Molly Barnhart's experiences with breast cancer are at once both unusual and quite typical.
The fact that the UI alumna contracted breast cancer in her early 20s is uncommon. According to the National Cancer Institute, the strongest risk factor for breast cancer is age, with a woman's chance of developing it increasing as she gets older (incidence rates are highest among those aged 55 to 64). In fact, breast cancer is so rare among young women that official statistics about age-related occurrences, physicians' screening tools, and mammogram guidelines generally don't even address women under the age of 30.
On the other hand, the fact that Molly survived—through earlier detection, improved surgical options, and better treatments—makes her story familiar. Currently, experts estimate that about one of every eight women born today will be diagnosed with breast cancer at some time during her life. Although breast cancer is the third leading cause of cancer death in the United States, more women are surviving than ever before. In 1975, the average rate of five-year survival was 75.2 percent; in 2005, it was 90.5 percent.
"Medical researchers and clinicians have done a great job in improving how people survive breast cancer," says Sonia Sugg, clinical associate professor of oncology at the UI Carver College of Medicine and medical director of University of Iowa Hospitals and Clinics' Breast Health Center.
Like many women, Molly Barnhart also had no obvious risk factors for developing breast cancer—other than what Dr. Sugg describes simply as "being female." Despite all the research under way, experts still don't know exactly what causes most cases of breast cancer. Although some genes, such as BRCA1 and 2, are known to increase risk in some women, other factors remain a mystery—although experts have disproved the myths that implants, antiperspirant, and underwire bras cause breast cancer.
"We don't really know of any specific environmental cause, and it's hard to detect cause and effect between environmental factors and breast cancer," says Sugg. "There may be genes that work in concert with other genes or environmental factors to affect risk."
Some factors known to increase the risk for breast cancer can't be changed, such as family history, inherited genes, breast density, and having a first menstrual period before age 12. But others are within a woman's control. UI experts recommend that women alter their lifestyle to reduce alcohol use (limit to one drink per day, or less), become more physically active, lose excess weight, and eat a healthy diet.
They also counsel that women follow current screening guidelines, having a mammogram annually from age 40. While studies show that self-exams don't affect the mortality rate from breast cancer, many experts recommend that women of all ages examine their breasts, get to know their bodies, and see a doctor immediately if they notice a change.
"Do everything you can to prevent it, but don't feel guilty if you do develop breast cancer," says Sugg. "And, breast cancer isn't a death sentence. There's so much we can do to cure or manage it, to make sure patients survive longer, with good quality of life, and, ultimately, to feel good about themselves and their lives, despite going through a very difficult experience."
At the University of Iowa Hospitals and Clinics' Breast Health Center, a multidisciplinary team of surgeons, cancer experts, and specially trained nurses provide education, prevention, diagnosis, treatment, and clinical trials for breast cancer. UIHC is often the first or only facility in the state of Iowa to offer innovative treatments and approaches to help women before, during, and after a breast cancer diagnosis, including:
Advanced diagnostic tools, including digital mammograms, 3D imaging (tomosynthesis), and whole breast ultrasound, that can better screen dense breast tissue.
Intraoperative radiation therapy, which delivers a therapeutic dose of radiation immediately following surgery while the patient is still in the operating room. Convenient for patients who lack access to radiation therapy facilities, the treatment also saves time and money and decreases radiation side effects.
Genetic testing to determine the best treatments and therapies for each patient and cancer. "This personalized medicine helps tailor treatments to patients," says the center's director, Sonia Sugg, pictured above. "Not everyone benefits from chemotherapy. These molecular tests can also sift out people who would do well with anti-estrogen treatment."
Breast preservation surgery, including immediate oncoplastic reconstruction, with plastic surgery if needed.
Nipple-sparing mastectomy, which removes breast tissue and/or tumor while saving the skin and nipple. As a result, incisions are less visible and the cosmetic results are improved. "Breast cancer and surgery are particularly hard on young women, who are typically very conscious of their body image," says Sugg. "It can be very traumatic, especially as many of these women haven't yet formed stable partnerships."
Microvascular procedures during reconstruction surgery that transplant blood vessels and tissue from the patient's abdomen for a natural shape and feel to the breasts.
A surgical treatment for lymphedema (swelling in arms), which affects a small percentage of women after breast cancer surgery.
National Cancer Institute:
UIHC Breast Care Center: www.uihealthcare.org/Clinic
This is an edited version of an article that first appeared in Iowa Now - now.uiowa.edu, the official, one-stop source for University of Iowa news produced by University Communication and Marketing and partners across campus.