Critical Mass: Keeping Breast Cancer at Bay

Somewhere today, a woman dressed only in a pair of underwear and a paper gown will sit on a crinkly sheet of white paper and listen to her doctor discuss the amputation of part of her body in order to save her life. She'll probably be forced to ingest all sorts of medical terminology and even make decisions affecting the rest of her life in the time it takes you to read this paragraph. Because breast cancer is the most common form of cancer among American women, this scene will unfortunately repeat itself about 175,000 times this year alone, sometimes to women well under 40 with no family history of the disease. Sometimes even to women with children in grade school.

That's the bad news. The good news is that four out of every five lumps found are not even cancerous and a good number of the lumps that are malignant are detected before the cancer has spread to surrounding breast tissue or other parts of the body. Women who perform monthly breast self exams (BSE's) find an amazing 85% of all lumps. Tragically though, the American Cancer Society estimates that the 44,500 women who will die this year as a result of the disease could have been significantly reduced if more women regularly practiced BSE's. The problem? Some women just forget. Others aren't exactly sure what it is they're looking for. Many are simply too afraid of what they might find.

My 50-year-old aunt, - who was 18 when she first diagnosed with fibocystic (or "lumpy" breast) disease after she found a cyst in her left breast and 28 when she had her first mammogram (low-dose x-ray of the breast tissue) - is still afraid. Although she began yearly mammograms at age 35 because of her condition, she still says she has to steel her nerves to call and make her yearly appointment. 

"I freak. I absolutely hate it. I dread it and I put it off. I know I need to go and I simply don't want to," she says. Still, to help keep her personal history from becoming a family one, she has taught her 18-year-old daughter to do BSEs and reminds her to check her breasts regularly.

Nurturers that we are, we mothers are so used to taking care of everyone and everything often before we even think of caring for ourselves. How many of us have climbed out of bed with a fever to do a quick load of laundry or prepare a hot meal for our families? Who of us hasn't ignored a nagging pain but made sure the children get their physicals in time for back-to-school? Especially for Black women, the belief that we are somehow pre-programmed to be able to endure any and every hardship that comes our way is powerful.

"The one myth that I have had to endure my entire life is that of my supposed birthright to strength," writes Meri Nana-Ama Danquah in Willow Weep for Me, a memoir on Black women and depression. "Black women are supposed to be strong - caretakers, nurturers, healers of other people - any of the twelve dozen variations of Mammy... hardship is supposed to be built into the structure of our lives. It went along with the territory of being both Black and female in a society that completely undervalues the lives of Black people and regards all women as second-class citizens." But, because no one is quite sure what causes breast cancer to develop and because there is, as of yet, no cure, we can't wait to begin fighting this disease. The only protection we have is early detection. Putting off until tomorrow what we need to do today can lead us down the slippery slope of passivity against a disease we have to be actively vigilant against to beat.

Each October, when all the Breast Cancer Awareness Month facts and figures are floating around, it hits me how much that lack of vigilance, as well as ignorance about the nature breast cancer may actually play in the number of deaths attributed to this disease. For example, before my mother lived through her own doctor's office scene in 1988, none of my female family members knew that African-American women make up too large a portion of breast cancer fatalities because it is often detected in later stages when the cure rate is so horribly low. 

Of the seven women on my mother's side of the family, only three of them - my 66-year-old grandmother, her 68-year-old sister and the aunt mentioned earlier - had ever even had a mammogram, although it is widely recommended that women have their first or "baseline" mammogram between ages 35 and 40, one every two years between 40 and 50 and one every year after age 50. My mother - who actually should have had four mammograms by the time she was initially diagnosed at age 44, was never given detailed information about mammography although she saw her doctor for a physical every year. The headstone erected over her grave site is a vivid reminder that what you don't know can hurt you very badly.

What you should know is that several factors, including having a personal or family history of the disease (especially if breast cancer occurred in a mother, sister or grandmother before they reached menopause), giving birth after age 30 and having a long menstrual history (menstrual periods that started early and ended late in life) can increase the chance that you may develop breast cancer at some point in your lifetime. Recent research has also linked high-fat, low-fiber diets to increase breast cancer risk.

But diagnosis does not automatically mean death or even the loss of a breast. The key is to catch the cancer early, before it has spread. So, take the time each month to examine your breasts. Have your health care provider conduct a manual exam and show you how to do one yourself at your next visit. Encourage your mothers, your daughters, your sisters, your aunts, your nieces, your friends, your neighbors and your co-workers to do the same. Remind the woman in the line behind you at the grocery store about her yearly mammogram. Like you, she is someone's mother or daughter, sister or aunt, niece or friend, neighbor or co-worker.

Please don't let cost keep you from getting a mammogram. In most cases, insurance carriers and Medicare will cover the cost fully. Some states have special programs funded by county health departments and administered through organizations like area YWCAs to help women without any health care coverage or with very high deductibles obtain free breast cancer screenings. Call your local YW or the National Cancer Institute at 1-800-4-CANCER for more detailed information. 

I can't help but think that if my own mother could have read this information all those years ago, she might still be around today, spoiling the stuff out of the grandson she never got to meet.

For my mom, for the millions of women whose lives have already been lost to this devastating disease, for the daughters like me that they have left behind: protect yourself. No one else can do it for you. 

The real fear should not be in finding a lump - it should be in not finding that lump in time enough to save your life.

Felicia Hodges is a freelance writer/editor in upstate, New York.

Originally appeared in Tri-CountyWoman magazine (Fall 2007)