"...How we can prevent cancer, what to do if we have breast cancer and how we live our lives after breast cancer." was the focus of Dr. Runowicz's hour-long presentation.

She reviewed statistics on the incidence of breast cancer; risk factors; rationale and technique of Breast Self Examination (BSE); and guidelines for mammography screening.

The commonly cited "one in eight" statistic is a lifetime risk for all women. Thus, at any given age, the risks are somewhat lower. For example, at age 45, one in 93 women will develop breast cancer.

Breast cancer is the second leading cause of death for all women, with 18% of breast cancer cases in women in their 40’s. Risk factors include age (postmenopausal women are at greater risk), personal history of breast cancer, women who have no children or delayed childbearing, early menarche, late menopause, family history of breast cancer, a biopsy revealing hyperplasia, higher socioeconomic status, obesity in post menopause, colon, uterine, or ovarian cancer, heavy alcohol use, and prolonged use of estrogen. Despite these many risks and daunting statistics, early detection significantly improves the prognosis.

Breast self-exam is still the most common method of early detection. Seventy percent of masses are discovered by women, themselves, with 8 out of ten masses found to be benign. For proper breast self-exam technique, women should first examine themselves in the mirror by raising arms behind her head and looking for retraction of the skin, followed by clockwise examination of the entire breast, around the nipple, and under the armpits. Regular (monthly) breast self exam should begin as soon as a girl gets her period. Current mammography guidelines are: annually after age 50, and every 1-2 years between ages 40-50.

Dr. Runowicz suggested that the reasons women often do not follow recommendations are related to cost, fear of radiation and pain, misconceptions of risk on the part of the woman as well as the health care provider. She emphasized that the average size lump found by someone doing regular BSE and having mammographies is smaller than that of women not following these recommended practices. Breast cancer survival rates calculated by stage at diagnosis are higher the earlier the cancer is detected.

Dr. Runowicz enumerated the types of treatment (and rationales) currently available: breast preservation is possible with early stage breast cancer including resection of primary tumor, axillary node dissection, and radiation therapy; modified radical mastectomy, total (simple) mastectomy; and adjuvant therapy (therapy with no current disease present to prevent tumor recurrence) with Tamoxifen or chemotherapy. The use of Tamoxifen has decreased the incidence of tumors in the contralateral breast and acts as an antagonist to estrogen. The usual dosage of Tamoxifen is 10 mg. twice a day, and side effects include hot flashes, nausea, swelling, vaginitis, and depression.

Dr. Runowicz shared her personal experience of dealing with breast cancer in her forties: the "loss of innocence"-facing mortality; difficulties getting life insurance; facing job discrimination; dealing with issues of fertility and genetics; the emotional "roller coaster;" and many physical changes.

She described the "cancer survivor syndrome" as portraying normal feelings such as fatigue, depression and anxiety. In addition, the physical changes that may also be present are scars, bowel problems, early menopause, swelling and difficulties with sexual intercourse and libido. As many women experience, the first anniversary of her diagnosis was very significant and although she is usually a very positive person she found it very depressing. She noted the common experience at the end of treatment of feeling cut off from the enormous amount of attention received from health care providers during treatment and not knowing how to go back to "normal life". Trying to get back on track with her life was the biggest incentive for writing her book To Be Alive.

In discussing hormone replacement therapy (HRT) following breast cancer, Dr. Runowicz expanded on her belief that the risks outweigh the benefits. She stated that: "Experimental studies do not support its safety, epidemiological data do not support its safety, and there have been no prospective trials to study its safety. Issues regarding tumor reactivation, contralateral breast cancer, and related cancers resulting from HRT have not been resolved".

Benefits of hormone replacement therapy for all postmenopausal women include a decreased incidence of cardiovascular disease (CVD) by 35%, decreased incidence of osteoporosis, and a lessening of menopausal symptoms. The risks and contraindications, however, are slight increases in endometrial cancer (2-8 times increased risk), breast cancer (relative risk is 1.3-1.5, that is, 3-5 additional cancers per 100,000 women related to estrogen use), and liver disease. While studies suggest no increased breast cancer risk for women who use HRT for less than 8 years, studies of longer term use suggest this slightly elevated risk. The American College of Physicians and the American College of Obstetricians and Gynecologists suggest that HRT should be considered as one option, but used after individual assessment of risk factors and potential benefits.

Dr. Runowicz pointed out that there are preventive measures other than HRT that can be undertaken for cardiovascular disease and osteoporosis, while there are not similar preventive measures for breast cancer. Thus, she feels, the benefits of HRT must be determined individually for each woman based on her family history, lifestyle, and other risk factors. For breast cancer survivors, however, she feels that the risks outweigh the benefits. Alternatives to HRT for CVD risk reduction include smoking cessation, lowering LDL and raising HDL through diet, treating mild to moderate high blood pressure, use of tamoxifen (which decreases LDLs and likelihood of myocardial infarctions). Alternatives for osteoporosis are weight bearing exercise, calcium supplements of 1500 mg/per day or more, medications including fosamax, calcitonen, and in the future, possibly, tamoxifen. For hot flashes, alternatives to HRT include exercise, and some medications such as bellergal, and clonidine. Anecdotally, some women have reported improvement using vitamin E. For vaginal atrophy and dryness, there are lots of preparations and lubricants including aci-jel, replens, and astroglide. Dr. Runowisz stated that she does not use hormone replacement therapy, but uses the alternative treatments of exercise, nutrition, weight control, calcium supplements, and topical therapies to deal with menopausal symptoms.

Dr. Runowicz’ upbeat presentation provided women with the tools for better prognosis through earlier detection of breast cancer and for improving the quality of life for breast cancer survivors.

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First Created: September 18,1997
Last Updated: September 18,1997