 out of 210) and we were just going to get married and never practice anyway. Many of the professors were of the same opinion. I wasn’t smart; I was just lucky on multiple choice tests, even if I did defy the odds consistently. As bad as my fellow medical students were, they couldn’t compare to my fellow surgical residents during training. It was not by chance that there were only 1200 female surgeons in the country at the start of my surgical residency. They really toughened me up.

Luckily, I met my husband who was working as an OR technician at the university hospital by my junior year. We’ve had a good marriage for the past 37 years. Long years of training in Family Medicine, General Surgery and then a Vascular Fellowship let the years fly by so it wasn’t until I had been married 17 years that I had my only child at age 41. If I had known then what I know now, that fertility decreases greatly at that age, I wouldn’t have waited so long to try for my first and only. I might have been too pessimistic to even try. My husband was the one who stayed home for her so she could get the kind of upbringing that would be the most conducive to being happy, healthy and secure. She is all that and more.

In the course of my professional career, I noticed that there were a whole lot more young women with breast cancer than there should be and that the incidence had gone from 1 in 12 when I graduated medical school to 1 in 8 in just 30 years. When I looked into risk factors for this, it became clear that oral contraceptives, induced abortion, and delayed first pregnancies accounted for a good number of these early breast cancers. Having patients in their 20s with breast cancer and seeing them die in their 30s made me want to try to do something that would prevent those cancers. To that end, in 1999 I co-founded the Breast Cancer Prevention Institute which educates the public and medical professionals on the risks and prevention of breast cancer.

The old feminism sought equality with men through complete reproductive control using oral contraceptives and the necessary back up of abortion. Without them, women felt they could never climb the corporate ladder. It was as if women needed to live their lives with the same sexual license as men in order to achieve equality. We thought we could have children whenever we wanted no matter our age. We could even have them without a husband. We just needed to buy a deposit from a sperm bank.

If we only knew then what we know now: that oral contraceptives are a Group 1 carcinogen for breast, cervical and liver cancer; that abortion causes breast cancer, premature births and serious psychological problems; that women need husbands as children need fathers; that sexual intercourse sets off hormonal changes within in us that bonds us to our mate. The theories of the old feminism, no matter how strongly or earnestly embraced, could not change the hard wiring in our brains or in our hearts. It is hard to look back and admit we were so wrong about so many things.

It is my hope, that by sharing those lessons that were so painfully learned, women will heal and help a new generation to enjoy the fruits of the New Feminism. I hope that women learn how they are different from men and why it’s a good thing.