This is the year that nurse Lisa Humphreville committed to getting healthy, with a cleaner diet and new workout routine.
But both her professional and personal lives have revealed that bad things sometimes happen to otherwise-healthy people.
“Cancer and other tragedies have been happening to friends, especially younger people,” says the Manheim Township mother of two. “I always thought it could never happen to me, but maybe it could.”
Earlier this month, Humphreville took Lancaster General Health’s new online Breast Cancer Profiler and found her risk is actually below the national average.
The 10-minute assessment is based on a model developed by the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project. It takes into account lifestyle, health and family history to determine a woman’s risk for developing breast cancer within the next five years or throughout her life.
In the U.S., about 1 in 8 women will develop breast cancer, with an estimated 232,670 new invasive cases diagnosed in 2014. Though both the number of cases and the breast cancer mortality rate are decreasing, Dr. Daleela Dodge says confusion about diagnosis is on the rise.
“Screening has become very controversial,” says Dodge, director of the Breast Cancer Program at the Ann B. Barshinger Cancer Institute and a breast surgeon with Lancaster General Health Physicians Surgical Group. “Our patients struggle with how to start a conversation with their primary care physicians. Do I need a mammogram at 40, 50, not at all? It’s confusing to them.”
Even the breast self-exam has fallen out of favor as a government-backed screening tool, though the American Cancer Society and the Susan G. Komen Foundation still credit the technique with helping women recognize changes in their bodies.
Overwhelmed by too much information or fear of losing this body part — one central to their identities as nurturers and lovers — Dodge says too many women choose inaction.
The Profiler allows women to identify risk factors they can change and seek professional advice on how to interpret those they can’t. Results are delivered in a red-yellow-green diagram, an individual’s specific risk factors outlined in detail.
An emailed version can be printed and taken to the next annual visit with a primary care doctor or a gynecologist. Those with significant risk can pursue more information through the Penn Medicine Cancer Risk Evaluation Program.
Kathleen Fouse, of West Donegal Township, has had annual mammograms since she was 16. With a strong maternal history and some breast problems of her own, she wasn’t surprised by her results: a 23.6 percent lifetime risk and a 3 percent five-year risk. She says the assessment was a good reminder that she needs to continue her efforts to stop smoking and stay on top of regular appointments.
“It comes down to personal vigilance,” Fouse says. “You can’t be afraid of it. You have to get in front of it.”
What does it ask?
Here is a look at several factors included in the LGH profiler, and why they affect a woman’s odds of getting the disease. The test is meant only for women, and not for those with a strong history of breast cancer on their father’s side; a personal history of invasive breast cancer, ductile carcinoma in situ or lobular carcinoma in situ; or a known BRCA mutation in themselves or in their family.
— Height and weight
A certain body-mass index doesn’t necessarily put a woman at higher risk, but being overweight or obese after menopause does, according to the American Cancer Society. Dodge says there’s a greater risk associated with gaining weight later in life, rather than being heavy throughout the years. And women who carry weight around the waist are also more vulnerable than their pear-shaped peers.
White women are the most likely to develop breast cancer, but it can be more dangerous for African-American women. Dodge says African-Americans are more likely to get breast cancer at a younger age, more likely to develop aggressive forms such as triple-negative — which doesn’t respond to hormone therapy — and more likely to die from it.
Five to 10 percent of U.S. breast cancers are linked to faulty genes. When healthy, BRCA genes help suppress tumors. The genes are mutated in 5 percent of whites and 12 percent of Eastern European Jews. A 2013 study found the number could be as high as 20 percent among African-American women. The National Cancer Institute reports 55 to 65 percent of women with the BRCA1 mutation and 45 percent of those with the BRCA2 mutation will develop breast cancer by age 70.
Dodge says the data is clear: Those who have smoked regularly from a young age are at higher risk of breast changes. Quitting presumably helps, but Dodge says the research doesn’t prove it yet.
— Activity level
According to the American Cancer Society, exercising as little as 75 minutes to 2.5 hours weekly reduced a woman’s risk by 18 percent. Walking 10 hours a week reduced the risk more.
— Breast-feeding experience
Though it generally means a woman will menstruate less over her lifespan, the protective factor of breast-feeding occurs after 18 months to two years. That length of time is almost unheard of in the U.S.
— Alcohol consumption
The American Cancer Society says one drink a day is generally safe, but two to five daily increases risk 1.5 times. For low-risk women and those with no family history of breast cancer — including Dodge — wine may be worth an occasional glass for heart-healthy gains.
— Ages at first period and start of menopause
According to the American Cancer Society, women who started menstruating before age 12 and/or went through menopause after age 55 have a slightly higher risk of breast cancer, likely due to more lifetime exposure to estrogen and progesterone.