October is National Breast Cancer Awareness Month, with reminders on TV, radio, and social media that women need to have their annual mammogram done for early detection and treatment of breast cancer. This year, with the Covid-19 pandemic, it is especially important that routine screening tests are not delayed. In March and April, many non-essential healthcare services were stopped due to the pandemic. On April 24th, the American Academy of Clinical Oncology recommended that routine mammograms and colonoscopies be postponed due to the risk of Covid-19. A recent study done by Epic Health Network found that cancer screenings across the U.S. dropped by 86%-94% in March 2020 compared to March 2019. In a Wall Street Journal article of October 16, 2020, the researchers at UnitedHealth Group, Inc. reported in early April that mammograms dropped by as much as 95%.
Declining mammogram screenings can have a negative effect on breast cancer detection. Many researchers feel cancers may go undetected and because of this breast cancer may advance rapidly and result in a delay in diagnosis and treatment options. Although the U.S. is still challenged by high numbers of Covid-19 in many states, women are still encouraged to get their annual mammogram and not delay this important screening. Despite knowing the importance of their annual mammogram, many women are still fearful of going to a healthcare facility for screening due to Covid-19.
Is it safe to go for a Mammogram?
Yes! The main message that health care professionals want to convey to all women is that it is safe to get a mammogram and that healthcare facilities, including cancer centers and imaging facilities, are educated on how to prevent Covid-19 transmission between patients. Some of the infection prevention practices they are following include using masks, gowns, and gloves for patient care, temperature checks for all patients, social distancing, hand-washing, and cleaning of all medical equipment between patients. Many appointments are being spaced out during the day and patients are being instructed to call the imaging center before they enter to make sure the waiting room is not full of patients. Many places will only permit one or two patients at a time.
I recently had to schedule my annual mammogram and will admit I was anxious about going into a healthcare facility as a patient. Given my background in nursing, patient advocacy, and infection prevention one would think I would be confident in knowing these control measures were being followed. I did what I would do for my patients and called the facility beforehand to find out exactly what they were doing to prevent the spread of Covid-19. This is something I would encourage all patients to do prior to going for imaging or any other medical service. I was reassured by the responses I received and had my annual mammogram done in a very safe and clean environment.
The importance of early detection
According to Dr. George Sledge, the Komen Foundation Chief Scientific Advisor and Chief of the Division of Oncology at Stanford University, a screening mammogram should not be delayed and it is important for the early detection of breast cancer. Delaying this important screening can lead to an increase in advanced breast cancer cases.
The American Cancer Society reports that breast cancer is the most common cancer in women. The average risk of women in the U. S. developing breast cancer is 12% and it affects 1 out of 8 women. For these reasons getting that screening mammogram should be a priority for women, particularly any women who are in a “high risk” group, which includes a family history of breast cancer, having a BRCA gene mutation, or having had a lesion detected on a recent mammogram.
Can lifestyle behaviors developed during the pandemic affect breast cancer risk?
Health experts are voicing concerns regarding poor health habits that were developed during the pandemic, which include drinking, inactivity, and weight gain. Most people found themselves working from home, sheltering in place, and doing most of their socializing on Zoom. At the beginning of the pandemic, people were not only stockpiling toilet paper and hand sanitizer but alcohol as well. Alcohol purchases were up as much as 55% per week! According to an article in AARP, October 13, 2020, a third of breast cancers can be attributed to drinking. Women who have three drinks per week are 15 times more likely to develop breast cancer compared to women who do not drink.
Also during this time, many people reported gaining weight due to lack of exercise and inactivity. Many people reported gaining between 10-15 pounds during the pandemic, referring to it as the “quarantine 15”! Studies have shown that women who have gained 20-30 pounds after high school have a 40% higher chance of developing breast cancer. For these reasons, oncologists are concerned that these poor lifestyle habits could predispose women to breast cancer. Some risk factors for breast cancer are uncontrollable, such as genetics and age, but drinking, weight control, and exercise are risk factors that can be modified and tweaked.
Combining traditional and alternative approaches to improve breast health during the pandemic.
For years women have been taught to have regular screenings for breast cancer, such as mammograms with their age and risk level determining the frequency of the mammogram. The revised and current American Cancer Society guidelines of 2015 recommend that women should start having yearly mammograms at age 45.
Along with this, women are encouraged to perform self-breast exams to detect changes in breast tissue or lumps. However, the current emphasis is “breast self-awareness” - knowing your breast and being familiar with changes instead of doing “detailed” breast exams. Of course, if any changes in the breast are detected by a woman she should discuss this with her physician and together they can discuss the next steps.
What else can women do to decrease their chances of breast cancer, given some poor health habits that may have developed during the pandemic? Hopefully, now that more activities and public places such as parks and gyms have opened up, some people may be more active at this time.
At Healthlink Advocates, Inc., health coaching is a huge part of our patient advocacy program. Giving clients practical tips and strategies outlined by health experts helps our clients to improve their over all health and well being.
Here are some tips that will improve your health, eliminate bad habits, and decrease your risk for breast cancer:
Decrease your alcohol intake. If you are participating in a Zoom “happy hour” or an outside seating “happy hour’ with friends, have a “mock-tail” instead of a drink. So many of our favorite drinks are now made without alcohol and taste great. In a study done in 2008, and reported in the article, “The Health Benefits of Wine for Women”having one 5 oz. glass of wine per day could cause a 10% increase in the risk of breast cancer.
Keep weight in check and exercise. Dropping those extra pounds from the quarantine can really help decrease your risk of breast cancer. Studies have shown that 1-2.5 hours of brisk walking per day can decrease breast cancer risk by 18%. The other benefits of exercising are improving your overall immune function and reducing estrogen production which plays a big part in breast cancer development.
Improve your diet. Increase fruits and vegetables in your diet plan. During the beginning of the pandemic, sales of baking supplies were very high. People were baking and consuming “comfort foods” to calm themselves and relax. Eating a diet high in carbohydrates can increase inflammation in the body which can be a risk factor for cancer. Replacing these high-calorie food choices with healthy substitutes will increase vitamin and antioxidant intake, which helps fight cancer.
Improve your peace of mind. Meditation and deep breathing can help reduce stress and improve the immune system. Taking three to six deep breaths each hour can help calm the nervous system and decrease anxiety. If contracting Covid-19 is stopping you from going for a mammogram, call the imaging center or facility beforehand to discuss with the technician what they are doing to prevent Covid-19 transmission. This should give you “peace of mind” that it is safe to obtain this important screening.
If you need support or further education, feel free to reach out to us. We are here to help you,