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PREVENTION BEATS EARLY DETECTION

[By Julia S. Whiteker, MSN, RN, AOCNS®]

It used to be that find­ing out you have a higher-​​than-​​average risk for breast can­cer was just depress­ing, because there wasn’t much you could do but worry. In recent years, that has changed. Now there are drugs, lifestyle behav­iors, and pro­ce­dures avail­able to high-​​risk women that can sig­nif­i­cantly reduce their risk. Newer breast screen­ing modal­i­ties and sched­ules are also rec­om­mended that detect can­cers in high-​​risk women ear­lier than annual screen­ing mammograms.

Con­se­quently, high-​​risk screen­ing pro­grams for breast can­cer are pop­ping up in com­mu­ni­ties across the coun­try. Some, includ­ing the Mam­mo­Plus pro­gram in Grand Rapids and the Red­wood Regional pro­gram out­side of San Fran­cisco offer a ques­tion­naire that iden­ti­fies women with increased risk at the same time as their annual mam­mo­gram. Also, some pri­mary care physi­cians and OB/​GYNs are start­ing to offer high-​​risk screen­ing to patients in their offices.

The 1%-3% of women who meet the cri­te­ria for high risk are referred into high-​​risk coun­sel­ing and offered test­ing or inter­ven­tions as appro­pri­ate. Fur­ther test­ing can include BRCA gene test­ing, other genetic tests, and annual MRI screen­ing. Inter­ven­tions can include tamox­ifen, Evista (ralox­ifene), and surgery.

This trend of offer­ing high-​​risk screen­ing to healthy women is excit­ing, because it rep­re­sents the first step towards get­ting ahead of breast can­cer: the first move from early detec­tion to pre­ven­tion. If a woman can make a change that pre­vents a breast can­cer, she won’t have to ever go through the shock of being diag­nosed with can­cer. She won’t have to lose her hair, suf­fer radi­a­tion burns, or worry about occult metas­tases grow­ing in her bones or brain. Some high-​​risk women may chose to reduce risk through surgery, but the surgery is at their con­ve­nience and they have time to eval­u­ate all of their recon­struc­tion options.

I am glad to be part of this par­a­digm shift from early detec­tion to pre­ven­tion, and I am pro­mot­ing for­mal screen­ing for high risk at my insti­tu­tion. There’s noth­ing I would love bet­ter than to start to see the num­ber of breast can­cer diag­noses decrease because of pre­ven­tion. Ulti­mately, I hope to see the day when every breast can­cer can be pre­vented and I have to find a new nurs­ing specialty.

If you like this, you may also like:

• Home Test May Aid in Early Detec­tion of Cer­vi­cal Cance
• Study Looks at Pre­ven­tion of Breast Can­cer Through Mod­i­fi­able Lifestyle Factors
• Older Women With Early-​​​​Stage Breast Can­cer May Skip Radi­a­tion Therapy
• New Strat­egy Screens for Ovar­ian Cancer
• Are the USPSTF 2009 Mam­mog­ra­phy Guide­lines Crazy Wrong?

Julia S. Whiteker MSN RN AOCNS®, is the manager of Breast Care at Indiana University Health North Hospital in Carmel, IN. She had the privilege of helping to develop this new multidisciplinary program that was founded in 2005. She has worked in breast oncology for 5 years and in women’s health for 17 years. She is a news junkie and enjoys podcasts, blogs, fiction, action/adventure movies, breakfast with friends, biking, travel, and spending time with her family. Read more articles by Julia S. Whiteker

http://www.onsconnect.org/2012/01/reconnect/prevention-beats-early-detection