Please Join the Before Forty Initiative & Help Us Save the Lives of Young Women Around the World
We walk for the cure. We ride for the cure. We eat yogurt for the cure. We wear jeans for the cure. But there is no cure, yet.
There are millions of breast cancer survivors thriving today. Many of the them were fortunate enough to have caught their cancer early while it is still in the treatable stage. However, many do not. These women battle their cancer every single day because their cancer was found too late. Of these women, a large proportion are young women, especially African American and Hispanic women.
These women often get diagnosed with the more aggressive, harder to treat form of breast cancer known as Triple Negative disease. This name refers to the fact that the cancer was not fueled by estrogen, progesterone nor does it carry the Her2Nue oncogene.
The American Cancer Society recommends that women get their FIRST mammogram, or baseline mammogram, at the age of forty. Insurance carriers use this standard to deny coverage for a younger woman who wants to get screened earlier than that.
The No Surrender Breast Cancer Foundation is asking you to help us help women who have never been screened for breast cancer. We want the guidelines to be changed. Women should get their baseline no later than their 35th birthday. Women of high risk categories, African American women, Hispanic women, women of Ashkenazi heritage, women with a family history of breast cancer, should get their first baseline at age 30. Studies prove that MRIs are superior to mammography in finding cancer when it is at its smallest, in younger women. Young women need breast MRIs for their baseline screening test.
The NSBCF wants insurance companies to stop denying coverage due to age, density of breast or insufficient medical reason for a proper screening before the age of forty.
- Increase awareness to young women about the risk of breast cancer. Inform them of the better prognosis and treatment options if their cancer is found early.
- Make the age of 35 be the standard for baseline screening. Make the age of 30 the standard for high risk groups.
- Get insurance companies to cover baseline MRIs and subsequent follow-up diagnostic tests if warranted.
- Increase awareness for African American and Hispanic women about Triple Negative Breast Cancer. Educate young women that African American and Hispanic women are at a higher risk of TNBC and have a poorer prognosis. The only way they can beat the disease, should they get it, is if it is found early.
Ferne Dixon and Gina Maisano
A Promise Kept... meet Ferne
Ferne Dixon was a beautiful, caring, talented printer who put off getting her first mammogram until she was 41, when she was diagnosed. But she had to fight to get it. She had no family history and as she said, “I wasn't taken seriously when I found my lump. I believe if the medical professionals I initially went to see would have taken me a bit more seriously and stopped prescribing antibiotics, telling me the lump was benign and I was too young to have breast cancer without even giving me mammogram or ultrasound, maybe it might have been caught before it went to the nodes.”
Ferne did aggressive chemotherapy, radiation and had a lumpectomy. Four months after she finished her radiation treatments she discovered her cancer had returned to her lungs which then spread to her liver and finally her brain.
Ferne’s tumor was Triple Negative. It had grown and spread to her lymph nodes.
If she had been screened before her 41st birthday, the likelihood that her tumor would have been found before it had a chance to become uncontrollable is high. She would have had a fighting chance against her Triple Negative Breast Cancer.
Ferne admitted that she didn’t think about mammograms or their importance before her diagnosis, “I just turned 41 when I found my lump, so was pretty on time in getting the mammogram. Although if I didn't have a lump, I probably would have waited to get one.”
This illustrates the battle that is being fought every day and young women, especially African American women, are paying for it with their lives. They don’t get screened early enough. When something is found a young woman is not taken seriously. The medical community needs to acknowledge this disparity.
Ferne was Gina Maisano’s best friend. Gina is the founder of the No Surrender Breast Cancer Foundation. She had also been diagnosed with a very aggressive Triple Negative tumor. The only difference was she had a baseline mammogram at age 35 and had yearly check-ups after that. When she was 39 a shadow was seen on one of her breasts. It was her tumor. It had the same features as Ferne’s. But because Gina’s was found earlier, she was able to fight the TNBC.
We do not want this story to repeat itself. Everyone should have a fighting chance.
We don’t have a cure yet for breast cancer. But we do have one weapon: Early Detection.
About a month before Ferne left this earth she said to Gina,
“I know I won’t ever fall in love or get married or have a baby. But I am really trying to fight this thing and I feel I have been blessed that I have survived as long as I have.”
Every woman should have a chance to fall in love and get married and have a child. Don’t let cancer rob another young woman of that chance.
Please Help Us Spread the Word. Please Take the Pledge and become an advocate for those who do not even know they have cancer yet. You can make a difference - right now.
We need your voices to tell your friends and neighbors about the importance of early diagnosis.
We need your support to change the national guidelines; make insurance carriers cover early screening; and educate young women, Hispanic and African American women about how this simple step may save their lives.
Our educational programs are active in local community groups, churches and college campuses.
The No Surrender Breast Cancer Foundation's Before Forty Initiative has been working tirelessly on informing young, African-American women about their increased risk of developing the more aggressive type of breast cancer known as Triple Negative Breast Cancer. Not only do we advocate baseline screening should begin BEFORE the age of forty, a new study has shed light on another way to fight this disease from striking African-American women.
The study appeared here
African-American women who do not breastfeed their babies face a higher risk of getting an aggressive form of breast cancer than their counterparts who nurse, said a US study on Tuesday.
The analysis found that women who had two or more children faced a 50 percent increased risk of hormone receptor-negative breast cancer, one of the toughest kinds to treat.
But this higher risk was only present in women who did not breastfeed their children.
"African-American women are more likely to have had a greater number of full-term births and less likely to have breast-fed their babies," said Julie Palmer, professor of epidemiology at the Slone Epidemiology Center at Boston University.
"This study shows a clear link between that and hormone receptor-negative breast cancer."
Data for the research, published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, came from the Black Women's Health Study which has followed 59,000 women since 1995.
From 1995 to 2009, researchers found 457 cases of hormone receptor-positive breast cancer and 318 cases of hormone receptor-negative breast cancer among study participants.
Among those diagnosed with hormone receptor positive breast cancer, which also tends to occur more frequently in white women, there was no link to the number of children a woman had and whether or not she breastfed.
"Our results, taken together with recent results from studies of triple negative and basal-like breast cancer, suggest that breastfeeding can reduce risk of developing the aggressive, difficult-to-treat breast cancers that disproportionately affect African-American women," Palmer said.
According to the Centers for Disease Control and Prevention, about 35 percent of white women in the United States are breastfeeding their babies at six months of age compared to 20 percent of black women.
Breast cancer is expected to kill nearly 40,000 people (39,520 women, 450 men) this year in the United States, according to the National Cancer Institute. It is the second leading killer among women after lung cancer.
The No Surrender Take Home Message? Not only should screening begin at age 35 (or 30 for high risk women) but if you are a young, African-American mom, try to breast feed your baby for as long as possible.
New Study Proves Why Before Forty Initiative is so Vital!
We have been working on spreading the word about The Before Forty Initiative. Read this new study and understand how important this work is:
A new study finds that African ancestry is linked to a more aggressive type of cancer called "triple negative."
Harry Jackson Jr.
July 23, 2010
A new study finds that African ancestry is linked to a more aggressive type of cancer that is more deadly.
Researchers at the University of Michigan Comprehensive Cancer Center in Ann Arbor found that, among women with breast cancer, 82 percent of African women had the breast cancer called "triple negative," 26 percent of African-Americans had the variety, and 16 percent of white Americans had it. In technical terms: Triple negative breast cancer is negative for three markers used to determine treatment: the estrogen receptor, the progesterone receptor and HER-2/neu.
Recent advances in breast cancer treatments target each of the receptors, but targeting all three is a major problem, said Dr. Lisa A. Newman, director of the Breast Care Center at the University of Michigan Comprehensive Cancer Center. "Outcome disparities are therefore likely to increase, because fewer African-American women are candidates for these newer treatments," she said.
These results and results from prior studies indicate a genetic link for the form of breast cancer a woman might develop. Prior studies have shown that while African-American women are less likely than white women to develop breast cancer, those who are diagnosed are usually younger and more likely to die from the disease.
Other studies have shown a hereditary breast cancer risk associated with racial-ethnic identity - most commonly among Ashkenazi Jewish women. Researchers looked at African-American women and white women diagnosed with breast cancer at the Henry Ford Health System in Detroit.
Researchers also looked at African women diagnosed at the Komfo Anokye Teaching Hospital in Ghana. Ghanaian women were diagnosed at a younger age than American women, with larger tumors, had more advanced cancer and were more likely to have the triple negative test results.
Researchers said the recent findings may help science find women predisposed to more aggressive and deadly cancers. The study is in the online journal "Cancer."
Breast cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year and 40,610 will die from the disease, according to the American Cancer Society.
WHY WE NEED YOUR SUPPORT
There is now proof that the US Task Force has done damage. This group of people announced in the fall that women under 50 years of age do not need mammograms. The No Surrender Breast Cancer Foundation is vehemently against this decision and has made our opinion known.
Our Before Forty Initiative is working hard to get the word out to all women that Early Detection is your BEST defense. If you want the highest chance of beating cancer: find it while it is still small. That is why we are educating women about the importance of baseline screenings BEFORE the age of Forty and follow-up care that involves not only mammography, but ultra sound and breast MRI.
We need your help to help us save the lives of women.
Please see our BEFORE FORTY INITIATIVE HERE.
Please DONATE to our foundation to help us. We need funding.
Read today's news, and you will find more proof why it is our duty to protect the women who come after us.
Mammogram screening down 13 percent since 'flawed' recommendations
By Aimee Heckel Camera Staff Writer
Posted: 06/23/2010 09:14:36 AM MDT
Read more: Mammogram screening down 13 percent since 'flawed' recommendations - Boulder Daily Camera http://www.dailycamera.com/lifestyles/ci_15351198#ixzz0ri8xRW5J
Terry Stiven, of Lafayette, almost didn't get the test.
She had no family history of breast cancer. She'd had mammograms in the past, and she had no signs of cancer.
Then, this fall, the United States Preventative Service Task Force released new recommendations: Women between 40 and 49 years old don't need mammograms. The benefits of testing don't outweigh the risks, the task force said.
Now, it seemed there was no reason to get the 10-minute, slightly uncomfortable screening. In February, Stiven, 46, went ahead and got tested anyway, expecting nothing.
She had cancer.
Not invasive breast cancer, though. Doctors removed the lump, and she had four weeks of radiation. The experience was frightening, but not damaging.
Today -- just four months later -- Stiven is cancer-free, with extremely low chances of it returning. She still has both breasts, she runs triathlons and her life expectancy has not been shortened.
"If I'd waited four years, I don't know if I would have been alive," she says.
Stiven is one reason of many that local doctors have launched an aggressive campaign to counter the U.S. Preventative Task Force's advisory.
"Getting a mammogram is one of the most important things a woman can do to live a long, healthy life," says David Oppenheimer, the chief physician of the mammography department of the Boulder Community Hospital.
And he's not just talking about women older than 50.
One third of women diagnosed with breast cancer in Boulder County are between 40 and 49 years old, according to the Boulder Community Hospital. More than 40 percent are younger than 50 -- the task force's "arbitrary" age cut-off, Oppenheimer says.
Since the task force's recommendation, the hospital's imaging department reports a 13 percent decline in mammograms -- the majority among women in their 40s and 50s.
Nanna Bo Christensen, the Boulder Community Hospital's Breast Health Navigator, attributes this drop at least in part to the national recommendation.
Other women may be afraid they can't afford it -- even though it is illegal in Colorado for insurance companies not to cover screenings for women age 40 and older. The Women's Wellness Connection offers financial support for women who need it, too, says Christensen.
"Mammography saves lives," she says. "The key to survival is early detecting."
In fact, the younger the woman, the faster the breast cancer grows, doctors say, due to higher levels of estrogen, which feeds the cancer cells.
And if you find cancer before it spreads to the lymph nodes, Oppenheimer says, doctors have a 97 percent chance of curing it. Once it hits the lymphs, the cure rate plunges.
The number of women who die from breast cancer is down since 1990, and experts say that's primarily due to increases in the number of women being screened.
So why would a government panel recommend against something that statistics show helps save lives?
The task force looked at false-positive tests and the related anxiety, unnecessary biopsies and exposure to radiation.
Oppenheimer asserts data used for the recommendation was scientifically flawed, and that the task force left out several important studies to skew the numbers in favor of its recommendation. As to the radiation question, he says about 1 in 3 million mammograms actually causes cancer.
"However, we know that one in eight women are going to get breast cancer in their lives, so the advantages far outweigh the tiny risk," he says.
Mammograms detect cancer 90 percent of the time, the hospital says, making them the most effective screening tool.
A slew of organizations have since denounced the recommendation, including the National Cancer Institute, the American Cancer Society, the Susan G. Komen Breast Cancer Foundation, Avon Foundation, the Obama Administration, American College of Radiology, American Society of Breast Imaging, American College of Obstetricians and Gynecologists.
"Now we as physicians and a health care community have a huge job on our hands to re-educate the community," Oppenheimer says. "Once people stop getting tested, it's a huge effort to convince people to start again."
The U.S. task force also said women older than 50 only need to get a mammogram every two years instead of annually.
When Jill Kamon, of Boulder, heard that, she says she was horrified.
Kamon was diagnosed at age 51 with breast cancer. If she had followed the recommendations, she would have skipped the mammogram that found the small lump in the back of her breast. The cancer would have had a year to grow before her next mammogram. She couldn't feel it with a self-exam.
"To me, the mammogram and radiologist who read the mammogram completely saved my life. There is no question," says Kamon, who had a double mastectomy in the summer of 2007. The lump was only 6 millimeters big, but it was growing aggressively.
"I'd had a mammogram exactly one year earlier that was clear," she says. "That dot was not there."
By the numbers:
13 percent -- Decrease in mammograms at the Boulder Community Hospital since the U.S.
Preventative Service Task Force recommendation in the fall. The majority of these women are in their 40s and 50s.
30 percent -- Decrease in breast cancer's death rate since 1990, nationally.
42 percent -- Of women diagnosed with breast cancer at the Boulder Community Hospital were younger than 50; 32 percent were in their 40s.
More than 30 percent -- Decreased death rate, due to mammography screenings for women in their 40s.
One in eight -- American women are affected by breast cancer.
97 percent -- Chance of curing breast cancer if it's caught before spreading to the lymph nodes.
About 1 in 3 million -- Chance of the radiation from a mammogram causing breast cancer.
Sources: Boulder Community Hospital, Susan G. Komen for the Cure.
Swedish Study Proves Early, Regular Screening Saves Lives in not only TNBC but in ER+ Cancers
Mammograms Reduce Breast Cancer Deaths, Period -- Swedish Study Finds
By COURTNEY HUTCHISON, ABC News Medical Unit
June 28, 2011
Mammograms save lives, period, end of story. But it takes decades to appreciate just how many.
That's the takeaway from the longest-running mammogram study -- which followed more than 100,000 Swedish women for 29 years -- that many doctors believe will put the recent ruckus over the frequency of breast cancer screening to bed.
The researchers found that seven years of mammograms made for 30 percent fewer breast cancer deaths years down the road, when compared with women who didn't receive mammograms.
"I think this study indicates the absolute benefit of screening in terms of breast cancer deaths prevented," says Stephen Duffy, a professor of cancer screening at Queen Mary, University of London, and lead author of the study.
While the American Cancer Society had long recommended that women over the age of 40 receive yearly mammograms, the U.S. Preventive Services Task Force challenged this recommendation in 2009, calling into question whether the number of lives saved were worth the cost of such regular mammograms and the increased possibility of false positives. In light of the possible adverse effects of yearly screening, the Task Force recommended that women get screened every other year starting at age 50, and stop mammogram screening altogether after age 75.
But the Swedish study, published Tuesday in the Journal Radiology, suggests that when women are followed over the course of decades (in this case 29 years) instead of the seven or so years that many past studies have looked at, mammograms may save many more lives.
Among the 133,065 women studied, one breast cancer death was prevented for every 414 to 519 women screened.
"The longer follow-up period, three decades, is crucial. It is important to have this length of time to allow the benefits of screening to become apparent," says Dr. Laurie Margolies, chief of breast imaging at Mount Sinai Medical Center in New York, who was not involved in the Swedish study.
This long-term view is important, in part because certain types of breast cancer can take decades to become lethal, says Dr. Richard Ellis, co-director of the Norma J. Vinger Center for Breast Care in Wisconsin.
"A less aggressive, slow-growing cancer could take 15 to 25 years before it spreads to a vital organ, resulting in a breast cancer death," he says. "Thus, a shorter-term follow-up study will likely account only for breast cancer deaths due to the more aggressive cancers. … That is why studies with shorter follow-up … understate the true value of screening mammography."
The Swedish Study and Mammogram Debate
The recent study looked at more than 100,000 women in two counties in Sweden. Beginning in 1977, researchers randomly assigned half the women to receive seven years of regular medical care that did not include mammograms, and the other half to receive regular mammograms -- every two years for those age 40 to 49 and every three years for those age 50 to 74.
When the seven-year trial ended, the researchers followed up with the women for 22 more years. After seven years, all the women were offered mammograms, but only those cancers detected during those first seven years were included in the study's results.
The researchers found that the preventive effect of mammograms became more apparent as the years went by: 10 years after the study began, 71 lives had been saved because of the screenings; 29 years later, 158 lives had been saved, study leader Duffy says.
The Value of Regular Screening
Critics of frequent mammograms have generally focused on the relatively few lives saved per thousands of screenings.
According to a 2009 analysis published in the Cochrane Collection, an international health care network, one in 2,000 women will have her life prolonged by 10 years because of a mammogram, but another 10 healthy women will undergo unnecessary breast cancer treatment, and 200 women will endure significant psychological stress because of a false positive result -- they'll be erroneously told they have breast cancer when they don't.
The researchers who studied the Swedish women challenge such findings, suggesting that it takes nearly half as many mammograms to save a life, perhaps fewer if mammograms were given continually throughout middle and old age -- a rate of prevention that study leader Duffy and other breast cancer experts argue makes screenings worth the risk of possible adverse effects from radiation and false positives.
For every 1,000 to 1,500 mammograms given in this study, one breast cancer death was prevented, and if the initial screening period had lasted 10 years instead of seven, only 300 screenings would have been needed to save one life, the researchers reported.
And this was found in a population that received mammograms half as frequently as the American Cancer Society currently recommends for women in the U.S. If the Swedish women had been screened every year instead, there would have been a more "dramatic" reduction in the number of breast cancer deaths, says Dr. Peter Jokich, head of the mammography Center at Rush University Medical Center in Chicago.
Overall, breast cancer experts believe this study out of Sweden supports the message they've been sending all along: Regular mammograms save lives. Period.
Breast Cancer Screening: MRI Sensitive, No Added Value With Mammography, Study Suggests
ScienceDaily (Mar. 8, 2010) — Do we need a revision of current recommendations for breast cancer screening? According to a recent prospective multicenter cohort study published in the Journal of Clinical Oncology, this appears advisable at least for young women carrying an increased risk of breast cancer. The results of the EVA trial confirm once more that magnetic resonance imaging (MRI) is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound: MRI is three times more sensitive for breast cancer than digital mammography.
For the EVA trial, almost 700 women were enrolled. Aim of the trial was to refine existing guidelines for surveillance of women at high and moderately increased risk of breast cancer. Findings suggest that in these women, MRI is essential for early diagnosis -- and that a mammogram or an ultrasound examination does not increase the "cancer yield" compared to what is achieved by MRI alone. Researchers conclude that annual MRI is not only necessary, but in fact sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and should be discontinued. Moreover, MRI screening is important not only for women at high risk, but also for those at moderately increased risk.
Between 2002 and 2007, the EVA trial recruited 687 women who carried a moderately increased risk of breast cancer (lifetime risk of 20% and over). Women underwent 1679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound examinations. During this time span, 27 women received a new diagnosis of invasive cancer or DCIS (Ductal Carcinoma In Situ).
Of all imaging methods under investigation (digital mammography, ultrasound and MRI), MRI offered by far the highest sensitivity: MRI identified 93% of breast cancers. 37% of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33%). These results confirm once more that MRI is essential for surveillance not only of women at high risk, but also for women at moderately increased risk of breast cancer. Moreover, the results contradict current guidelines according to which mammography is considered indispensable for breast cancer screening. One aim of the EVA trial was to question this concept and to ask whether it is still appropriate to require that MRI should only be used in addition to mammography. The results speak for themselves: If an MRI is available, then the added value of mammography is literally negligible. Researchers conclude that MRI is necessary as well as sufficient for screening young women at elevated risk of breast cancer. Since mammography appears to be unnecessary in women undergoing MRI, its use is no longer justifiable, and current guidelines should be revised to reflect this.
Current guidelines questionable
Current guidelines for women at high familial risk of breast cancer recommend annual MRI (with or without ultrasound) and annual MRI starting at age 25-30. "These guidelines were set up based on little or no scientific evidence, and mainly reflect expert opinion," summarizes Prof. Christiane Kuhl, radiologist at the University of Bonn and principal investigator of the EVA trial. "In the light of the results of the EVA trial, such recommendations should be revisited." This seems even more important because digital mammography uses x-rays (ionizing radiation) to detect breast cancer. "The radiation dose associated with regular mammographic screening is clearly acceptable and safe," underscores Kuhl. "However, regular mammographic screening usually starts at age 40-50." The situation is different if systematic annual mammographic screening is started at age 25-30. "Not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation." This appears to be especially true for BRCA mutation carriers. "Accordingly, we impose more radiation on less radiation-tolerant breast tissue -- for a very limited, if any, diagnostic benefit." Therefore, Kuhl advocates a revision of existing guidelines: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI."
MRI is a mature technology
In the past, MRI was used strictly in addition to mammography only. The allegedly high rate of "false positive" diagnoses and the allegedly insufficient sensitivity for DCIS were the main reason to discourage its use as a stand-alone method for breast cancer screening. "In this multicenter trial, with basic quality assurance implemented not only for mammography, but also for MRI, we were able to prove that false positive diagnoses are avoidable if MRI studies are interpreted with adequate radiologist expertise." In the EVA cohort, the Positive Predictive Value achieved with MRI was already even higher than that of mammography or breast ultrasound. "Moreover, we found that MRI offered the highest sensitivity especially for DCIS," adds Dr. Kuhl. "It is simply wrong to state that we need a mammogram to detect intraductal cancer."
Kuhl et al. Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial. Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.23.0839
Study Finds Racial Disparity in Breast Cancer Outcomes
Black women had higher death rates, no matter what kind of breast cancer they developed
FRIDAY, Jan. 14 (HealthDay News) -- In an ongoing effort to shed light on the reason for racial disparities in breast cancer prognosis, researchers in North Carolina report new findings from their research on black women and breast cancer.
Previous research has shown that breast cancer in younger black women in the United States is more likely to be the more aggressive basal-like (triple-negative) subtype, which may help explain why black women are more likely to die from breast cancer than other women.
In this new study, researchers analyzed tissue from 518 black women and 631 white women with invasive breast cancer who were enrolled in the Carolina Breast Cancer Study.
"Our data show that basal-like breast cancer is an equally aggressive disease in African-American women and white women," study co-author Charles M. Perou, a professor of genetics and pathology at the University of North Carolina at Chapel Hill School of Medicine, said in a university news release.
"In addition, African-American women had worse outcomes no matter what kind of breast cancer they developed, suggesting that other factors such as disparities in access to care and treatment, for example for the more common subtypes of breast cancer like luminal A breast cancer, also contribute to the higher breast cancer mortality observed in African-American women," Perou said.
The data suggest that it may not be possible to "identify a truly good prognosis subtype [of breast cancer] in African-American women and we need to find out why," study co-author Dr. Lisa Carey said in the news release.
The study was published in a recent issue of the journal Clinical Cancer Research.
The Before Forty Initiative is thankful for the support from breastreconstructionmatters.com.