For breast cancer prevention, fear is the enemy

 

Don’t be afraid. Be brave. Get a mammogram. Ask questions.

While women have a 1 in 8 chance of developing breast cancer, the best defense is a good offense, according to health care advocates.

“Don’t be afraid if your last mammogram 15 years ago was painful and you’ve never come back and now you’re embarrassed,” said Carrie Riccobono, a clinical nurse specialist who is vice president of the Wisconsin Breast Cancer Coalition. “That fear of uncertainty is so powerful.”

Experts say women should overcome their fears, their desire to avoid thinking about cancer, to be their own health-care advocates. There’s a lot that women can do to empower themselves.

For good self-care, Dr. Sheldon Wasserman, a local OBGYN, recommends losing weight, breast self-exams, staying generally healthy, talking to your doctor and getting mammograms.

“Mammograms have made a difference,” he said. “Getting them done is important. Is it 100 percent? Absolutely not.”

Genetic issues for Jewish women

Mutations in a pair of genes, BRCA1 and BRCA2, can create a higher risk of breast cancer and the mutations are more common in women of Ashkenazic (European Jewish) ancestry, according to medical experts.

Today, genetic testing is available for women who want it. The Centers for Disease Control in Atlanta recommends genetic testing for individuals of Ashkenazic Jewish ancestry with at least a “moderate” family cancer history.

One 2014 article in the Journal of the American Medical Association argues that “it is time to offer genetic screening of these genes to every woman, at about age 30, in the course of routine medical care.”  But the U.S. Preventive Services Task Force recommends against routine genetic counseling or BRCA testing for all women.

The American College of Obstetricians and Gynecologists does not recommend genetic counselling for all. But Wasserman does feel more information, including genetic information, can be beneficial if “a person’s very concerned about it … or with a family history.”

Sandra Gines, the executive director of the Wisconsin Breast Cancer Coalition, who also happens to be a member of Congregation Shir Hadash of Milwaukee, said that prior to becoming an advocate, she didn’t know about the elevated risk of breast cancer for Ashkenazic Jewish women.

“This strengthened my resolve to work for an end to breast cancer, because while that isn’t my heritage, it is the heritage of my daughter,” she said. “She has breast cancer on both sides of her family, and with her Ashkenazic Jewish heritage, she will need to be well-educated about her risk level and to be vigilant about her breast health.”

Riccobono recommends both mammograms and seeing a genetic counsellor. Technology today makes it possible to uncover genetic predisposition for various diseases, including breast cancer, and genetic counselling is offered by all the major local health providers, she said. It’s often covered by insurance or can cost just a few hundred dollars, she said.

“I would say it’s better to know what you’re dealing with than be walking in the dark,” Gines said. “Once you know what it is, you can muster a very, very effective counter-fight. Knowledge is power.”

“Women need to be their own best advocates,” she said, suggesting that a woman can talk to her health care providers about cancer and whether she has a genetic predisposition. “She could say, ‘I know there’s something out there about Ashkenazic women. What does that mean to me?’”