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Taking Charge of Breast Cancer: A Guide for African American Women

Breast cancer is the most common cancer among African American women.This video explains the risk factors for breast cancer, screening tests to find it early, and some common treatments for it.

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Narrator: Breast cancer. It is the most common cancer among African American women. But here’s the good news. Many women survive. With their doctor’s help – they take charge of breast cancer.

This program is for African American women – because we need to know about breast cancer so we can make good decisions about our health.

Changing the outlook for African American women – begins with you!

Lynn Whitfield: Don’t procrastinate. Get the checkups regularly. Be conscientious, be informed, be consistent and be positive!

Narrator: Lynn Whitfield has portrayed many memorable characters. But when the role comes from the south – she can reach back to her own roots. She grew up in Louisiana, where her ambitions were sparked by both of her parents.

Lynn Whitfield: My mom was very, sort of, stylish, and my father was talented. He was a dentist, but he also wrote music and had a choral group there. So I did get to see stage experience, and see the magic of theater and music and glamour.

Narrator: A third generation graduate of Howard University, Lynn had a solid foundation for a successful career. And, her life is enhanced by the healthy choices she learned to make, as the daughter of a health care professional. She’d like to see more people in her community share that awareness.

Lynn Whitfield: I live in New York City and honestly on a Friday you can walk down a street and every nail salon is full or any street in America where African American people live and the hair salons of the weekend are full! But somehow we don’t always think that the maintenance program for our health is just as important. So it’s troublesome to see, you know, people maintain the outer beauty, and not think about what’s going on inside.

Narrator: Lynn is very careful about her own health. She knows the importance of getting checked for breast cancer on a regular basis. It’s a lesson taught – by her mother.

Lynn Whitfield: My mother discovered she had breast cancer in her yearly mammogram. That was how they caught it very early.

Narrator: Lynn’s mother is a breast cancer survivor. So is her aunt. So Lynn is keenly aware of the importance of taking action to detect breast cancer early.

Lynn Whitfield: What I’ve learned from my mother and from my aunt is that being proactive and positive is so important. Not being fatalistic, not allowing fear to get the best of you.

Narrator: Esther has faced down that fear – twice. After treatment for cancer in one breast…she got it, in the other. But she’s back feeling her best.

Esther: Right now I feel that I have licked the big C – and Right now I am feeling very strong.

Narrator: Like millions of other breast cancer survivors, Esther has taken charge of breast cancer. She’s joining the other women in this program – sharing their experiences, so that other African American women will learn what they need to do to beat this illness.

Lisa A. Newman, MD, MPH: We need to get out there and talk to each other about how to be vigilant regarding breast cancer screening, and breast cancer early detection. We need to take care of each other as a community.

Kathie Ann Joseph, MD, MPH: We’ve made such great strides in this country as far as treatment for breast cancer, and it’s important that African American women go for screening, get mammograms, and avail themselves of all the treatments, all the screening options available for them, because we know that early detection leads to improved survival.

Lynn Whitfield: And I just encourage people to remember that it’s not just about you. It’s about everybody else who loves you and everybody else who needs you.

Lisa Newman: A cancer of the breast is a growth that begins in the breast, and which continues to grow beyond the body’s normal control systems.

Narrator: Abnormal cells may form a tumor, or lump, in the breast. If the tumor is not cancer, it’s called “benign.” A cancerous tumor is called “malignant.” That means it may spread - in a process called “metastasis.”

Lisa Newman: Metastasis from breast cancer is a spread of the cancer beyond the breast, either through the bloodstream or through other routes to other parts of the body.

Narrator: With early detection and treatment, a woman’s chance of surviving breast cancer can increase. So can the possibility of saving her breast.

Dr. Joseph: Hi Karen

Karen: Hi Dr. Joseph

Dr. Joseph: How are you doing?

Karen: I’m ok

Narrator: At 45, Karen has been regularly getting the kind of x-rays called mammograms. She has a history of lumps called ‘cysts’ in her breast. Recently, a mammogram turned up something different. It turned out to be breast cancer.

Karen: When I got the diagnosis, I was very surprised, shocked, didn’t know what to say.

Narrator: But because her cancer was caught so early, the doctor told Karen her breast could be saved, and the treatment would be over quickly.

Narrator: Esther W. is alive and thriving – more than 20 years after surgery to remove a lump from her breast. She’s another example of the success of early detection. But she knows she must stay on guard. Because all women are at risk – even survivors.

Esther W: My advice to women, they must get regular checkups.

Narrator: Though all women are at risk for breast cancer – the chance for getting it increases with various risk factors.

For example, the chance of getting breast cancer increases as you get older. So age is one risk factor.

Another is family history: having a mother, sister, daughter or other close blood relative who has had breast cancer.

Some breast cancers are linked to genetic changes that are then inherited.

Previous breast cancer is also a risk factor. Having breast cancer in the past increases a woman’s risk for developing breast cancer again. So if you have had breast cancer – you’re at higher risk than a woman who has never had it.

Kathie Ann Joseph, MD, MPH: Most breast cancer recurrences are going to happen within the first two to three years after diagnosis, which is why it’s so important that patients follow up with their physicians and continue to get screened, even after they’re gone with their treatment.

Narrator: Being overweight after menopause also increases your risk. It affects the level of the hormone, estrogen, that is linked to breast cancer.

Lisa Newman: A woman that is obese after the menopause can have an excessive amount of estrogen circulating in her body, because of these estrogen like compounds produced by fat cells.

Narrator: The risk is also raised for women who take hormone replacement therapy –“H R T” for several years after menopause... especially if the HRT combines estrogen with progesterone.

You should also be aware, that when your menstrual periods first start, and finally end, can be a factor. If you began having them before age 12, or went through menopause after age 55, you’re at slightly higher risk. Talk about your risk factors with your doctor. But remember - EVERY woman is at risk. And EVERY woman needs to take action, to protect her health.

Narrator: It’s important to know that breast cancer can be detected even before symptoms appear. That’s why the x ray called a mammogram can be a lifesaver.

Lisa Newman: Mammograms can find cancers at earlier stages, and if we find that breast cancer at an earlier stage, we are more likely to treat it successfully.

Narrator: The American Cancer Society recommends the following screenings:

Mammograms – every year starting at age 40. Or perhaps earlier, depending on a woman’s risk factors.

A breast exam by a healthcare professional should be performed once a year beginning at the age of 40, and during regular health exams for women in their 20s or 30s. At least every three years.

Checking one’s own breasts is also an option for women, starting in their 20s. But whether or not you do this regularly, being aware of breast changes is important.

Lisa Newman: A new lump, a bloody nipple discharge - these women should see their physicians right away, and they might need to have yet another mammogram, even if they had a normal mammogram just a few months earlier.

Narrator: Even if your breasts feel perfectly normal, you should be talking with your healthcare professional about your breast cancer risk. You might need to start mammograms at a younger age, or have additional imaging tests.

And remember, getting your first mammogram is the beginning of a life-long commitment.

Phillipa Woodriffe, MD: That’s the screening mammogram. After that, additional mammograms are compared to that. One mammogram is not enough!

Narrator: Dr. Woodriffe reminds her patients that mammograms may detect breast changes before they can be felt. She knows that – from personal experience.

Phillipa Woodriffe: I am the poster girl for having a yearly mammogram. My mammogram was 362 days apart, and yet a change was seen which led to a biopsy, which led to a diagnosis.

Narrator: That was more than four years ago. Dr. Woodriffe is reassuring proof for her patients – that breast cancer can be effectively treated.

Narrator: Linell is a musician, a minister, and a mother. She has a lot to live for! And yet when she first felt a lump in her breast…she did nothing about it.

Linell: Denial. That was denial – not wanting to admit, scared, you know – afraid to hear the truth.

Narrator: Fortunately, Linell saw a public service announcement urging women to get their mammograms. She was diagnosed and treated – and now she’s back with the Jubilation Choir - celebrating life.

Whether you find a lump yourself, or an abnormal area is found on a mammogram, the next step will be use of a diagnostic test such as an ultrasound and in many cases a biopsy. That means a small amount of tissue is removed to be examined under a microscope. But it does not automatically mean you have cancer.

Phillipa Woodriffe: Actually, the majority of breast biopsies that are done are benign, meaning that it’s not a cancer. The problem is, we don’t always know by a mammogram or an examination which lump is cancer, which one isn’t. So anything that is suspicious will be subjected to be biopsied.

Narrator: If a biopsy shows a cancer is present, the next step is to determine how far it has advanced. This is measured in stages.

In Stage 0 – the cancer cells have not invaded into fatty breast tissue surrounding the duct where it is located.

Stages I, II and III are determined by the size, whether it has spread to the chest wall or skin, and whether the cancer has spread to lymph nodes near the breast.

In Stage IV – the most advanced stage – the cancer has spread to other organs, or to lymph nodes far from the breast.

There are different types of breast cancer – so tests also are done to find out which kind you have. Here are some terms you might hear:

A tumor can be hormone receptor positive. Or hormone receptor negative.

If the tumor has too much of a certain protein it’s called HER2-positive.

A tumor is called triple negative if it’s HER2-negative and hormone receptor negative.

Lisa Newman: We have a variety of different treatments for breast cancers. It’s important to know exactly what type of breast cancers we are dealing with in an individual woman, because that will determine the type of treatment that the woman needs.

Narrator: Women who are facing cancer, first must overcome their fears. Fears about the illness. Fears about the treatment. Even fears about the diagnosis.

Lisa Newman: They may even have a lump in the breast and ignore the fact that it’s present, and this contributes to one of the most life threatening aspects of breast cancer: The fact that an untreated breast cancer, and ignored or neglected breast cancer, can continue to grow and can spread to other organs of the body, and threaten that woman’s life.

Narrator: Reverend Janet remembers an aunt who died of breast cancer, after tragically, just giving up.

Reverend Janet: We knew that she was diagnosed, she’d gone to a doctor a couple of times, and then didn’t go any more.

Narrator: But when Reverend Janet found out she had breast cancer – she took a very different path.

Reverend Janet: And I remember this prayer so clearly. I clearly said, okay, if I gotta fight, I’ll fight, but I won’t quit!

Narrator: No one fights cancer alone. You should feel comfortable with the doctor you choose.

Phillipa Woodriffe: Because the teamwork with the doctor, which is based on communication between the patient and the physician, is critical to a good outcome.

Narrator: And remember, communication goes both ways. You’ll have choices to make about your treatment, so you need to have a straightforward discussion about your options – and how they’ll affect every part of your life.

Karen: It is very important to have good communication with your doctor. You have to feel very comfortable in letting them know everything that’s going on with you physically and emotionally. You have to be able to ask questions and make sure that the doctor understands your questions, and make sure that you understand what the doctor is telling you as well.

Narrator: As you consider your treatment options, you might also seek information online and on the phone – at cancer.org/breastcancer. Or 1-800-227-2345.

Narrator: Most women with breast cancer have surgery. There are three main types.

A lumpectomy removes only the breast lump, and some nearby tissue.

A partial mastectomy removes more of the breast tissue along with the lump – but leaves much of the breast in place.

A mastectomy involves removing the entire breast.

For most breast cancers, some of the lymph nodes under the arms are removed as well, and tested to find out if the cancer has spread there.

When Reverend Janet talked over her options with her doctor – her decision was to have a mastectomy.

Reverend Janet: I had a choice between a lumpectomy and a mastectomy – not that one is better than the other. I just chose, and I felt more comfortable deciding to have a mastectomy.

Narrator: After surgery, women may choose to have breast reconstruction – to make the breast area look more normal.

Phillipa Woodriffe: There have been many advances in the approach to how it can be reconstructed, and this is something that is pretty much discussed and handled by a plastic surgeon. Reconstruction can be done immediately after the mastectomy – or it can be done at any time in the future.

Narrator: Surgery is one part of the treatment process. But there are other weapons in the fight.

Radiation therapy is used to destroy cancer cells.

Lisa Newman: Radiation therapy is very good at killing microscopic cancer cells hiding in the breast.

Narrator: Chemotherapy is treatment with cancer-killing medication.

Phillipa Woodriffe: It can be a pill, or an injectable medication in an IV – but the whole purpose of chemotherapy is that it goes everywhere in the body and that it can attack a cell wherever it happens to be.

Narrator: Women with hormone receptor-positive breast cancer may be given oral medications called “hormonal therapy.”

Kathie Ann Joseph: And they basically function by blocking the hormone, and by blocking the hormone we are basically blocking off the hormones that these cancers feed off of.

Narrator: Targeted therapies use medications directed at certain genes that cause cancer.

Lisa Newman: Targeted therapy refers to treatments that focus on killing certain markers, or certain components, certain parts of cancer cells.

Narrator: For example, some targeted therapy medications are only for HER2-positive breast cancer. They may be used along with chemotherapy.

With any treatment plan, it’s very important to follow the doctor’s instructions. This includes going to all appointments, getting tests, and continuing to take medications as the doctor directs – including medications to help manage side effects.

Reverend Janet experienced several of the typical side effects of chemotherapy. Nausea. Fatigue. The temporary loss of her hair. But now all that is in the past; she recently passed an important milestone. Cancer free for five years.

Reverend Janet: I would not have thought in my mind that a number, five, would make a difference in my mindset or in my thought process. But it really did//(1:50:00 - :20) it’s like I’ve been living all along, but now, it’s like now I’m alive-alive. And it’s really hard to explain but it’s like, hey, wow – that wasn’t so bad.

Narrator: Following their surgery, women are often given cancer-fighting drugs to help reduce the chance of the cancer coming back – what is called recurrence. And they are seen by their doctor regularly for many years after their diagnosis.

Kathie Ann Joseph: I can’t emphasize enough that patients once they’ve completed treatment, keep up with their doctors’ appointments, keep up with their mammogram appointments and continue taking their medications.

Phillipa Woodriffe: There is always the likelihood of a possible recurrence, or another tumor at another place.

Narrator: That’s an important point. While most cancer survivors don’t have a recurrence in the same location, they are at higher risk for getting breast cancer again. When Esther first discovered she had breast cancer – she found it herself.

Esther: I was taking a shower, and I noticed, and felt a lump in my right breast. And I went to the doctor, and with all the tests and everything that was done – I was diagnosed with cancer.

Narrator: Esther had a lumpectomy, and went back to her job as a nurse. But her battle with cancer wasn’t over yet.

Esther: I was getting the follow up mammograms, and then I believe two years later I had a mammography, and they called me back that afternoon and told me they founds something suspicious in my left breast. I was thinking when I got the second diagnosis – how could this happen to me again?

Kathie Ann Joseph: I think when patients are told they have cancer again, it can be devastating, and many patients just feel like it’s their fate, and this is their destiny and that they have to accept it and there’s nothing more they can do about it. We sort of have to work with them and get them to sort of move past so they can get, get into treatment.

Narrator: The second time around – Esther and her doctor decided to be more aggressive. She chose to have a double, or bilateral, mastectomy, and went on to have both breasts reconstructed.

Esther: And now I’m to the point where I’ve got the nipples put in, and I also had the tattooing around the areoles.

Narrator: Esther’s story is an example of how breast cancer survivors need to continue their commitment to good health.

Kathie Ann Joseph: It may be a, a little bit of a relief once you’re done with all your chemo therapy and all your other therapies you sort of wanna forget that this all happened, and you may not want to keep up with your doctors or, you know keep up with your appointments. But it’s really important to keep up with them, because if God forbid something were to happen again, you really want to catch it early.

Narrator: Ask your doctor how often you should have follow up visits and mammograms. After a certain amount of time, survivors return to the normal, yearly mammogram. For all of us - regular checkups are part of a healthy lifestyle.

Lisa Newman: The lifestyle choices that are important to reduce the chances of getting breast cancer, or to be successfully treated for breast cancer as well, are the same lifestyle choices that we should make to protect ourselves from heart disease and lung disease.

Phillipa Woodriffe: Exercising on a regular basis, keeping our weight within a normal range, definitely not smoking or using alcohol products to an excess, are definitely things that we can do on a daily basis to decrease our likelihood of getting breast cancer again.

Narrator: To fight breast cancer – and other diseases – making healthy choices is a way to celebrate life! Reverend Janet and her friend Renee get together often for a healthy meal together. Renee is a survivor, too.

Renee: The main thing I focus on, myself is trying to reduce my stress level and eat better, which of course is a challenge for all of us, exercise, all the things that we know we’re supposed to do to stay healthy. But sort of, when you are healthy you take those things for granted.

Narrator: Whether you are one month beyond breast cancer – or ten years, taking care of your overall health is the way to feel your best.

Your health care professional can help you determine what kind of diet and exercise program would be best for you. Not only because fitness feels good - striving for a healthy weight can be an important part of preventing cancer – and other diseases as well.

Karen: And how about nutrition – watch my diet?

Dr. Joseph: Yeah absolutely.

Kathie Ann Joseph Being overweight is not a good thing and it’s not a good thing for breast cancer. Reducing your weight will decrease your risk for developing breast cancer as well as for breast cancer survivors decreasing your chances of developing breast cancer again.

Narrator: The American Cancer Society recommends you…

  • choose foods in amounts that help achieve and maintain a healthy weight.
  • eat five or more servings of vegetables and fruits each day.
  • choose whole grains over processed grains.
  • limit processed meats and red meats…and
  • limit alcohol to one drink a day or less.

Lynn Whitfield: Everything in moderation, and trying to be consistent. We all know the good things to do!

Narrator: These healthy lifestyle choices may also help with menopause symptoms. That’s important, because women who have had breast cancer are advised not to have hormone replacement therapy.

Talk to your healthcare professional about managing menopause symptoms and protecting your bones, without HRT.

But keep in mind as you get older – you’re never too old to be tested for breast cancer.

Kathie Ann Joseph: I often get asked is there an age at which you should stop getting a mammogram. No, there’s no age at which you stop getting a mammogram. Because there’s no age at which you, a woman, can stop getting breast cancer so it’s always good to get a mammogram.

Narrator: During and after breast cancer, tending to your emotional well being can make a big difference in how you feel. For Esther, support has come from family ... friends, co-workers and church brothers and sisters.

Esther: I can say, I am too blessed to be stressed.

Narrator: Reverend Janet relies not only on faith and family – but on her friendship with her fellow survivor, Renee.

Narrator: Continuing connections in the community can also help carry you through. Linelle drew strength from her music – and the choir. Just as another member of the group drew strength from her place of worship.

Esther: I had a very good support group around me at my home church. And they prayed the fear away, as well as prayed for me, and as a result I believe my inner spirit helped me to heal faster, and helped me to cope with what was going on at the time.

Narrator: When Lynn Whitfield’s mother was making the hard choices, they stayed in touch by phone. And drew other family members into the process.

Lynn Whitfield: It’s a scary thing, and there’s lots of information, and there’s a period of time where people aren’t able to do as much for themselves, and I think it’s really important that everybody understand what it’s like after these surgeries, what radiation does, what chemotherapy does. In our case, we have family and so my mother has sisters and they were very, very supportive.

Narrator: We cannot all be surrounded by family and friends. But every woman touched by cancer – has places to turn. Support groups are available in almost every community. To find one, ask your health care professional, or contact the American Cancer Society.

There’s also help online and on the phone.

Phillipa Woodriffe: For example, the American Cancer Society has a program called “Reach for Recovery,” where a woman is paired with someone who has been diagnosed in the past, and is doing well, for her to help her through these emotional times.

Narrator: So reach out for information – from sources you can trust.

Lisa Newman: Women should be cautious about the information that’s available on the internet, however looking at the established programs such as the American Cancer Society, the National Cancer Institute, the Sisters Network, Komen for the Cure, these are the reputable websites. And also, many cancer centers will have their own websites which offer information pertinent to that specific cancer center.

Narrator: Taking charge of breast cancer means being an advocate. For yourself – and your loved ones.

Lynn Whitfield: Get all of the information. Do not allow anyone to insult your intelligence, don’t be afraid to ask every question, and don’t be afraid to ask ten times if you don’t understand it.

Narrator: Breast cancer. We all fear it. But we cannot let our fear paralyze us. Because effective treatment is available. Especially with early detection. So be aware of your risk. Get your mammogram every year, and if you’re diagnosed with breast cancer, follow the doctor’s guidance. You can take charge of breast cancer!

Lynn Whitfield: And I just encourage people to remember, you know, that it’s not just about you and not wanting to do it. Not wanting to have your checkups and not wanting to get this – but it’s about everybody else who loves you and everybody else who needs you.