Connecticut's Rate of Breast Cancer is Among the Highest in the Nation

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October is Breast Cancer Awareness Month and every year efforts are taken to spread awareness about the deadly disease. Charity runs are organized, NFL players add pink to their uniforms, cautionary tales are told and preventative measures are encouraged.

But if we’re being honest with ourselves, many of us don’t pay as much attention to these awareness efforts as we should, and arguably those of us in Connecticut should pay extra attention. In 2013, the American Cancer Society released data showing that between 2005 and 2009, Connecticut had the highest per capita incidence of breast cancer in women in the country.

Before you pack your bags and flee the Constitution State, however, there’s another statistic you should be aware of: the death rate from breast cancer in Connecticut is actually lower than the national average. While the reason for these seemingly diametrically opposed numbers remains unclear, the experts have some theories—and advice—in regard to the terrible disease.

The Numbers Don’t Lie, But Don’t Tell the Whole Truth, Either

“Connecticut has one of the highest rates of breast cancer incidence; but interestingly, it also has a relatively low rate of mortality,” says Dr. Anees Chagpar, director of the Breast Center at the Smilow Cancer Hospital at Yale-New Haven. “My sense is that this is related to increased screening, where we are finding more cancers, but at a relatively low stage so that mortality rates are lower.”

Anne Morris, CEO of Susan G. Komen for the Cure Connecticut, agrees that increased awareness and access to health care may lead to more breast cancer diagnoses in Connecticut, but suggests that does not completely explain Connecticut’s high occurrence rate. “Unfortunately researchers are not privy to the total number of screenings done because many screenings are paid for privately and done by private facilities and are therefore not reported to any central bureau,” she says. “I think there is a feeling that perhaps the top ten [states on the list] are accurate as being in the top 10, but who’s actually No. 1 and who’s maybe No. 4 might be impacted by the rate of screenings.”

As for why Connecticut and its surrounding states have such high rates to begin with (Massachusetts and Rhode Island are also in the top 10), Morris says no one is really sure. “We don’t know what causes breast cancer yet—we know some of the significant risk factors—but we have not determined exactly what the causes are,” she says. “There is some conjecture that early industrialization, and possibly wealth, might come into play. But there really is no evidence supporting either of those theories. There’s also a fairly high concentration in certain parts of the state of women who have Ashkenazi Jewish backgrounds, and we know that Ashkenazi Jewish women are more likely to carry the BRCA1 or BRCA2 genetic mutation [which increases the likelihood of breast cancer]. Again, it’s conjecture.”

However, not enough is known about the stats to conclude that Connecticut is a dangerous state in which to live in terms of breast cancer, says Morris. “Women need to be diligent about their breast health regardless of where they live,” she adds.

Prevention

“The two main risk factors for developing breast cancer are being a woman and getting older, so in truth, there is nothing we have in our armamentarium that will completely prevent breast cancer,” explains Chagpar. “However, there are a few things women can do to reduce their risk.” She advises women to “maintain a healthy body weight, don’t consume alcohol in excess, etc. For women taking hormone replacement therapy, talk to your doctor about risks and benefits, and tailor your therapy accordingly (often using the lowest dose for the shortest amount of time possible).”

Those who are at particularly high risk are sometimes advised to take more dramatic steps. “We have risk reducing strategies—for example, with tamoxifen, raloxifene or aromatase inhibitors—that can reduce risk by 50 percent,” Chagpar says. “These strategies have risks as well, so it’s important to talk to your doctor about your absolute risk and whether one of these strategies is right for you.”

Though it’s far more common in women, breast cancer can also occur in men.

“One percent of all breast cancers occur in men—so that’s over 2,000 cases per year in this country,” Chagpar says. “Men often present late, since they don’t get screening mammography, but can find cancers relatively early if they are cognizant of the symptoms. If men have a breast lump or bloody nipple discharge, they should seek medical advice. Breast cancer is very treatable in men, just as it is in women. Men should also be aware of their family history—the risk of breast cancer in men who have a BRCA2 or PALB2 mutation are significantly higher than the general population of men.”

Misconceptions Persist

Despite breast cancer awareness campaigns every October and throughout the year, many misconceptions about breast cancer still persist. One of the top ones, according to Chagpar, is the belief that you are unlikely to get the disease if you don’t have a family history.

“Some people are still surprised to discover that the majority of breast cancers occur in women who do not have a family history,” she says. “Family history can increase risk, but breast cancer is very common, and so most women who get breast cancer do not have a family history.”

Another misconception is that a genetic tendency toward the disease is only passed on from mother to daughter, says Morris, from Susan G. Komen for the Cure Connecticut. “You need to look at both sides of your family tree not just your mother’s side,” she says. “I think a lot of women think they can only get that genetic mutation from the female side of the family but that’s not true at all. The men carry and pass the gene also.”

There can also be a lack of understanding about what traits constitute a risk factor. Nancy Cappello of Woodbury learned this the hard way. In 2004, she was diagnosed with breast cancer just two months after her yearly mammogram reported no significant findings. What Cappello later learned was that the density of her breast tissue made a mammogram alone an ineffective cancer-screening technique. For Cappello and women like her, there is less than a 48 percent chance of having breast cancer detected by a mammogram.

After her harrowing experience, Cappello founded Are You Dense, a nonprofit organization dedicated to spreading information about breast density and encouraging women with dense-breast tissue to supplement mammograms with ultrasounds, which increases the likelihood of detection from 48 percent to 97 percent. In addition, the organization lobbies to change public policy regarding dense breast tissue and pushes for laws that require mammogram reports to include information about breast density. In 2009, thanks in large part to the efforts of Cappello and others in her organization, Connecticut was the first state to pass a density-reporting bill; since then several other states have passed similar bills.

“Mammograms should be the first line of defense, but if you have dense tissue it should not be the last,” Cappello says.

Beyond Prevention

Though preventative measures decrease your odds of being diagnosed with cancer, none are fully effective. While getting a breast cancer diagnosis is clearly a difficult moment in anyone’s life, there are steps to take, and services available, to help manage the disease. Ann’s Place in Danbury is a nonprofit organization that provides free support services for those suffering from cancer and their families. Laura Donnelly, a licensed clinical social worker who works with cancer patients and families at Ann’s Place, says that while each patient is unique there are some common mental challenges breast cancer patients often face.

“Typically it affects a women’s self esteem because oftentimes it requires a mastectomy or a lumpectomy—it changes the physical makeup of the body,” she says. It can also be difficult for women, breast cancer’s most common victims, to allow others to take care of them. “They’re often moms, they’re always kind of doing for others. So it’s a big shift to go from the doer to be able to receive the help.”

Ann’s Place offers three breast cancer support groups: one for those who have recently been diagnosed; one for those who have just finished treatment; and another for long-term survivors of the disease. In addition, there are one-on-one counseling sessions available, plus advice and counseling offered to family members of those suffering from the disease who may want assistance in learning how to better assist their family member.

“To get that diagnosis is so overwhelming,” Donnelly says. “It’s usually such a surprise and people will say, ‘I never thought this would happen to me.’ And it’s not uncommon for a person’s mind to go everywhere.” She encourages breast cancer patients she works with to slow down and really take one step at a time, usually treatment is a multistep process.

“Focus on what’s in front of you right now,” she says. “If the first step is the surgery, don’t think about the steps after that.”

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