October is Breast Cancer Awareness month. It is a particularly suspenseful month for me this year because we have not been scheduling as many mammograms as usual during the past 2 and a half years of the pandemic. Normally, I diagnosed 1-2 cases of breast cancer every year. In a bad year, it'd be 5 cases. In the past 3 years, I've had 2 cases total. So I'm still waiting to see when the other shoe will drop.
In 2020, during the lockdown, we were only treating active medical issues and paused most preventative screening tests. I did not have any patients diagnosed with breast cancer that year. Ironically, 2020 was the first year that breast cancer became the most common cancer worldwide, edging out lung cancer for the first time.
In 2021, when the covid vaccines were being rolled out, many workplaces and radiology centers were going through rolling closure due to infection surges from the Alpha and then the Delta variants, we were seeing preventative patients via telehealth but many patients were still reluctant to go to these centers to get their screening mammogram. During this year, the only patient I had who was diagnosed with breast cancer was a woman who developed an aching left arm after her covid vaccine and as she was rubbing her shoulder, found a lump in her axilla. After the mammogram and the biopsy came back showing invasive breast cancer, her husband said "I told you not to get that vaccine, it would kill you". I had to reassure her that, in fact, the vaccine saved her life by prompting her to find the cancer at an early stage, before it metastasized to her lungs or brain.
In 2022, when the vaccine mandate kicked in requiring healthcare workers to be vaccinated against Covid, we experienced medical personnel shortages because so many of our older, more experienced radiologists and radiology technician have quit, retired, or were laid off due to fear of contagion or due to non-compliance with the mandate. Depending on the radiology center, it may take months for the patients to schedule a screening mammogram and months for the result to come back to our office. Last month, a patient with a family history of breast cancer was found to have a new nodule on her screening mammogram and a biopsy showed invasive ductal carcinoma. She has been referred to a breast cancer surgeon and treatment team so hopefully, that is it for the year. But at the beginning of October, I was still telling all my staff, only half-jokingly, that everybody who walks into the office this month should get a mammogram order.
The good news about breast cancer is that it is very treatable and has a very high cure rate, up to 99% when we catch it at an early stage. The survival rate goes down more and more with the later or more advanced stage of cancer at the time of diagnosis, though. So that's why it's so much easier to catch it early before it can spread.
The bad news about breast cancer is that women in the developed world have a very high chance of getting it. The American Cancer Association estimates that 1 out of 8 women in the developed world will get breast cancer in their lifetime. The biggest risk factor for breast cancer is genetics and family history. Although the expression of that risk may be less when you have a lower-risk lifestyle.
We know this because the incidence of breast cancer is lower in less developed, less westernized countries. 20 years ago, before China and Southeast Asia were barely entering their industrial revolution, the incidence of breast cancer in Asia was 10 times less than that of the United States. But as their societies get more modern and wealthy, their incidences of breast cancer have been slowly rising, from low to intermediate levels. This disparity in breast cancer rate occurs between eastern and western Europe as well as between North and South America.
Several years ago, when one of my sisters was diagnosed with this disease, my mom told me that nobody in Vietnam has breast cancer. So I looked it up and she was right. Each year 10-30 out of 100,000 women in Asia get breast cancer, compared to 100-128 per 100,000 women in the US. In Hong Kong, breast cancer was once known as a rich woman's disease because it was noticed that the wealthier the family, the more likely the women are to get breast cancer.
Other factors that point towards this cancer being related to lifestyles include the well-documented phenomenon of Asian immigrants developing the same incidents of cancer upon arrival in the United States, such as US-born Filipinos and Hawaiian-born Chinese.
Lifestyle risk factors include early menarche, late menopause, delayed child-bearing, weight gain during adulthood, eating red meat, hormonal therapy after menopause, and, sorry ladies, any alcohol use whatsoever.
So while we cannot control the genes that we were born with, the age of our menarche, first pregnancy, or our menopause, we can control some of the other risk factors. We can keep our weight reasonable, eat less red meat, and consume less alcohol.
And for sure, we can examine our breasts regularly for lumps, and go get our mammogram every year after we turn 40.