What Women Should Know About Breast Cancer

THE number of cases of breast cancer is rising on every continent. According to some estimates, by the year 2000, about one million new cases of breast cancer will be diagnosed throughout the world each year.

Is any woman safe from getting this disease? Can anything be done to prevent it? And what comfort and support are needed by those fighting this foe?

Most skin cancers are caused by ultraviolet rays from the sun. Most lung cancers are caused by smoking. But no single cause has been established for breast cancer.

However, according to recent research, genetic, environmental, and hormonal factors may play a role in breast cancer. Women who are exposed to these factors may be at increased risk.

Family History

A woman having a family member with breast cancer, such as a mother, a sister, or even a maternal aunt or grandmother, has an increased likelihood of developing it. If several of them had this disease, her risk is greater.

Dr. Patricia Kelly, a geneticist in the United States, tells Awake! that while hereditary factors are involved, they may account for only 5 to 10 percent of all breast cancers. “We think,” she explains, “that a block of others are due to not-​quite-​as-​strong hereditary factors working in combination with the environment.” Family members having the same genes tend to share the same environment as well.

Environmental Factors

“Clearly there are environmental factors, broadly conceived, that are involved” in triggering the disease, said Devra Davis, a scholar commenting in the journal Science. Since the female breast is one of the most radiosensitive parts of the body, women exposed to ionizing radiation have an increased risk of breast cancer. So do those exposed to toxic chemicals.

Another environmental factor is diet. Some suggest that breast cancer may be a vitamin-​deficiency disease and point to a lack of vitamin D. This vitamin helps the body absorb calcium, which may in turn help prevent uncontrolled cell growth.

Other studies link the fat in diet, not as a cause, but as a promoter of breast cancer. The magazine FDA Consumer stated that the death rate from breast cancer was the highest in countries like the United States, where the intake of fat and animal protein is high. It commented: “Japanese women historically have a low risk for breast cancer, but that risk has been rising dramatically, concurrent with a ‘Westernization’ of eating habits; that is, from a low-​fat to high-​fat diet.”

A recent study suggested that the large number of calories consumed in a high-​fat diet may represent the real risk. Science News stated: “Every excess calorie raises breast cancer risk, with each excess fat-​derived calorie posing about 67 percent more risk than calories from other sources.” Excess calories can put on excess pounds, and women who are severely overweight are thought to have about a threefold higher risk of breast cancer, especially women past menopause. Body fat produces estrogen, a female hormone that can act adversely on breast tissue, leading to cancer.

Personal History and Hormones

Within a woman’s breast is a rich hormonal milieu that produces changes in the breast all throughout her life. Dr. Paul Crea, a surgical oncologist, writes in the Australian Dr Weekly: “In some women, however, the exposure of breast tissue to prolonged hormone stimulation . . . will set off a series of cytological changes that eventually result in malignant [cancerous] conversion.” For this reason it is thought that women who have had an early menarche, by age 12, or have a delayed menopause, in the mid-50’s, have a higher risk.

The additional estrogens received from ERT (estrogen replacement therapy) as a possible link to breast cancer has been the subject of much controversy. While some studies indicate that ERT creates no increased risk, other studies show a significant risk for long-​term recipients. Considering the studies reviewed, the British Medical Bulletin of 1992 stated that the possibility exists that “non-​contraceptive oestrogen increases the risk of breast cancer by 30-50%” after long-​term use.

Reports on the relationship between oral contraceptives and breast cancer suggest little risk from use. However, there emerges a subgroup of women who are at higher risk. Younger women, women who have never had children, and women who have used birth-​control pills for a long time may have as much as a 20-​percent higher risk of breast cancer.

Yet, 3 out of every 4 women with breast cancer cannot point to anything specific that contributed to their having the disease. The question is therefore posed, Should any woman consider herself safe from breast cancer? FDA Consumer reports: “From the point of view of the clinician, all women should be treated as being at appreciable risk for breast cancer.”

Thus, women, especially those advanced in years, are vulnerable to this disease. Dr. Kelly comments that while there are various causes of breast cancer, ‘some of it, I suspect, is just because of getting older, and a misdivision of cells takes place.’

Why Vulnerable

Examining the makeup of the female breast explains why it is so vulnerable to cancer. Within it are ducts, tiny passageways, that channel milk from milk-​producing sacs to the nipple. Lining the ducts are cells that divide and change continually in response to a woman’s monthly cycle, preparing her for pregnancy, lactation, and nursing her young. It is in these ducts where most breast cancers develop.

In the book Alternatives: New Developments in the War on Breast Cancer, researcher Rose Kushner explains: “Any routine that is constantly being upset by one interruption or another​—even if it is perfectly natural . . . ​—is subject to a greater risk of errors.” She further states: “The overworked breast cell is always being bathed in some hormone that orders, ‘Stop doing that. Start doing this.’ No wonder so many of the daughter cells go haywire.”

Breast cancer begins when an irregular cell divides, loses control of its growth mechanism, and begins to proliferate. Such cells do not stop reproducing, and in time they overwhelm the surrounding healthy tissue, turning a healthy organ into a diseased one.

Metastasis

When cancer is contained within the breast, the malignancy can be removed. When breast cancer has spread to distant sites in the body, it is called metastatic breast cancer. This is the most likely cause of death in breast-​cancer patients. As cancer cells multiply in the breast and the tumor grows in size, cancer cells can quietly and secretly exit the primary tumor site and penetrate blood vessel walls and lymph nodes.

At this point tumor cells can travel to distant parts of the body. If they evade the body’s immune defenses, which include natural killer cells circulating in both the blood and the lymph fluids, these malignant cells can colonize vital organs, such as the liver, lungs, and brain. There they can proliferate and spread again, after making these organs cancerous. Once metastasis has begun, a woman’s life is in jeopardy.

Therefore, a key to survival is detecting breast cancer early in its development, before it has had a chance to spread. What can each woman do to improve the chances of early detection? Is there anything that can be done to help prevent breast cancer in the first place?

[Blurb on page 4]

Three out of every 4 women with breast cancer cannot point to anything specific that contributed to their having the disease

Keys to Survival

IF YOU heard a news report that a killer was stalking your neighborhood, would you take measures to protect yourself and your family? Likely you would lock and bolt your doors so as not to invite an easy entry. You would also keep on the watch for suspicious-​looking strangers and report them right away.

Should women do any less regarding a killer disease, breast cancer? What measures can they take to protect themselves and increase their chances of survival?

Prevention and Diet

It is estimated that 1 out of 3 cancers in the United States is caused by dietary factors. A good diet that will help maintain your body’s immune system may be your first line of defense. While no known food can cure cancer, eating certain foods and cutting down on others can be preventive measures. “Following the right diet could reduce your risk of getting breast cancer by up to fifty percent,” stated Dr. Leonard Cohen of the American Health Foundation in Valhalla, New York.

Foods rich in fiber, such as whole-​grain breads and cereals, may help lower the amount of prolactin and estrogen, possibly by binding to these hormones and flushing them out of the body. According to the journal Nutrition and Cancer, “these effects could suppress the promotional phase of carcinogenesis.”

Cutting down on saturated fats may reduce risk. Prevention magazine suggested that switching from whole milk to skim, reducing butter intake, eating leaner meats, and removing skin from chicken can bring saturated fat intake down to safer levels.

Vegetables rich in vitamin A, such as carrots, squashes, sweet potatoes, and dark leafy greens, as spinach and collard and mustard greens, may be a help. It is thought that vitamin A inhibits the formation of cancer-​causing mutations. And such vegetables as broccoli, Brussels sprouts, cauliflower, cabbage, and green onions contain chemicals that induce protective enzymes.

In the book Breast Cancer​—What Every Woman Should Know, Dr. Paul Rodriguez says that the immune system, which recognizes and destroys abnormal cells, can be strengthened through diet. He suggests eating foods rich in iron, such as lean meats, leafy green vegetables, shellfish, and fruits and vegetables high in vitamin C. Fruits and vegetables high in C reduce the risk of breast cancer, reports the Journal of the National Cancer Institute. Soybeans and unfermented soy products contain genistein, known to suppress tumor growth in laboratory experiments, but the effectiveness in humans has yet to be established.

Early Detection

“Early discovery of breast cancer remains the most important step in altering the course of breast cancer,” says the publication Radiologic Clinics of North America. In this regard three key measures are regular breast self-examination, annual examination by a doctor, and mammography.

Breast self-​examination should be done regularly each month, as a woman must be vigilant in looking for anything suspicious in the appearance or the feel of her breasts, such as a hardening or a lump. No matter how small her finding may seem, she needs to contact her doctor immediately. The earlier a lump is diagnosed, the more control she has over her future. A report from Sweden showed that if a nonmetastatic breast cancer was slightly over one half inch [15 mm] or smaller in size and was surgically removed, a life expectancy of 12 years was 94 percent possible.

Dr. Patricia Kelly comments: “If you haven’t heard from a breast cancer in 12 1/2 years, it’s very unlikely to come back. . . . And women can be taught to find breast cancers smaller than a centimeter [1/3 in.] in size just using their fingers.”

It is recommended that a physical exam by a clinician or physician should be done routinely each year, especially after a woman reaches the age of 40. If a lump is discovered, it would be good to get a second opinion from a breast specialist or surgeon.

The National Cancer Institute in the United States says that a good weapon against breast cancer is a regular mammogram. This form of X ray can detect a tumor perhaps up to two years before it can be felt. The procedure is recommended for women over 40. However, Dr. Daniel Kopans informs us: “It is far from perfect.” It cannot detect all breast cancers.

Dr. Wende Logan-​Young of a breast clinic in New York State tells Awake! that if a woman or her physician finds an abnormality but a mammogram shows no sign of it, the tendency may be to ignore the physical findings and believe the X ray. She says that this is “the biggest mistake that we see nowadays.” She advises women to have a certain reservation about mammography’s ability to detect cancer and rely heavily also on breast examination.

While mammography can detect tumors, it cannot really diagnose whether they are benign (noncancerous) or malignant (cancerous). That can only be done by means of a biopsy. Consider the case of Irene, who went for a mammogram. Based on the X-ray film, her doctor diagnosed her lump as a benign breast disease and said: “I’m absolutely sure you don’t have cancer.” The nurse who did the mammogram was worried, but Irene said: “I felt that if the doctor was sure, maybe I was being paranoid.” Soon the lump grew larger, so Irene consulted another doctor. A biopsy was taken and showed that she had inflammatory carcinoma, a fast-​growing cancer. To determine whether a tumor is benign (as about 8 out of 10 are) or malignant, a biopsy must be performed. If the lump looks or feels clinically suspicious or is growing, a biopsy should be performed.

Treatment

At present, surgery, radiation, and drug therapy are the conventional treatments for breast cancer. Information about the type of tumor, its size, its invasive quality, whether it has spread to lymph nodes, and your menopausal status can help you and your doctor determine the method of treatment.

Surgery. For decades radical mastectomy, the removal of the breast along with underlying muscles and lymph nodes, has been widely used. But in recent years breast-​conserving treatment that includes removal of only the tumor and lymph nodes, plus radiation, has been used with survival rates that equal those of mastectomy. This has given some women more peace of mind when deciding to have a small tumor removed, that being less disfiguring. But the British Journal of Surgery says that younger women, those with cancer in several locations in the same breast or with tumors larger than one inch [3 cm], have a higher risk of recurrence with conservation treatment.

An important factor in recurrence-​free survival is noted by the Cleveland Clinic Journal of Medicine: “Blood transfusion does have an adverse effect on the survival and recurrence rate . . . after modified radical mastectomy.” The report showed that the five-​year survival rate was 53 percent for one group who received blood transfusion, as opposed to 93 percent for the no-​blood group.

Another aid to survival is reported in The Lancet, where Dr. R. A. Badwe stated: “The timing of surgery in relation to phase of menstrual cycle has a large impact on long-​term outcome for premenopausal patients with breast cancer.” The report said that women who underwent tumor excision during a phase of estrogen stimulation fared worse than those operated on during other phases of the menstrual cycle​—54 percent survived ten years versus 84 percent for the latter group. The optimal timing of surgery for premenopausal women with breast cancer was said to be at least 12 days after the last menstrual period.

Radiation Therapy. Radiation therapy kills cancer cells. In the case of breast conservation treatment, tiny cancer seeds may escape a surgeon’s knife as he tries to preserve the breast. Radiation therapy can clean up lingering cells. But with radiation comes a slight risk of inducing secondary cancers in the opposite breast. Dr. Benedick Fraass recommends minimizing radiation exposure to the opposite breast. He states: “With a few simple maneuvers it is possible to reduce significantly the dose received by the opposite breast during primary breast irradiation.” He suggests that a one-​inch-​thick [2.5 cm] lead shield be placed over the opposite breast.

Drug Therapy. Despite efforts to eradicate breast cancer by surgery, 25 to 30 percent of women with newly diagnosed breast cancer will have hidden metastases too small to produce symptoms at first. Chemotherapy is a treatment that uses chemical agents to attempt to kill those cells that invade other parts of the body.

Chemotherapy is limited in its effect because cancerous tumors are made up of different types of cells that each have their own sensitivities to drugs. Those cells that survive treatment may spawn a new generation of drug-​resistant tumors. But the January 1992 issue of The Lancet gave evidence that chemotherapy increased by 5 to 10 percent a woman’s chance of surviving an extra decade, depending on her age.

Side effects of chemotherapy may include nausea, vomiting, hair loss, bleeding, heart damage, immune suppression, sterility, and leukemia. John Cairns, writing in Scientific American, commented: “These may seem like relatively minor hazards for a patient who has an advanced and rapidly growing cancer, but they would be serious considerations for a woman who has a small [1/3 inch] [1 cm] and apparently localized cancer of the breast. Her chance of dying of her cancer within five years is only about 10 percent even if she receives no additional treatment after surgery.”

Hormone Therapy. Antiestrogen therapy cuts off the growth-​stimulating effects of estrogen. This is achieved by reducing estrogen levels in premenopausal women either by surgical removal of the ovaries or by drugs. The Lancet reported a ten-​year survival rate for every 8 to 12 women out of 100 treated with either measure.

Follow-​up care for any woman with breast cancer is a lifelong endeavor. Close surveillance needs to be maintained, for if one regimen fails and relapse occurs, other types of treatment may provide the needed weapon.

Another type of cancer therapy that takes a different approach revolves around a syndrome called cachexia. The journal Cancer Research explains that two thirds of all cancer deaths are caused by cachexia, a term used to describe the wasting away of muscle and other tissues. Dr. Joseph Gold, of Syracuse Cancer Research Institute in the United States, tells Awake!: “We feel that a tumorous growth cannot extend itself through the body unless the biochemical pathways for cachexia are open.” One clinical study, using the nontoxic drug hydrazine sulfate, showed that some of these pathways can be blocked. Stabilization was achieved in 50 percent of the late-​stage breast-​cancer patients involved.

Alternatives known as complementary medicine have been looked to by some women to provide noninvasive or nontoxic treatment for breast cancer. Therapies vary, some using diet and herbs, as in the Hoxsey therapy. But published studies enabling one to assess the efficacy of these treatments are few.

While this article is designed to present keys to survival, it is not the policy of Awake! to underwrite any treatment. We encourage all to look circumspectly at these different avenues in the treatment of this disease.​—Proverbs 14:15.

Stress and Breast Cancer

In the journal Acta neurologica, Dr. H. Baltrusch explains that extreme or prolonged stress may reduce the body’s antitumoral defenses in the immune system. Women who are fatigued, suffer depression, or lack emotional support may have their immune system compromised by as much as 50 percent.

Thus, Dr. Basil Stoll, writing in Mind and Cancer Prognosis, emphasized: “Every effort should be made to minimize the inevitable physical and psychic trauma sustained by cancer patients during and after treatment of their disease.” But what kind of support is needed?

[Blurb on page 7]

While no known food can cure cancer, eating certain foods and cutting down on others can be preventive measures. ‘Following the right diet could reduce your cancer risk by up to fifty percent,’ stated Dr. Leonard Cohen

[Blurb on page 8]

“Early discovery of breast cancer remains the most important step in altering the course of breast cancer,” says the publication “Radiologic Clinics of North America.” In this regard three key measures are: regular breast self-​examination, an annual examination by a doctor, and mammography

[Blurb on page 10]

Women who are fatigued, suffer depression, or lack emotional support may have their immune system compromised

[Box on page 9]

Self-​Examination​—A Monthly Checkup

BREAST self-​examination should be done four to seven days after the menstrual period. Postmenopausal women also need to check every month on the same day.

Signs to Look for Every Month on the Same Day

• Lump of any size (tiny or large) or thickening in the breast.

• Puckering, dimpling, or discoloration of the skin of the breast.

• Drawing back or turning in of the nipple.

• Rash or scaling of the nipple or escaping fluid.

• Enlarged glands under the arm.

• Changes in moles or incisions of the breast.

• Marked asymmetry of breasts that is a change from normal.

Self-​Examination

While standing, raise the left arm. Using the right hand and beginning at the outer edge of the breast, press the flat part of the fingers in small circles, moving slowly around the breast and toward the nipple. Give attention also to area between underarm and breast.

Lying flat, position a pillow under the left shoulder, and place left arm over or behind the head. Use the same circular motion as described above. Reverse for the right side.

Gently squeeze the nipple to check for any discharge. Repeat for the right breast.

The Support That Counts

“I HAD to fight the fear of death and periods of depression,” relates Virginia, one of Jehovah’s Witnesses in Argentina. She underwent radical mastectomy and removal of both ovaries in her fight against breast cancer.a

Indeed, the fear of death as a consequence of breast cancer is universal. This fear, along with a dread of disability and a loss intimately associated with femininity and nurturing capacity, can wreak havoc in a woman’s life emotionally. Overwhelming feelings of isolation can quickly cause her to spiral into the depths of despair. How can she be spared such emotional battering?

The Need for Support

“She needs support!” answers Joan, from the United States. Her own mother and grandmother were victims of breast cancer, and she now faces the same fight they had. This is a time when loyal family members and friends can provide comforting support and help. Joan’s husband, Terry, became for her a strong positive advocate. Terry explains: “My position, as I saw it, was to be a stabilizing influence. I needed to help Joan to make decisions regarding treatment that would give her confidence and strength to fight and not give up. Her fear of cancer surgery was something we had to come to grips with, and I tried to be sure her questions and fears were addressed in our discussions with the doctors.” Terry added: “This is something we can do for our families and for fellow Christians who do not have family support. We can be their eyes, ears, and voice with the medical personnel.”

Special attention needs to be given to those who are single or widowed. Diana, from Australia, tells us: “My husband died following a cancer operation five years ago, but my children helped to fill the void. They were kind but not emotional. That gave me strength. Everything was attended to quickly and calmly.”

Breast cancer makes an emotional impact on the entire family. So they are all in need of loving concern and support from others (particularly from their spiritual brothers and sisters, if they are Jehovah’s Witnesses).

Rebecca, from the United States, whose mother fought breast cancer, explains: “The congregation is your extended family, and their actions have a huge bearing on your emotions. Although many did not personally agree with the unorthodox treatment my mom chose, emotionally they supported us with telephone calls and visits. Some would even come and lend a hand in preparing her special diet. The elders arranged a telephone linkup so that we would never miss the meetings. The congregation even sent a card with a money gift.”

Joan admits: “To this day, when I think of the love my spiritual brothers and sisters displayed, I get goose bumps! For seven weeks, five days a week, my loving sisters would take turns driving me to and from the hospital for treatment. And that was a 92-​mile [150 km] round-​trip! How I thank Jehovah for the rich blessing of this Christian brotherhood!”

Another way all of us can be encouraging and supportive is by our upbuilding comments. Care needs to be exercised that we do not inadvertently cause distress by dwelling on negative things. June from South Africa explains: “One can’t expect a person who has not had cancer to say just the right thing. In my case I felt it was better for others not to mention cancer cases unless they were positive.” Noriko from Japan agrees: “If people tell me about someone who has recovered and not had a relapse, then I too have hope that maybe I will be like them.”

Keep in mind that some women would prefer not talking about their health all the time. Others though, for the sake of their own well-​being, need to talk about their experience with breast cancer, especially with those close to them. How would one know what is the most helpful thing to do? Helen, from the United States, suggests: “Ask the individual if she wants to talk about it, and let her do the talking.” Yes, “be ready to listen,” says Ingelise from Denmark. “Just be there for her so that she is not left alone with her own sad thoughts.”

Working for a Positive Outlook

Breast cancer therapy can leave a patient exhausted and fatigued for weeks, months, or years. One of the greatest trials for a woman with breast cancer may be in facing the fact that she can not do as much as before. Coming to terms with her body will mean pacing herself and resting during the day.

When depression sets in, quick measures need to be taken to keep a positive attitude. Noriko relates her experience: “The results of hormone treatment left me depressed. In this condition I couldn’t do the things I wanted, and I began feeling useless to Jehovah and in the Christian congregation. As my thinking became more negative, I would call to mind the final sufferings of those in my family who had died with cancer. Fear would engulf me as I wondered, ‘Can I go through with it as they did?’”

Noriko continues: “It was at that time that I made an effort to adjust my thinking by using the publications of Jehovah’s Witnesses to make myself think of how Jehovah views our existence. I learned that godly devotion is shown, not by the amount of work done, but by the motive in which it is done. As I wanted Jehovah to take pleasure in the condition of my heart and my thinking, I decided that I should serve him with joy and be whole-​souled even if I could only do a little in the Christian ministry.”

The long-​term uncertainty for many women fighting breast cancer can tend to erode a positive outlook. Diana explains that what has helped her the most is filling her heart and mind with all the lovely things Jehovah God has given her: “My family, friends, beautiful music, looking at the mighty sea and beautiful sunsets.” She especially encourages: “Tell others about God’s Kingdom. And cultivate a real longing for the conditions that will prevail on earth under the Kingdom, where there will be no more sickness!”​—Matthew 6:9, 10.

Virginia also gains the strength to fight her depression by meditating on her purpose in life: “I really want to live because I have such a precious work to do.” As for the times when critical moments come and fear wells up, she says: “I put my full trust in Jehovah, knowing that he will never abandon me. And I think about the Bible verse at Psalm 116:9, which assures me that ‘I will walk before Jehovah in the lands of those living.’”

All these women have centered their hope upon the God of the Bible, Jehovah. The Bible book of 2 Corinthians 1:3, 4, at chapter 1, verses 3 and 4, calls Jehovah “the God of all comfort, who comforts us in all our tribulation.” Does Jehovah stretch out his hand to support those needing comfort?

Mieko from Japan answers: “I am convinced that by staying in his service, I receive Jehovah’s strong comfort and help.” Yoshiko also tells us: “Although people may not understand my suffering, Jehovah knows everything, and I am convinced that he has helped according to my needs.”

Joan says: “Prayer has the power to lift you out of despair and get you back on your feet. When I think about the grand healing Jesus accomplished when on earth and the complete healing he’ll do in the new world, how those words comfort me!”​—Matthew 4:23, 24; 11:5; 15:30, 31.

Can you imagine a world without breast cancer, in fact, without any illnesses at all? This is the promise made by the God of all comfort, Jehovah. Isaiah 33:24 speaks about a time when no person on earth will ever say that he or she is sick. That hope will soon be realized when God’s Kingdom in the hands of his Son, Christ Jesus, brings its full rule to the earth, wiping away all causes for sickness, sorrow, and death! Why not read about this wonderful hope at Revelation 21:3 to 5? Take courage to face the future with the support that gives true comfort.

[Footnotes]