Once I had a patient who was a mother in her late 20s. Her sister, in her early 30s, had breast cancer and was undergoing her second round of treatments. Their mother had died from breast cancer in her 40s. While my patient was very aware of her high risk of breast cancer, every time we set her up for a mammogram or a meeting with a genetic counselor, I would receive a note that she had missed her appointment. Attempts at rescheduling the tests persistently failed. She didn't return phone calls or answer letters. During routine office visits, I would coax her to proceed with routine breast screening, but she always redirected our discussions to other health issues. She eventually stopped seeing me. I often think about her, wonder how she is doing now, what I could have done better, and whether someone else has been able to get past her fears of breast-cancer screening. Cases like these hit me hardest — the women who delay screening and testing in the face of high risk. Their denial can prevent them from seeking testing that may save their lives. During Breast Cancer Awareness Month this October, let us turn our attention to this group of women and focus on how we can help. Denial is a tough thing for one person to overcome. But by creating a network of women — reaching out to a friend, co-worker or family member — we can play an important role in counseling women who are at high risk of breast cancer. Any woman with a sister, mother or daughter with breast cancer is at higher risk of breast cancer and must take cancer screening very seriously. Depending on the person, testing may be advised every year starting at the age of 40 or earlier, or as often as every 6 months. If the relative with breast cancer was diagnosed before the age of 60 and if more than one close relative had breast or ovarian cancer, the possibility of genetic mutation increases. The person with multiple relatives with breast and/or ovarian cancer faces a more difficult decision — whether she should have genetic testing. Genetic testing offers you a chance to better understand your risk of breast cancer. In particular, testing looks for mutations in the BRCA1 and BRCA2 genes that are associated with a high risk of breast and ovarian cancers. Having one mutated gene can increase your risk of breast cancer from the standard 12% all the way to 50% to 85%. Why does a woman delay screening or testing? Put yourself in her shoes. Testing means possibly finding out that you have breast cancer. It might bring back painful memories of a relative's diagnosis, treatment and maybe even death. A woman at higher risk of breast cancer faces more frequent screening tests, whether it is a mammogram or MRI. And if she chooses genetic testing, the results could mean additional decisions about preventive treatment. While for many women, the possibility of treatments to lower their cancer risk is reassuring, for many others, the thought of treatments is frightening. While you can opt to take medications like tamoxifen or raloxifene to block estrogen, you also have to seriously consider surgically removing both breasts and ovaries to lower your cancer risk. These are not easy considerations for anyone. You don't have to do or say a lot to help a friend. Here are some ways you can make sure that your network of friends is giving the best education and support they can:
I can tell countless stories about the positive impact family and friends have in encouraging healthy changes and helping people through the treatment and recovery process. We all should take seriously our potential power as a friend to promote healthy behaviors and prevent disease. Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.
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