Breast cancer is the most common cancer among women, accounting for more than 30% of all of their cancers. While spinal cord injury itself does not place women at higher risk of breast cancer, some of the results of SCI­reduced sensation, less likelihood of bearing children­can place SCI women in higher risk categories.

What Is Breast Cancer?
Cancer is really a number of diseases caused by the abnormal growth of cells. Often the cells grow out of control, divide more than they should, and form masses known as tumors. Malignant, or cancerous tumors not only invade normal tissue, but their cells can travel to other parts of the body to form more malignant tumors. This spreading is called metastasis. Breast cancer most often begins as a painless lump or thickening in the upper, outer portion of the breast; it can, however, occur anywhere in the breast, including the nipple. Breast cancers may spread to the lymph nodes in the arm pit and then, throughout the body.

Because the cause of breast cancer is unknown, there is no way to truly prevent it. However, several things put women at higher risk of developing breast cancer:

• a personal or close family history of breast cancer­mother, sister, aunt, grandmother
• never giving birth, having your first full-term pregnancy after the age of 30, or experiencing an abortion during your first pregnancy
• obesity
• early onset of menstruation­before age 12
• late menopause
• cigarette smoking
• high fat diet
• alcohol consumption

And, risk increases dramatically with age: at age 25 the odds are one in 20,000; by age 50 the odds are 1 in 50; by 85 the odds are 1 in 8.

Does Spinal Cord Injury Increase the Risk?
Probably not. While spinal cord injury does not place women at greater risk of
developing breast cancer, some of the consequences of SCI may increase risk and interfere with prevention and early detection. Women injured young may be less likely to bear children. Inactivity may lead to weight gain. Reduced hand function and sensation can interfere with self-exams. And living in a chair may make positioning for mammographies challenging or impossible.

How Can I Decrease the Risks?
Several basic steps keep your risk as low as possible. Avoid obesity­cut fat intake to 25-30% of your total calories, less than 50 grams of fat per day. Eat high fiber foods like whole grain cereals, fruits and vegetables, foods rich in vitamins A and C, and deep green vegetables, like broccoli, cauliflower, or other foods from the cabbage family. Limit salt-cured, smoked and nitrate-cured foods­cold cuts, ham, hot dogs, sausage. If you have fluid-filled sacs or small cysts in the breasts (called fibrocystic breasts), cut down or eliminate caffeine. Reduce your alcohol use to two or less drinks a day. Quit smoking!

The most common sign of breast cancer is a lump or thickening, especially one that does not go away and does not change the way it feels. Other signs include: swelling, puckering or dimpling, discoloration, or soreness of the skin; a fixed inversion of the nipple which is a change from before; skin ulcers; and scaling, crusting or drainage from the nipple or areola.

The American Cancer Society recommends:

• Monthly breast self examination for women over 20
• A baseline mammogram by age 40, with a repeat every 1 to 2 years for women in their 40’s, then yearly starting at age 50
• Clinical breast exam by a health care professional­ every three years from 20-40, yearly after 40
• The American Cancer Society also strongly recommends the biopsy of ALL suspicious lumps!

Monthly exams are a must… Monthly breast self-exams are recommended because breast cancer can develop between clinical exams or mammographies. Actually, most breast lumps are found by women themselves or by their sexual partners. For your monthly exam, first use a mirror to look for lumps, changes in breast shape, pain, or discharge from the nipple. Then, palpate, using your fingers to feel your breasts in overlapping areas about the size of a dime. Remember to also check the underarm and upper chest areas.

“…but I have quadriplegia, and decreased sensation.” Changes in your risk factors make these self-exams even more important. You can still do your own visual inspections, but if your sensation is at all impaired, get help to do a proper and complete exam. Have your husband, lover or friend help. Ideally, you should do your self-exam four to seven days after your menstrual period. However, you may wish to combine these exams with a monthly catheter change and have your nurse or caregiver help you at that time. Be sure to have whoever helps you write down any questions or changes they feel so that the changes can be rechecked by your doctor.
Remember: do these exams faithfully every month. Your SCI has changed some of the risks, so exams are even more important.

What If I Find Something?
This is the dreaded question, often the one which prevents self-exams in the first place. Remember that 80% of lumps­4 out of 5­are benign, but they feel the same as cancerous lumps. If you find a lump or notice a change see your health-care professional immediately.

Is There Any Good News?
YES!!! A new, large core biopsy technique has been developed which can be done in the doctor’s office. This procedure has a shorter recovery time, doesn’t leave a scar, costs much less than a surgical biopsy. It's available in about 100 US hospitals . And, over 600 Contour Mammography Systems are now available in nearly all 50 states to serve women with SCI. This system allows you to remain in your chair while a tilt arm conforms to your position. Ask your doctor or call Bennett X-ray Technologies at 516-691-6100 to locate one in your area.
The best news of all is that breast cancer treated at its earliest, non-invasive stage has an almost 100% survival rate.

Resources:

• American Cancer Society -- 1-800-ACS-2345
• Y-ME -- 1-800-221-2141
• Susan G. Komen Breast Cancer Foundation -- 800-462-9273
• National Cancer Institute -- 1-800-422-6237
• For accredited mammography centers --1-800-4-CANCER

This is one of more than 20 educational brochures developed by Craig Hospital while it was a federally-funded Rehabilitation Research & Training Center on Aging with Spinal Cord Injury. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

For a hard copy of a METS brochure, click on your selection above and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.