Breast Cancer Survival Improves with Self-Exam
By Doug Boyd
Breast cancer patients in eastern North Carolina frequently find their tumors themselves, and those tumors, often discovered later than they would be through mammograms, are larger and more difficult to treat, according to studies at East Carolina University.
A team led by Dr. Andrea Rosenberg, a resident physician at the Brody School of Medicine at ECU, analyzed the medical records of more than 1,500 women diagnosed with breast cancer at ECU between 1999 and 2004 and found that 12 percent of them had tumors at least 5 centimeters in diameter. One-fifth of black women had tumors that size, compared to less than 9 percent of white women. Those lacking health insurance or on Medicaid were also more likely to have larger tumors.
A tumor 5 centimeters or more in diameter would be at least a stage 2 cancer, Rosenberg said. Cancer is classified in four stages, and stage 2 cancer is advanced and may affect lymph nodes but has not yet spread to other parts of the body. Rosenberg added that catching a cancer before stage 3 can make a significant difference in treatment and quality of life for patients.
The five-year breast cancer survival rate ranges from 98 percent for stage 1 cancers to approximately 16 percent for stage 4 cancers, according to Rosenberg. Therefore, a patient is more likely to be cured or have prolonged survival if she presents with a smaller tumor.
Rosenberg also said her research points to a need for a better understanding of the cultural explanations for why larger tumors are more often found among black women than white women.
In a separate study, Rosenberg found that three-quarters of breast cancers were discovered by women examining themselves. That figure included women who had regular mammography.
Breast cancer survival is improved by early diagnosis. Some experts have questioned the usefulness of self-exam, saying it leads to unnecessary diagnostic procedures without improving survival. Rosenberg said community-based education needs to be provided to all women on how to perform a breast self-exam to help them identify tumors sooner and improve survival rates. “These findings suggest that self-examination remains an important method of breast cancer identification,” Rosenberg said. Self-exams are easily taught by primary care physicians, she added.
She surveyed patients who had been diagnosed with breast cancer and were attending the Leo W. Jenkins Cancer Center for care. Rosenberg found that breast cancers were first identified by the patients themselves in 75 percent of cases. Cancer was first identified by mammogram in 16 percent of cases, by provider in 9 percent and by the spouse in 2 percent. The women surveyed crossed all demographic, educational and income levels.
While women discovered most cancers themselves, those discovered by mammogram were identified earlier and thus were more likely to be successfully treated.
Breast cancer is the second leading cause of cancer death in women after lung cancer, according to the Centers for Disease Control and Prevention. Although African-American women have a slightly lower incidence of breast cancer after age 40 than white women, they have a slightly higher incidence rate of breast cancer before age 40. However, black women are more likely to die from breast cancer at every age. The rate of breast cancer among women in North Carolina is approximately 110 to 119 cases for every 100,000 women.
Other researchers were Drs. Lillian Burke and Darla Liles of the Department of Internal Medicine at the Brody School of Medicine; Dr. Paul Vos, chairman and professor of biostatistics in the ECU School of Allied Health Sciences; Merrill Brinson of Pitt County Memorial Hospital; and Kendral Knight, now an internal medicine resident at the University of Washington.