The chances are fifteen to one that you will never get breast cancer. Furthermore, if you do, and have followed the simple precepts, the chances are two out of three that your cancer will be detected in a curable stage, even at the present state of our knowledge—and our knowledge of this disease is increasing all the time.
Is breast cancer common? Emphatically, no! What is common is the fear of breast cancer. It is this fear that keeps many women from helping themselves by having breast examinations or even examining their own breasts. Our fight must be against this fear as well as against breast cancer itself.
It is true that most of us have been exposed to the miseries of breast cancer in close relatives, friends, or acquaintances. It is true that most women develop breast symptoms or even lumps at some time or other. It is true that many women who do develop the disease delay going to a physician until it is too late. But it is also true that only infrequently do such breast symptoms or lumps mean cancer. And it is also true that you can protect yourself by learning what breast cancer is all about and by following a few simple rules.
You must say to yourself: "I will most likely never get breast cancer, but if I do, I want to be in a position to overcome it!" That is the message of this article.
You will learn why women are so afraid of breast cancer, what it is, who will get it, how we find it, and what you can do to protect yourself against it. Read carefully, follow through—and don't be afraid!
We live in a breast-oriented society. To the average woman, her breast is the badge of femininity, an important part of her allurement to charm her male. To the man, the breast is a source of excitement and erotic stimulation. It has become a bridge between male and female and is used as a reward to be flaunted before the eyes of the male in the female's attempt to attract him. This emphasis on the breast as a sex symbol begins in adolescence and apparently persists throughout life.
The problem of breast cancer is a double one: the cancer itself and, perhaps equally important, the fact that the breast is involved. Of course, the most dreadful of all diseases to a woman is breast cancer. The specter of this disease hovers like a black cloud over all her thoughts and hopes. For many years, breast cancer wasn't even mentioned in news media, as though it were a stigma. The word "breast," referring to that important part of the female anatomy which we have all been intimately acquainted with from the time of birth, seemed to be taboo. A conspiracy of silence seemed to surround this remarkable feminine structure as though its existence were a myth. In recent years, thanks to efforts on the part of forward-seeing women and physicians, especially of the American Cancer Society, the women of our society have become increasingly aware of the importance of the breast in the health of a woman, and the need for constant vigilance against the possibility of trouble.
Consider the following typical incidents, which occurred in one day in the life of a physician interested in breast conditions:
"I'm a schoolteacher in a supervisory position," said an attractive 45-year-old woman. "I first noticed this lump in my left breast two and a half years ago. At first, I thought it would just go away. It didn't hurt or bother me in any way. Then as I watched it get bigger and produce changes in the skin, I thought it was probably serious. I felt strongly about breast surgery and the fear of losing my breast. I simply couldn't bring myself to see a physician. I even wear a bra at night to hide the condition from my husband."
Mrs. Hammer was shifting uneasily in her chair. "Tell him, Gayle. You tell him about the lump." Gayle was obviously distraught and couldn't manage to communicate. Finally she blurted out: "I've got this small lump in my left breast. I know it's nothing. Do you think I may have to lose my breast?"
My secretary was buzzing frantically. "Mrs. Weil out here is so nervous I think her teeth are chattering. She whispers something about a lump in her breast and she's really frightened. Please see her soon."
"Sit right here and talk to me," I said to the 42-year-old woman. "Why are you so hesitant?" "Doctor," she began, "I know I'm cystic. Three doctors have told me that I have what sounds like cystic mastitis. It sounds terrible to me. I feel I have a serious disease that is progressing and will lead to my losing a breast. What can I do to prevent this happening?"
Mrs. K. lowered her eyes, clasped her hands, and began shyly. "My husband likes to manipulate my breasts as part of our love-making. Sometimes he's rather vigorous and once my breast was black and blue. I've heard that an injury can lead to cancer. Is that true? I've been worrying about our relationship."
The common thread in all these episodes is the tremendous preoccupation with the female breast that has been developing in the past thirty years. The interest has been accelerating in recent years. Billboards, movie marquees, newspaper ads, and magazine photos all stress the female breast as the sex symbol of our age. A successful movie must show a closeup of a woman's breast with the hero looking at it admiringly. Topless waitresses, dancers, and actresses have become a hallmark of our society. The younger female is being stampeded into a bra-less generation. Designers vie with each other in attempting to emphasize the bosom with low-cut or transparent blouses. All this is a far cry from the situation fifty years ago, when young developing breasts were strapped and tightened with viselike brassieres, in an attempt to hide this womanly attribute from the predatory male's gaze.
This elevation of the female breast as an important sex attribute has brought with it a greater apprehension and anxiety about breast conditions. All women from early childhood have heard gruesome stories about serious breast diseases that led to all types of surgery. And the totally erroneous idea has been spreading among many women that the loss of a breast is equivalent to loss of sexual attraction or prowess or both. In short, a pathological national anxiety bordering on hysteria has come into existence in regard to the breast. Is it any wonder, then, that concern about breast diseases has reached alarming proportions and that a small, non-tender lump or a pain or a discharge can produce a state of abject terror?
Unfortunately, it is true that breast cancer is a dangerous, troublesome, worrisome disease today. For instance:
- Every seven minutes, breast cancer is diagnosed in the United States and every fifteen minutes a woman dies of the disease.
- One of every four cancers in women is in the breast, so that this organ is the most common of all cancer sites.
- Breast cancer is the most common cause of death in women aged 40 to 45.
- The chances of developing the disease increase throughout a woman's life, and the rate of development is about ten times greater at 70 than it is at 40.
- We have really made no progress in this disease since 1930, so far as saving lives is concerned. Even today, one third of patients with breast cancer are inoperable when first seen. Of the remainder, only one third are alive and well ten years later. In other words, despite all our surgical, radiotherapeutic, and chemotherapeutic techniques, we are probably curing only about 25 percent of women who present themselves to their physicians with this disease—and all because most breast cancer seen by the medical community is late cancer.
Add to this information the fact that even in the most expert hands three of every four breast operations show a benign condition. If it were known definitely that no cancer was present, the operation, called a biopsy, would not need to be done. It is, of course, proper that such a look-see" procedure be carried out to make sure that cancer is not present, but the fact remains that the operation generates apprehension and concern. In some institutions where the clinician's expertise may be less or his own anxiety greater, nine out of ten operations fall into this benign category. The sum of it all is that, although only one woman out of fifteen develops breast cancer, it is also true that one in two or three develops a condition warranting an operation, with all the concern it brings. Most women are then conditioned and concerned about their breasts for the rest of their lives, awaiting and often expecting the worst.
But the sun is beginning to show through the dark clouds, and a brighter tomorrow is beginning to dawn. The new hope is based on the following information:
It has long been known that if at the time of a breast cancer operation the local glands in the armpit (the axillary lymph nodes) are free of disease, meaning that the cancer is localized or confined to the breast, better than four out of five such women will be alive and well five years later. If, however, the glands are involved, only one out of two will remain well. Since cancer is a progressive disease that grows and usually spreads to the neighboring glands or through the bloodstream, it seems obvious that in order to improve the present situation, we must find breast cancers when they are still confined to the breast, before they have spread. We must engage in what is called earlier detection.
This concept is not new—it has been with us for many years. It has been the cornerstone of a major educational program of the American Cancer Society. It has been the reason for the ongoing campaign of that society for breast self-examination—to watch for the warning signals of cancer, such as a lump. But, unfortunately, the campaign has had slow success. Educational drives and prodding physicians to teach breast self-examination have not caused the death rate from breast cancer to decline. Over the years, some medical prophets of doom have felt that the fate of a woman who develops a breast cancer is sealed at the time of the appearance of the growth—that the outcome of the disease depends solely on the virulence of the cancer and the resistance of the woman's body. They have indicated that earlier detection was merely a way of finding the condition earlier, thus producing an apparent improvement equal to the period of earlier detection, but that the end result was the same.
What was needed in this controversy was proof—statistical proof—that earlier detection of breast cancer could indeed result in saving more lives, and not merely lead to increased survival from the time of diagnosis. The bright star on the horizon today is that such evidence is now at hand. How this evidence was obtained is an exciting story which we will go into subsequently. Suffice it to say here that in more than five years of follow-up of two large matched groups of women it has been statistically proved that a reduction of more than one third in the mortality rate was achieved in the group that received special examinations as compared with the group that did not. A method is today available that can save the lives of more than 10,000 of the 32,000 women who now die every year of breast cancer in the United States.
Another hope is also becoming apparent. Many surgeons in various areas of the United States and abroad feel that in those cancers found in the early stages—when small and localized in the breast—lesser surgery can achieve results as good as the more extensive kind needed for more advanced disease.
One of the dilemmas of breast cancer involves detection. We know that the earlier we find the disease the better are our results. We also pride ourselves as physicians that our training and knowledge permit us to diagnose medical conditions more easily and even before our patients discover them. Yet it is common knowledge that well over 90 percent of breast cancer is detected by the woman and not by her physician. Why do we rely on the woman to become aware of a condition that is curable in its early stages?
Physicians are trained to treat disease. They spend many hard years learning the intricacies of the normal structure and function of the human body and the abnormal changes we call disease. They learn to recognize the abnormalities and apply the appropriate treatment. Over the years there has been an increasing awareness of the value of the old Chinese concept that the worth of a physician can be measured more by his ability to keep you well than by his ability to make you whole—that much pain and suffering could be avoided if body derangements were detected in the earliest stages, when less drastic measures would be needed for correction.
This concept has reached its acme in "screening" for disease. This means setting up standards, like sieves, checking people to see how they measure up, and sifting out those with abnormalities. Of course, it also means getting people to accept the concept and to present themselves before a derangement makes itself known—before symptoms or signs of disease are present. It also means a heightened awareness on the part of the physician of the earliest signs of disease and a dedication to be willing to screen many people to find disease in only a few. It means a new orientation on the part of one who has been trained to treat disease when it exists. It also means that a physician must say to himself: "Examining many well people can be boring and hardly satisfying. However, the thought that every once in a while I'll find unsuspected disease at a stage when it is curable and thus perhaps save a life makes the whole business worthwhile." Fortunately, breast cancer falls into such a category.
The new day that is dawning in breast cancer thus means saving of lives and perhaps less radical surgical procedures for very-early cancers. Someday the medical profession will be able to offer our girl babies the promise of immunity from breast cancer. Someday we may have the magic remedy that will cure the disease wherever it may have spread in the body and at whatever stage it may be. Until that time, let us use the remedies at hand that can perhaps save most of the women who become afflicted with this disease.
