Higher education may contribute to breast cancer risk

By Cara Miller

Arizona Daily Wildcat

Approximately 1.09 million women in the United States are alive with a history of breast cancer. Five years ago, Cheryl Ritenbaugh became a part of history.

At the age of 42, Ritenbaugh, an associate professor of family and community medicine, was diagnosed with breast cancer.

"I noticed that my breast had changed," she said. "It was not a discreet lump, but a thickening."

She said after examining the results of a sonogram, her physician could tell the lump was something abnormal. But going into the initial surgery, neither Ritenbaugh nor her physician thought it was cancer.

After an initial lumpectomy, the physician found it was cancerous and Ritenbaugh underwent a second surgery that removed the upper outer-quarter of her breast.

"It never occurred to me that it might be cancer," she said. "I have no cancer in my family and no official risk factors."

Although 75 percent of all cancers occur in women over 50, every woman is at risk for breast cancer, regardless of her age, family history or current health.

"I was probably more oblivious to it than I should have been because I didn't have the risk factor," she said. "At that point there was not a lot of publicity that one in nine people would get it."

One in 12 women will get cancer even if they do not have risk factors. Only about 10 percent of cancer patients have a familial pattern, Ritenbaugh said. Women who fall into the high risk category are at higher risk, but across the country, the most prominent numbers are sporadic cases.

The American Cancer Society considers women with a family history of breast cancer as high risk


patients. Women who have never had children or have had their first child after age 30 are also at risk.

Recent studies have also shown that women with a higher education and socioeconomic status are at a higher risk, Ritenbaugh said.

Ritenbaugh supported this idea in a survey conducted last year among the women faculty at the University of Arizona. To determine the prevalance of breast cancer among facutly women, 612 surveys were sent out.

Seventy percent of the surveys were returned and the results were determined assuming that everyone who had breast cancer responded, Ritenbaugh said.

"Assuming we had found all the cases and those who did not respond did not have breast cancer, the women have 2.0 times the national average of breast cancer risk at every age," she said.

In an attempt to broaden the spectrum, a new survey has been released to 950 staff members. The survey that is currently out is designed to determine if the risk is related to being in Tucson or being at the UA.

"The women faculty that we surveyed were mostly master's or PhD's," Ritenbaugh said. "That's pretty specific."

The staff has already received 100 surveys and is hoping that more are returned so it can determine if the risk is indeed occupational or educationally related.

According to recent statistics, approximately 182,000 new breast cancer cases nationally will be diagnosed. In Arizona, an estimated 2,500 new cases will be detected. And out of existing cases, approximately 600 patients will die this year.

Dr. Charles Taylor, a breast cancer medical oncologist, said early detection is the best way to improve the outcome.

He stressed that it is important for any age group to perform monthly self-examinations.

"It has been shown to be a benefit," he said. "And it takes a minimal amount of instruction to get used to the feel of your breast."

Taylor said there are four stages of breast cancer.

"Once a patient reaches stage four of the disease, there is a zero chance of cure. But if it is caught in the first stage, there is a 90 percent cure rate," he said.

Diana Sheldon, executive director of Southern Arizona American Cancer Society, agreed.

"The main focus for people that are younger is to practice good breast health," Sheldon said. "Monthly breast exams are the simplest thing. Know your own body and you can detect the changes immediately."

Sheldon recommended monthly breast self-examinations for those over 20 years old. For those 20 to 40 years old, she suggested having a clinical breast exam every three years and annually after age 40.

When performing the breast self-examination, Sheldon said to look for breast changes that are persistent, such as a lump, thickening, swelling, dimpling and pain.

If patients are diagnosed with breast cancer they basically have two choices: a mastectomy or a lumpectomy coupled with radiation.

Ritenbaugh opted for the lumpectomy.

"My tumor occurred right before the definitive study of radiation was published," she said. "The controversy was swirling around while I was receiving treatment."

She was told that chemotherapy treatment would only provide a 20 percent outcome improvement because her outcome already looked good.

"But I felt like anything was worth doing," she said. "Twenty percent looked to me like a help."

Ritenbaugh said while most patients focused on a two- to three- year success rate, her medical knowledge caused her to look at the 10-year reoccurrence rates.

"I really looked into the long term picture," she said.

Taylor agreed that most people believe that if it hasn't reoccurred in five years then it will not reoccur.

"The longer you go without the disease coming back, the less likely it is to come back," he said. "But it is not true that it won't come back in 10 to 15 years."

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