Younger, African American Women, and Men, Get Breast Cancer Too

There is a time in a nurse's career when we need to step up, even though we may feel overwhelmed.

For me, that day arrived early in my career. I had promised to be available for an IV start for a friend with late-stage breast cancer. She had extreme peripheral lymphedema, which made vein selection impossible. Her port had failed. My IV skills were decent, but I could not fail her. A promise is a promise.

Thankfully, I accessed a vein and her final journey with breast cancer could begin.

Today, the science of treating breast carcinoma is vastly different, and even late-stage breast cancer patients may live as if they have chronic disease, but the premise for optimal prognosis remains the same:

Early Detection of Breast Cancer Is Crucial!

While we think of October as a month of pink ribbons and themes to remind us of breast cancer awareness, this disease affects both women and men.

A woman's risk for breast cancer over her lifetime is 1 in 8. Approximately 43,000 women are expected to die from breast cancer in 2021, but overall death rates in women over age 50 have dropped 1% in the years 2013 to 2018, with the decrease thought to be the result of both "treatment advances and early detection," according to BreastCancer.org.

These statistics remind us that women who might have put off mammography during the pandemic should schedule screening appointments ASAP, as well as continue with monthly self-exams to detect the presence of abnormalities at the earliest point of discovery.

We like to believe that breast cancer is a disease of middle age, but it can also be a deadly disease for younger women. For example, breast cancer is more common and deadly in African American women under the age of 45. Additionally, although we hear discussion in the media about BRCA gene mutations from celebrities such as Angelina Jolie, only 1 in 400 (or 0.25% of the population) actually carry this mutation.

Breast cancer in men, although seldom discussed, will result in 2650 new cases of invasive breast cancer in the US alone in 2021.

Understanding Breast Cancer by Type

There are multiple types of breast cancer, but oncologists primarily divide it into two broad categories: invasive and noninvasive.

Most breast cancers are invasive, meaning the cancer has spread from the original site to other areas. These could be lymph nodes, nearby breast tissue, the bloodstream, or other areas of the body. The most common type of invasive breast cancer is invasive ductal carcinoma, which accounts for 70%-80% of all cases. This type of breast cancer starts in a milk duct and then grows into other parts of the breast. With time, it may metastasize.

Sadly, I cared for a nursing mother in her 20s who believed that the abnormal lump she palpated in her breast was a milk duct cyst. While extremely rare, these cases do occur.

Noninvasive (or in situ) breast cancer does not spread beyond the milk ducts or lobules of the breast. There are two types of noninvasive breast cancer: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). LCIS is technically not a cancer but a change in breast cells that puts a woman at risk for invasive breast cancer over time.

Hormone Receptor Status

We have learned about genomic testing while following the pandemic. We know about Alpha, Beta, and Delta variants of the original SARS-CoV-2 coronavirus, but nurses may not know that the same genomic testing has long been in use to treat breast cancer.

Breast cancer cells are evaluated during tumor dissection utilizing similar genomic testing.

According to the American Society of Clinical Oncology (ASCO) as cited by Cancer Treatment Centers of America, 60%-75% of breast cancers have hormone receptors that are responsible for fueling the tumor's growth. Tumors with receptors are more responsive to drugs that may suppress tumor growth over time.

Additionally, breast tumors are defined by ASCO/ACP (Advance Care Planning) as HER2 positive or negative depending upon the amount of a growth-promoting protein found within the cancer cells. HER2-positive breast cancers account for 15%-20% of invasive breast cancers. According to the National Institutes of Health, HER2 is "a valuable treatment target" in breast cancer therapy.

Unfortunately, for 10%-15% of all breast cancer patients, when hormone receptors for estrogen, progesterone, and the HER2 protein are absent, these tumor cells are called triple negative. These tumors tend to grow more rapidly and occur more frequently in younger women, African American women, and those with the BRAC1 gene mutation.

A Final Note

One of the saddest stories I have read about the disease was the experience of Lucille Ball's great-granddaughter, Desiree S. Anzalone, who passed away at the age of 31 from metastatic breast cancer. She was diagnosed by her oncologist at the age of 25 after finding a small lump in her breast. She was already stage II.

In the article, Desiree wanted to leave everyone with this thought: We should know the feel of our breasts, the contour and texture. We should know when something feels wrong, and we should act swiftly to seek a diagnosis.

I wholeheartedly agree. There are times when we need to step up to be advocates for breast safety; this would be one of them.

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About Diane M. Goodman

Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who works from home contributing to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Diane worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!

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